Basic sterility evaluation

Basic sterility evaluation

Sterility evaluation includes the initial tests a couple has to undergo to make a diagnosis on their sterility problem. These diagnostic tests concentrate on examining both female sterility factors, as well as male.

I am not getting pregnant.
What should I do?

Achieving a pregnancy is not always easy and several months can pass to achieve it. When trying to become pregnant takes more than one year, something might not be working as it should be and a basic sterility evaluation is recommended to determine the cause.

There are situations where it is recommended to have a sterility consultation after no more than six months:

  • Women aged ≥38

  • Irregular cycles of more than 35 days

  • Previous ovarian surgery

  • Diseases like endometriosis

  • Previous treatments with chemotherapy

  • Two or more consecutive miscarriages

I am not getting pregnant.<br>What should I do?

What can I do to increase my fertility?

We will tell you everything you need to know.

Recommendations
Improve your lifestyle

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.

Improve sexual intercourse

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.

Improve sperm quality
It is not very clear whether there are treatments that improve sperm quality. Nevertheless, there are some habits that can affect its quality, such as smoking, drinking or stress. Other treatments, such as antioxidant multivitamin supplements might improve sperm motility.
Alternative therapies
We have seen that alternative therapies such as acupuncture can improve natural fertility in some couples. In assisted reproduction, practising acupuncture before and after embryo transfer facilitates its performance by completely relaxing the patient.

Female sterility tests

You can find below the most common female sterility tests.

Ovulation
What is ovulation?

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.

How can I know if I am ovulating?
The best way to know if a woman is ovulating is by checking her cycles. If they are regular and no longer than 30-35 days, it means ovulation is working correctly.
How can I learn my ovarian reserve?

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.

How can I learn the quality of my eggs?

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.

What should I do if I have polycystic ovaries?

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.

Hysterosalpingography
What is the function of the fallopian tubes?

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.

How can I know whether my fallopian tubes are permeable?
The diagnostic test of choice to check that the fallopian tubes are permeable is a hysterosalpingography. This test consists of performing serial x-rays while a contrast agent is inserted into the uterine neck to see how it passes through the uterine cavity and fallopian tubes.
Is examining the fallopian tubes always recommended?

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.

What can I do if I want a pregnancy despite a tubal ligation?
The best treatment for a woman with tubal ligation to achieve a pregnancy is In Vitro fertilisation. The tubal repermeabilisation has been shown to be an ineffective and expensive technique.
What are the most common causes of blocked fallopian tubes?
The main causes for blocked fallopian tubes are abdominal infections and endometriosis. Occasionally abdominal surgery can also affect the fallopian tubes by producing adhesions that attach to the tubes and block them.
Ultrasound
What role does the uterus play and what is its structure?

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.

What are the most common uterine abnormalities?

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.
How can I know if my uterus is normal?

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.

What is the endometrium’s importance in assisted reproduction?

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
What is hysteroscopy?
Hysteroscopy is a diagnostic test on the endometrial cavity that allows us to directly access the inside of the uterus to evaluate it more accurately.
When is hysteroscopy recommended?

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.

Male sterility tests

Up to 50% of the couples that visit for sterility may have sperm problems. For this reason, the basic sterility evaluation must always include an assessment of sperm quality.

Semen analysis
How can I learn more about the state of my sperm?

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.

What needs to be considered when undergoing semen analysis?

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.

Is one semen analysis enough?
Usually there are variations between different sperm samples. Therefore, it is recommended to perform two semen analyses to get an accurate diagnosis.
Can sperm quality be improved?
It is not very clear whether there are treatments that can improve sperm quality. The worse the quality of the sample, the more difficult it is to improve it. Nevertheless, in cases with mild motility abnormalities, the use of antioxidants has been observed to be beneficial.
Does a normal semen analysis guarantee fertility?
In the majority of cases, a normal semen analysis represents good male fertility, but in some cases there may be problems that are not detectable by semen analysis. When pregnancy is not achieved despite a normal semen analysis, it is advisable to have a complete andrological examination.
Other circumstances to be checked
What can I do if I want to have a child despite having a vasectomy?
The most effective treatment in cases of vasectomy is In Vitro fertilisation with sperm collected directly from the testicles by testicular puncture. Vasectomy reversal is limited to few rare cases where only a very short amount of time has passed since the vasectomy was performed, with a good reproductive prognosis.
What should I do if I have a varicocele?
A varicocele is a venous dilation in the testicles. It does not usually cause a problem for fertility, although in more severe cases it can affect sperm quality. Surgery is indicated if it causes pain.