Basic Sterility Evaluation

The basic sterility evaluation includes all initial tests a couple should pass through to establish the origin of their sterility problem. These diagnostic tests concentrate on studying the female factor as well as the male.

I am not becoming pregnant, what should I do?

estudio-esterilidad

Getting pregnant is not always easy and several months can pass to finally achieve it. When trying takes longer than one year, there might be something not as it should be and a basic sterility evaluation is recommended to determine the causes.

There are situations where it is suggested to seek for a sterility consultation already after six months:

    • Women of/over 38 years
    • Irregular cycles of more than 35 days
    • Previous ovary surgery
    • Diseases like endometriosis
    • Previous treatments with chemotherapy
    • Two or more consecutive miscarriages

What can I do to increase my fertility?

Improve your lifestyle

A healthy lifestyle is important and improves the probabilities of pregnancy. Therefore you should maintain an adequate weight according to the BMI limits, if the index is too low ovulation problems can occur, on the other hand excessive weight might be associated with poor egg quality, endometrium and cycle alterations. Other factors, such as smoking, using drugs, sexual transmittable diseases (STDs) and an excessive intake of coffee and alcohol also can negatively influence the fertility of a couple.

We recommend a Mediterranean diet rich in antioxidants and Omega 3 and moderate physical activity.

Optimize sexual intercourse

First thing a couple trying to become pregnant should know is that ovulation takes place in the middle of the cycle, if it is regular. If the cycle has a duration of approx. 28 days, the best way to optimize success rates is concentrating sexual relations on the ovulation phase, which means between day 12 and 16 of the cycle.

Improve sperm quality

It is not proven that treatments for improving sperm quality work. Nevertheless, there are some habits that might affect sperm quality negatively such as smoking, drinking alcohol or stress. Other treatments like multivitamin supplements with antioxidants might improve the sperm motility.

Alternative therapies

Is has been recognized that alternative therapies like acupuncture can improve natural fertility in some couples. In assisted reproduction acupuncture before and after embryo transfer eases the entire process since it relaxes the patient.

First sterility visit

During the first sterility visit an evaluation of the couple is made to establish the origin of their problem. Special emphasis will be laid on factors like age, duration of sterility, personal records, habits of life and regularity of her menstrual cycle.

For achieving pregnancy it is important that the ovaries function correctly, the fallopian tubes are permeable, the uterus shows no alteration and a good sperm quality exists. The basic sterility evaluation allows us to analyse each of these aspects in order to diagnose and treat the couple.

Ovarian function

In the moment of birth the ovaries already have all the follicles, which will produce egg cells during the entire reproductive life of a woman. Time passes by and this reserve diminishes until it is used up and the menopause starts.

From puberty on, every month follicles grow in the ovaries where during the ovulation one egg is exposed to be fertilized.

How can I know if I am ovulating?

The best way to know if a woman is ovulating is cycle control. If they are regular and not longer than 30-35 days it means ovulation is working correctly.

How can I know my ovarian reserve?

Studies about the ovarian reserve evaluate the capacity of the ovary to produce eggs after stimulation. The ovarian reserve is directly related to the age of the woman, maintaining stable until 35 years and diminishing progressively from this moment on.

We dispose of several tests to analyse the ovarian reserve, which should always be carried out in possible cases of sterility.

The ovarian reserve helps us to determine the adequate assisted reproduction treatment for each couple. In case of a very low ovarian reserve, egg donation treatment is indicated.

How can I know the quality of my eggs?

The best indicator for egg quality is the age of the woman, with optimum quality between 20 and 35 years. We do not dispose of any tests, which allow us to determine the quality of the eggs.

Even though a low ovarian reserve usually relates to low egg quality, it is not necessarily the case, a young woman can produce few eggs of very good quality. As well as a woman of advanced age can produce many eggs what does not guarantee their good quality. It is practical to say, that quality and quantity do not always go hand in hand. Egg quality is marked by age, egg quantity depends on the ovarian reserve.

What should I do if I have polycystic ovaries?

The polycystic ovary syndrome is the most frequent cause for ovulation alterations. One of its major characteristics are ovaries with an elevated number of follicles. In many cases it is related to overweight, acne and excessive body hair.

Weight loss can normalize the ovulation of a woman with polycystic ovaries. In other cases an ovulation induction treatment is indicated.

The sperm

Almost 50% of the couples consulting for sterility problems might have sperm issues. That is why the basic sterility evaluation should always include an analysis of the sperm quality.

How can I know more about the state of my sperm?

A spermiogram is the easiest way to know the state of your sperm. It evaluates aspects like quantity, mobility and morphology. A low number of spermatozoa, bad mobility or an elevated number of sperm with morphological abnormalities might explain why a pregnancy is not achieved.

When the result of the spermiogram is borderline normal a REM test should be made. This test informs us about the total number of mobile spermatozoa found. Depending on the result, we then decide for the adequate assisted reproduction treatment.

What needs to be considered having a spermiogram made?

To have a valuable spermiogram a series of aspects need to be considered:

  • Time of abstinence between three and five days
  • Examination of the sample in less than one hour
  • It also is important to take into consideration that certain medication or events like fever might affect sperm quality.

Is one spermiogram sufficient?

Usually there are variations between different samples. Therefore, it is recommended to have two spermiograms made.

Can sperm quality be improved?

It is not proven that treatments exist to improve sperm quality. The worse the quality of the sample the more difficult it is to improve it. Nevertheless, in cases with only light mobility alterations it has been observed that the use of antioxidants can be beneficial.

Does a normal spermiogram guarantee fertility?

Usually a normal spermiogram represents a good male fertility but in some cases problems that are not detectable via spermiogram might still exist. When despite a normal spermiogram no pregnancy is achieved, it is recommended to have a complete andrological check-up.

