Basic sterility evaluation Spain

It is important to take into consideration that a healthy lifestyle improves the chances for pregnancy. Therefore, it is recommended to maintain a suitable weight according to BMI limits; if the index is too low, ovulation problems can occur. On the other hand, excess weight can be associated with poor egg quality and endometrium and cycle abnormalities. Other factors, such as smoking, drugs, sexually transmitted diseases (STDs) and high coffee and alcohol consumption can also compromise a couple’s fertility.

We therefore recommend a Mediterranean diet rich in antioxidants and Omega 3, and moderate physical exercise.

The first thing a couple trying to become pregnant should know is that ovulation takes place in the middle of the cycle, when it is regular. If the cycle lasts approximately 28 days, the best way to improve the chances for success as much as possible is by focusing sexual intercourse during the ovulation phase, that is, between days 12 and 16 of the cycle.

At the time of birth, the ovaries will have all the follicles that will produce eggs throughout a woman’s entire reproductive life. Time passes and this reserve will diminish until it is used up and menopause starts.

From puberty onwards, a follicle grows in the ovaries each month, whereby an egg is released after ovulation that can be fertilized.

An examination of the ovarian reserve evaluates the ovarian capacity to produce eggs after stimulation. The ovarian reserve is linked to a woman’s age, remaining stable until the age of 35 and gradually decreasing from then on.

There are several tests available to us that allow us to analyse a woman’s ovarian reserve and which should always be requested in case of sterility.

The ovarian reserve helps us to decide on the adequate assisted reproduction treatment for the couple. In the event of a very low ovarian reserve, egg donation treatment may be recommended.

The best indicator for egg quality is a woman’s age, with optimum quality being between ages 20 and 35. We do not dispose of any test, which allows us to determine the quality of the eggs.

Even though a low ovarian reserve is usually related to poor egg quality, this is not always the case; a young woman can produce few good-quality eggs. Likewise, although an older woman produces many eggs, it does not guarantee they will be good-quality. In practice, we can say that quality and quantity do not always go hand in hand. Egg quality is marked by age and quantity by the ovarian reserve.

Polycystic ovary syndrome is the most common cause for ovulation abnormalities. One of its main characteristics are ovaries with a high number of follicles. In many cases, it is related to excess weight, acne and excessive body hair.

Weight loss can normalize ovulation in a woman with polycystic ovaries. In the remaining cases, an ovulation induction treatment will be recommended.

Once ovulation has occurred, one of the fallopian tubes collects the egg. The sperm climbs from the vagina, passing through the uterine cavity, travels through the fallopian tubes to find the egg and fertilise it.

The fallopian tubes actively participate in this process since they must facilitate sperm movement towards the egg and afterwards move the embryo into the uterine cavity.

Examination of the fallopian tubes will only be recommended when the clinical history and results from additional tests do not steer the case towards In Vitro fertilisation or egg donation.

The uterus is the organ in which pregnancy takes place and where ideal conditions help the foetus grow until its birth.

The uterus consists of two clearly differentiated layers, the myometrium and the endometrium. The myometrium is a muscle layer that acts as a wall, while the endometrium is the internal layer where the embryos have to be implanted.

The most common abnormalities that we can find in the uterus are:

• Malformations: the most common are uterine septum and arcuate uterus, with uterine septum being related to reproductive problems the most.
• Fibroids: these are fibrous formations that grow in the muscle layer of the uterus. The relationship between fibroids and fertility will primarily depend on their location. Submucosal fibroids, which affect the endometrial cavity, are the ones that affect the chance to achieve a pregnancy the most.
• Endometrial polyps: endometrial polyps are glandular formations that are found in the endometrial cavity. Their diagnosis is usually accidental and can reduce chances to achieve a pregnancy.

The diagnostic test of choice to learn the status of the uterus is an ultrasound. The ultrasound allows us to evaluate the morphology of the uterus as well as the endometrial cavity, in order to rule out the presence of pathological formations.

The ultrasound has the advantage of being an easy technique, that does not need any prior preparation and can be performed during the consultation.

With the addition of 3D ultrasound, we can obtain additional information which allows us to improve the uterine malformation diagnosis, preventing the performance of more complex tests like magnetic resonance imaging.

The endometrial tissue participates in embryo implantation 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 the implantation window.

Analysis of the implantation window is of great importance in the face of assisted reproduction treatments.

Hysteroscopy is the recommended test if any type of uterine disease is suspected. Hysteroscopy consists of a tiny camera being inserted inside the uterus to directly view the endometrial cavity. Furthermore, endometrial tissue samples can be taken for analysis with hysteroscopy.

Surgery is reserved for uterine problems that affect the cavity. In such cases, surgery is performed by hysteroscopy. Hysteroscopy is a type of minimally invasive outpatient surgery.

Semen analysis is the simplest test to learn about the state of your sperm. Semen analysis evaluates aspects like sperm count, motility and morphology. A low number of sperm, bad motility or high number of sperm with morphological abnormalities might explain why a pregnancy is not achieved.

When the result of the semen analysis is borderline, a MSR test should be performed. This test informs us about the total number of motile sperm that has been recovered. Depending on the result, we can choose the adequate assisted reproduction treatment.

For the semen analysis to be valuable, a series of requirements need to be met:

• Time of abstinence between 3 and 5 days
• Evaluate the sample in less than one hour of its collection

It also must be taken into consideration that the use of certain medication or events like fever can affect its quality.