1. How is female infertility diagnosed?
  2. Which are the most common investigations for female infertility?

How is female infertility diagnosed?

Female infertility is diagnosed through gynaecological examination. On the basis of the patient’s clinical history, the gynaecologist may prescribe tests that are useful for diagnostics. Anamnesis is very important because it informs the gynaecologist on possible pathologies affecting the patient that might not be strictly related to uterus, tubes and ovaries, but that may interfere with conceiving like thyroid disorders, diabetes, diabetes mellitus, or food allergies. Hormone tests provide the most relevant information for the gynaecologist as they aim to evaluate women’s ovarian reserve (i.e. their reserve of oocytes). In the first half of the cycle, FSH (follicle stimulating hormone), LH (luteinizing hormone) and estradiol (oestrogen produced by the ovaries) are analysed, while in the second half of the cycle, progesterone and prolactin are considered. TSH and AMH (Anti-Mullerian hormone) are also analysed as the circulating quantity of the latter is always proportional to the number of follicles that are still available to women and is independent from the phase of the menstrual cycle. 

Which are the most common investigations for female infertility?

In addition to hormone tests, other tests and examinations are also necessary for a correct female infertility diagnosis. Among the most complex of such tests there is endometrial biopsy that consists in the removal of a small tissue fragment to be analysed under a microscope. A vaginal swab or Pap test may also be useful to reveal the presence of vaginal infections or infections of the neck of the uterus that may interfere with women fertility. Another tool that is often used to diagnose infertility is the transvaginal ultrasound that allows to obtain information on the aspect and dimensions of the organs of the reproductive system and on the possible presence of fibroids in the uterus or ovarian cysts. If the ultrasound shows alterations to the uterus, the ovaries or the tubes, it may be possible to go for in depth examinations like hysteroscopy. Laparoscopy may also be useful to evaluate the external aspect of organs of the reproductive system and to detect the presence of further pathologies or disorders. Further examinations also include the so-called post coital test, which consists in the collection of a sample of cervical mucus the day after sexual intercourse to analyse it under a microscope in order to evaluate its quality as well as the motility of the spermatozoids that it contains. 

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