If after a year of continuous sexual relationships without protection pregnancy hasn’t been achieved, it is considered that there is a sterility problem. From this moment on it is recommended to turn to a fertility clinic where specialists can assess the causes of the problem.
During the first visit an exhaustive case history will be carried out, as well as all the tests needed for diagnosing the problem and choosing the proper treatment. That’s why, if it’s a couple, it’s important that both members go to the clinic, even if they already know who has the fertility problem..
During the first part of this visit the case history will be analysed. All the medical records of the couple, related to previous or current fertility treatments, or treatments unrelated to that, surgical interventions, family history and hereditary diseases etc., will be written down. If the patients have any medical reports it would be interesting to bring them to this first visit, so that the case history is as complete as possible and enables the specialist to reach a proper diagnosis.
This first visit may be long, since the doctor needs to be certain that the health conditions of the woman are ideal for achieving pregnancy without any contraindication. The couple will be asked about drugs, toxics and alcohol consumption, contraceptive methods, work life, etc. Especially important will be the information related to the menstruation of the woman, age when she first had it, regularity of the cycles, duration… Whether there have been any previous pregnancies with the current or past partners or not will be especially revealing when it comes to determining the causes of infertility.
After that, a gynaecological examination will be performed and from that moment on, the doctor will determine other tests that need to be carried out before making up his mind about the treatment or actions needed to take, in order to achieve pregnancy. If the couple brings the results of some tests that have already been performed and if they are still valid, they won’t be done again.
Once all this information has been gathered, the specialists will be able to decide the cause of the infertility. The causes can be due to female or male factor, although most of the times it will be due to a mixed factor, or it can even be the case of an infertility due to unknown factor. Not giving a definitive diagnosis in the first visit is not uncommon, since the doctor usually needs the results of the analysis to be able to assess the cause. The most common tests will be named and explained next.
- Assessing the ovarian function: if a woman has regular cycles (26 – 36 days) it’s considered that ovulation is taking place. Nevertheless, and in the case that there’s any doubt, proof of that is needed. In order to assess the ovarian function three tests can be performed:
- Basal body temperature: it’s an old fashioned method and is not precise or easy to carry out.
- Endometrium biopsy: it’s the analysis of the endometrial tissue. However, as it is not precise and might be painful, it’s not commonly performed.
- Hormonal analysis: it’s the most practical and precise method for assessing the ovarian function. It’s a blood analysis on a specific day of the cycle in which the hormones related to ovulation will be analysed: FSH (follicle-stimulating hormone), LH (luteinizing hormone) and estradiol at the first ovulation stage, or luteal hormone and lactogenic hormone at the second half of the cycle.
- Basal ultrasound scan: they allow to value the ovarian function depending on the follicle development, as well as to detect any alteration in the ovaries such as cysts or tumours. Alterations in the uterus, such as muscular tumours or endometrial polyps, are also discarded. If some anomaly was detected and in case of needing more specific information, several tests such as laparoscopy, endoscopy or hysteroscopy could be performed.
- Assessing tubal permeability: it’s performed through a test named hysterosalpingography between the eighth and eleventh day of the cycle. It’s a radiography with contrast dye, with the objective of studying the uterus and the Fallopian tubes. If there was any anomaly, the following step would be performing a laparoscopy with dye.
- Sperm analysis: it would be recommended that the male partner is examined by the andrologist, who will study the patient more deeply in order to be able to determine the treatment to follow. Sometimes it will be needed to carry out some other tests to study some aspects more profoundly.