Diagnostics of infertility
In a majority of couples who struggle with getting pregnant, infertility is caused by both male and female factors. Infertility is rarely caused by the problems of only one of the partners. Due to a large number of possible causes of unsuccessful attempts to get pregnant, in-depth and effective diagnostics are crucial.
Diagnostics of infertility – choosing the therapeutic approach
Infertility can be considered when after a year of regular sexual intercourses without any contraceptives the woman does not get pregnant. Earlier diagnostics may be started when:
- The woman is over 35 years of age,
- Her menstrual cycles are irregular,
- The patient has structural uterine abnormalities or endometriosis,
- Infertility is caused by the male factor.
The process of diagnosing infertility
Diagnosing infertility starts with a medical interview which may provide some insight as to the possible problems with conceiving a child. During the interview, the physician collects information about the sexual activity, medicines used, lifestyle and addictions of the partners, as well as the regularity of the menstrual cycles of the woman. See the information that may help diagnose the causes of infertility.
- Surgical history – history of appendicitis, especially if complicated with peritonitis, and any surgery within the lesser pelvis that might cause adhesions and fallopian tube disorders.
- Gynaecological history – abnormal length of menstrual cycles, pain during intercourse, adnexitis, electrocoagulation or cervical conization.
- Obstetric history – (important for secondary infertility) previous births, their complications, development of the children, ectopic pregnancies, miscarriages.
- Endocrine disorders (thyroid, pituitary gland, adrenal glands etc.) and systemic disorders that may cause infertility or sterility.
- Previous diseases in the man – important information regard a potential history of: cryptorchidism, ectopic testis, mumps, surgery for inguinal hernia or genitourinary system infections.
- The couple’s sexual life – frequency of intercourse determines the probability of getting pregnant. It is important to establish if the infertility treatment itself, or pain experienced by the woman during intercourse, are not the causes of reduced sexual activity or marital disharmony. Disorders such as vaginismus, reduced potency, absent or premature ejaculation are treated in our centre by a specialist in sexology.
Further steps in diagnosing infertility
- Physical examination – i.e. anatomic assessment of the reproductive organs.
- Endoscopic examination – enable to detect changes in the reproductive organs, such as polyps, adhesions or tumours.
- Laboratory test – include hormonal, immunological, genetic or bacteriological testing.
Diagnostics of infertility in women
Infertility in women can be classified into two categories:
- primary infertility – when the woman has problems getting pregnant for the first time, and,
- secondary infertility – when the problems with getting pregnant are encountered after having one or more children.
Female infertility – causes
Problems with fertility in women often are caused by hormonal abnormalities, resulting from disorders of the thyroid, hypothalamic-pituitary system, or excessive body weight. The effects of abnormal hormonal function include:
- disturbed ovulation,
- premature menopause,
- development of empty Graafian follicles,
- inability of the oocyte to burst out, which prevents its fertilisation by sperm.
These problems are diagnosed using hormone testing – to verify a normal function of the hormone-producing organs and glands, and to check the sex hormone levels – or using comprehensive immunological diagnostics.
Female infertility can also be caused by structural changes or abnormalities in the reproductive organs, including:
- obstruction of the fallopian tubes,
- uterine fibroids,
- structural abnormalities of the uterus,
- cervical mucus hostility towards sperm.
Diagnostics of infertility in men
The most important test in the diagnostics of male infertility is sperm analysis, i.e. seminogram. It involves examination of sperm count and sperm motility parameters. It should be performed together with testing for the presence of anti-sperm antibodies in the semen. The quality of semen is determined by lifestyle, diet, addictions and external factors.
Post-coital test (PCT)
We also perform post-coital tests to verify if sperm can migrate to the uterine cervix in the fertile phase of the cycle. The test consists is analysing the woman’s mucus a few hours following sexual intercourse.
As is the case with women, male infertility may be caused by abnormal hormone concentrations. Therefore, as part of the diagnostics of male infertility, we also offer hormone tests to determine the concentrations of testosterone, gonadotropic hormones, estradiol or TSH and FT4.
Microbiological causes of infertility
Problems with male fertility may be due to previous diseases or infections. Therefore, to detect the causes of infertility in men we perform culture tests for the presence of pathogens, bacteria, fungi and viruses.
If occurrence of testicular tumours is suspected, it is important to conduct AFP and beta HCG marker tests.