Investigation of an infertile couple

After the first round of examinations, the Assisted Reproduction Specialist Gynaecologist will request the following examinations:

– Hormone testing
As part of the control of a woman’s infertility, it is necessary to measure the levels of certain hormones, giving us important information about the function of the ovaries and the quality of the eggs. The hormones requested are : FSH, LH, E2, AMH and the measurements are usually taken on the 2nd to 3rd day of the cycle. Prolactin (PRL) measurement may also be requested, as an elevated value of PRL means that the ovulation process may be impeded, and thyroid hormone (TSH) measurement to check thyroid function.

– Ultrasound
Ultrasound is used to diagnose many pathologies associated with infertility such as uterine malformations, fibroids, polycystic ovaries, hydrocephalus and endometriotic cysts. Ultrasound can also provide basic information about the size of the uterus and ovaries and the thickness of the endometrium.Ultrasound can be performed either transvaginally or transabdominally. In transvaginal ultrasound the bladder must be empty while in transabdominal ultrasound the bladder must be full.

– Trumpet patency test

• • Hysterosalpingography
    Hysterosalpingography is a special X-ray in which the outline of the uterus and both fallopian tubes can be visualised. This procedure is used to determine whether the fallopian tubes are deep (open) or not. It can also show if there is a variation in the shape of the uterus or a malformation. Hysterosalpingography is done within the first 10 days of the cycle and after the blood has stopped.
  • HyFoSy
    The tubal patency test (hysterosalpingography) is one of the necessary tests in the investigation of a couple’s infertility. HyFoSy is a new technique, painless and patient-friendly, without radiation exposure, with comparable results, which is coming to change the standards and replace the classic hysterosalpingography. The new ultrasound method using polysaccharide foam (ExEmFoam) evaluates the patency of the fallopian tubes and can also examine the contours of the uterine cavity and detect possible abnormalities. It is carried out by injecting the foamy contrast agent into the uterine cavity which is then directed towards the fallopian tubes while being imaged ultrasonographically. The duration of the examination is approximately 20 minutes and is carried out between the 6th and 10th day of the cycle.

– Vaginal fluid culture
During the investigation of infertility, a vaginal fluid culture is usually done to check for the presence of microbes that may have caused a genital infection. During this test, fluid is taken from the woman’s vagina and/or cervix to be sent for culture. It is quite important because it helps to treat many infections that can cause serious problems and are sometimes asymptomatic, such as chlamydia.

– Virological testing
As part of the control of a woman’s infertility it is necessary to perform a virological test which is required by law for both partners. The tests required are: HIV I&II, HbsAg, HCV, VDRL

– Specialist tests
If we are still in a vacuum with this series of tests, then more specialised tests are required, such as:

• • Hysteroscopy, with intoxication or with local – office hysteroscopy – the intrauterine cavity, which is the alpha and omega for implantation of embryos, is inspected. Polyps, adhesions, diaphragms and submucosal fibroids are the most common abnormalities found and corrected at the same time (invasive hysteroscopy)
  • If this is not enough to make a diagnosis or if endometriosis is suspected, we proceed to laparoscopy. It is done under general anaesthesia and any damage found is corrected at the same time (invasive laparoscopy).
  • Thrombophilia testing is needed by women who have miscarried or have a history of thrombosis or women after multiple failed IVFs or miscarriages.
  • Intrauterine biopsy where the sample is either sent for histological examination or for gene testing, such as ERA test
  • Similarly, in women with a history of miscarriages, a complete immunological test with quantification and determination of cytotoxic lymphocytes (natural Killers T-cells) is recommended.
  • More specific genetic tests will be required more and more often as medicine advances. At present we recommend some such as CFTR for cystic fibrosis, Fragile X for premature menopause, KAL1 for Kallmann syndrome.
  • Finally, an MRI will rarely be requested to clarify some morphological abnormalities of the uterus or to diagnose adenomyosis.

A complete investigation of Male Fertility includes the following tests & examinations:

• Background: previous pregnancy, cryptorchidism, childhood infections, diabetes, cancer, cancer, smoking, medications and frequency of intercourse or impotence are critical points for assessing a man’s fertility.

• Spermogram: The spermogram remains perhaps the most valuable tool for assessing male infertility.According to the criteria established by the World Health Organization (WHO), the characteristics of normal semen are:
  • Volume > 1,5 ml,
  • sperm count: at least 15,000,000/ml,
  • total sperm count: at least 39,000,000,
  • forward mobility of at least 32%, within 1 hour of taking
  • at least 4% of sperm with normal morphology.

• Male infertility is mainly manifested by disorders in the number, motility or morphology of spermatozoa.
  • Thus, we distinguish the following conditions:
  • Oligospermia: Reduction in sperm count below the threshold of 15 million/ml
  • Asbestos spermatozoa: Reduction of sperm propulsive motility below 32%.
  • Teratospermia: A reduction in the percentage of sperm with normal morphology below 4%.
  • Oligoasthenotospermia (OTA):A simultaneous decrease in the number, motility and percentage of normal forms of sperm in the semen, which is the most common disorder.
  • Azoospermia: Absence of sperm from the semen.
  • If the sperm count is found to be too low, additional hormonal (Testosterone, FSH, LH, LH, PRL), genetic (karyotype, Y chromosome/Yq-microdeletions, cystic fibrosis mutation) and ultrasound (scrotal ultrasound) tests may be requested

• In some cases, such as unexplained infertility following failed IVF attempts or multiple miscarriages, additional tests such as DNA fragmentation and sperm oxidative stress testing may be recommended

• Finally, FNA or Testicular Sperm Extraction (TESE) is performed in cases of azoospermia with high rates of successful sperm recovery