UZ Leuven

Following a detailed interview and a general physical examination, an exploratory gynaecological examination takes place in order to gain an initial insight into the problem. These targeted examinations cover:

Blood tests

including:

• screening for infectious diseases including toxoplasmosis, rubella, HIV, hepatitis B and C and chlamydia; the latter in particular is a major cause of infertility problems in women, especially as a result of the infections and the subsequent adhesions to the internal sex organs. Toxoplasmosis and rubella are not so much a threat to fertility, but to the normal development of the foetus if women are exposed to these diseases during pregnancy. HIV, hepatitis B and C, which can cause serious illness, can be transmitted from mother to child;
• determining the various hormones that play a role in the female cycle and their evolution: oestrogens, progesterone, androgens, follicle stimulating hormone, luteinizing hormone, inhibin and prolactin;
• possible determination of blood group and rhesus factor. If a woman who is rhesus negative becomes pregnant by a rhesus positive man, this can produce an immune reaction which can cause serious damage such as delayed growth, mental handicap, miscarriage or still birth, if the blood group of the embryo is positive. Thankfully, this problem is very rare and usually only occurs in a second pregnancy. It is also entirely preventable;
• a genetic test to detect certain chromosomal abnormalities or genetic defects; if there is a previous history of hereditary diseases or congenital abnormalities, the advice of a geneticist is sought;

Change in body temperature (optional)

in order to gain an understanding of the progress of the cycle. These measurements are not suitable for determining the most fertile period;

Cervical mucous test (optional)

(inspection with the naked eye and microscopic examination) in order to evaluate the sperm cells' accessibility at the moment of ovulation. The test includes taking a sample of the mucous, inspecting it with the naked eye and a microscopic examination;

Examination of the fallopian tubes

(hysterosalpingography, laparoscopy) to screen for two major problem groups:

• narrowing or complete obstruction of the fallopian tubes;
• adhesions in the pelvic cavity compressing and shutting off the fallopian tubes from the outside or limiting their normal freedom of movement.

The accessibility of the fallopian tubes can be examined either using either hysterosalpingography or laparoscopy. The presence of adhesions can only be determined with certainty during laparoscopy. Hysterosalpingography is an X-ray examination following injection of a liquid into the uterine cavity, through the vagina and cervix. The X-ray provides information about access to and accessibility of the fallopian tubes. In a laparoscopic examination, the doctor inserts a narrow tube into the abdominal cavity through a small incision in the navel, in order to make a visual inspection of the various organs in the abdominal cavity. Fertility treatment can also be carried out at the same time, involving re-opening sealed fallopian tubes and loosening adhesions around the fallopian tube. A laparoscopic examination always takes place under general anaesthetic, usually as a day patient (arrival at the hospital in the morning, home again in the evening) followed by 1 week of inability to work;

Laparoscopic inspection of the abdominal cavity

Abnormalities in the abdominal cavity can be detected and repaired, such as endometriosis, ovarian cysts, adhesions, etc.;

Inspection of the uterus

using hysteroscopy, ultrasound or endometrium biopsy.

• The hysteroscope consists of a long tube which is inserted into the uterine cavity via the vagina and the cervix. This enables the doctor to see any abnormalities in this area. These are usually polyps, myomas or congenital abnormalities. The diagnostic examination can be carried out as an out-patient, without general anaesthetic. However, it is often combined with a laparoscopy, under general anaesthetic.
• Examination of the endometrium using ultrasound. Ultrasound provides information in particular about the thickness of the endometrium, which is usually around 14 mm at about the time of implantation. This examination enables the doctor to check whether the structure of the endometrium is normal and whether it is in the ideal condition at the right time to allow implantation of the fertilized ovum.
• Examination of the endometrium via endometrium biopsy. In this procedure, the doctor aspirates a small piece of endometrium, using a thin flexible tube which is inserted through the cervix. The biopsy is then sent to the lab for further microscopic examination.

This series of tests seems quite an undertaking and can often cause a fair amount of stress and tension. However, it is important to detect the faulty aspects of the complex female reproductive system as meticulously as possible. Whenever possible, the required tests are combined.

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