What can I do if I want a pregnancy despite a vasectomy?

The most efficient treatment in cases of vasectomy is In Vitro Fertilisation with sperm extraction directly from the testicle via testicular puncture.

The reversion of a vasectomy is limited to few exceptional cases where only short time has passed since the intervention and a very good reproductive prognosis is given.

What should I do if I have a varicocele?

A varicocele is a dilatation of the spermatic cord that drains into the testicle. Usually it does not alter the fertility but in more severe cases it might affect the sperm quality. Surgical treatment is indicated if it produces pain.

Fallopian tubes

Once the ovulation has happened one of the fallopian tubes picks up the egg. The sperm rises from the vagina, drifting through the uterine cavity, passing the tubes to meet with the egg and fertilise it.

The fallopian tubes play an active role in this process since they are involved in directing the sperm towards the egg and afterwards move the embryo into the uterus.

How can I know if my fallopian tubes are permeable?

The most common diagnostic test to check whether the tubes are permeable is the hysterosalpingography. This test consists of taking a series of x-ray pictures meanwhile a contrast agent is introduced into the cervix to see how it passes through the uterine cavity and fallopian tubes.

Is a study of the fallopian tubes always necessary?

A closer study of the fallopian tubes only is indicated if the clinical record and the results of the additional tests do neither orientate the case towards In Vitro Fertilisation (IVF) nor egg donation.

What can I do if I had a tubal ligation and want to get pregnant?

The best treatment for a woman with tubal ligation is In Vitro Fertilisation. The reversion of a tubal ligation has shown to be an inefficient and pricy technique.

What are the most common reasons for an obstruction of the fallopian tubes?

The main causes for obstructed fallopian tubes are abdominal infections and endometrioses. Occasionally abdominal surgery can also affect the tubes by producing adhesions, which fix and obstruct them.

The uterus

The uterus is the organ in which the pregnancy develops and where ideal conditions help the fetus grow until its birth.

The uterus consists of two different layers, the myometrium and the endometrium. The myometrium is a coat made out of muscles acting as an outer wall. The endometrium is the internal layer where the embryos implant.

What are the most frequent alterations of the uterus?

The most common alterations we can find in the uterus are:

  • Deformations: most frequent are the uterine septum and the uterus arcuate, whereas the septum is mostly related to reproductive problems
  • Myomas: these are formations of fibroids growing in the muscular layer of the uterus. The relation between myomas and fertility depends basically on their location. Submucosal myomas near the endometrial cavity are mostly the ones altering pregnancy probabilities
  • Endometrial polyps: endometrial polyps are formations of the glands, which are found in the endometrial cavity. Usually their diagnosis is casual and they can reduce chances of pregnancy.

How can I know if my uterus is normal?

The most frequent diagnostic test to know the status of the uterus is an ultrasound. It permits us to evaluate the morphology of the uterus as well as the endometrial cavity and helps to exclude the presence of pathological formations.

The ultrasound has the advantage to be easily done, no need for preparations and is available during consultation.

With the 3D ultrasound we obtain additional information allowing us to improve the diagnosis of deformations in the uterus and avoiding more complex tests like an MRI.

The Hysteroscopy is the most common test if a pathology of the uterine cavity is suspected. A tiny camera is introduced into the interior of the uterus to check directly on the endometrium. Furthermore, with this technique we are able to take also a tissue sample of the endometrium for further studies.

What is the treatment for uterine problems?

Surgical treatment is reserved to uterine problems affecting the cavity. In these cases surgery is done via hysteroscopy. Surgical hysteroscopy is an ambulant minimum invasive intervention.

What is the importance of the endometrium in assisted reproduction?

The endometrial tissue participates in the implantation of the embryo inside the uterus. The endometrium has a certain period of time during each cycle in which it is receptive for the embryos. This receptive period is called implantation window.

The study of the implantation window is of great importance to assisted reproduction treatments.

Endometriosis

What is endometriosis?

With endometriosis endometrial tissue implants in other places outside the endometrium. Endometriomas, also known as “chocolate cysts” are produced if endometriosis affects the ovaries.

What are the most frequent symptoms of endometriosis?

Most common symptoms of endometriosis is pain during the menstruation. This pain can grow to be so strong that it generally affects the woman’s quality of life.

How does endometriosis affect fertility?

Endometriosis is a frequent cause for sterility since it can affect the fallopian tubes as well as the ovaries. In consequence to the inflammation produced by the endometriosis adhesions can develop, affecting the fallopian tubes and making them unusable. Endometriosis in the ovaries might lead to “chocolate cysts” destroying healthy tissue, reducing the ovarian reserve and even might affect the normal production of eggs.

How can endometriosis be treated?

The principal objective of endometriosis treatment is to reduce pain and therefore improve the quality of life. For this, we dispose of different therapeutic options, which reach from medical treatment to surgery.

A pregnancy often helps to improve the evolution of endometrioses.

When should endometriosis be surgically treated?

Surgery should be the last treatment option for endometriosis. It is reserved to those women whose quality of life is strongly affected or where very big endometriomas are found.

Endometriosis surgery does not improve women’s fertility and might even lower the ovarian reserve and consequently worsen her reproductive prognosis.

What should I do if I suffer from endometriosis and want to get pregnant?

Many women suffering from endometriosis achieve pregnancy without difficulties. If you have endometriosis and you are trying for more than six months to become pregnant a consultation at a fertility clinic is recommended.

What is the most effective treatment with endometriosis?

The In Vitro Fertilisation (IVF) is the most frequent treatment for women with sterility problems and endometriosis. Depending on the age of the woman or if the ovarian reserve is very low, egg donation could also be considered.