During the first visit the specialist will gather some relevant information concerning the couple’s medical and fertility history, particularly:
- Couple’s age.
- Previous pregnancies.
- Previous surgeries; toxic habits.
- Possible hereditary diseases.
- Gynaecological disorders such as pelvic infection, fibroids, cervical conization, endometriosis, etc.
- Duration and frequency of menstrual cycles. Period duration.
- Frequency of sexual intercourse.
- Male: occupational history, toxic habits, medications, prior medical record, urological conditions and infections, previous pregnancies with a different partner.
The first tests to be performed are a vaginal ultrasound, a hormone test and a hysterosalpingography (HSG), as well as a sperm analysis.
Vaginal ultrasound: It is used to assess the size, appearance and shape of the ovaries and the condition of the uterus, as well as to check for ovarian cysts, endometrioid cysts, polyps, fibroids, hydrosalpinx, etc.
Tubal patency test (hysterosalpingography): This is a pelvic x-ray which is performed by injecting a blue dye into the fallopian tubes to asses their condition and patency.
Hormone test: A blood extraction is done to assess the various hormone levels that contribute to the reproductive cycle. This test provides useful information about the ovarian reserve and the probability of ovulation.
Sperm analysis: This test is performed to check the number, motility and morphology of the sperm in the ejaculate. Additionally, a sperm recovery test as well as an antisperm antibody test and a vitality test are usually done.
Depending on the results, additional tests may be necessary to make a conclusive diagnosis for explaining the causes of sterility.
The sterility study may show normal results. In such a case, depending on age, duration of sterility and medical history, ovarian stimulation as a step to artificial insemination or in-vitro fertilisation may be advised. In addition to seeking pregnancy, these treatments allow for further investigating the causes of sterility.
Additional tests include, among others, the following:
- Sperm DNA fragmentation test.
- Sperm FISH analysis.
- STUDY of meiosis in testis tissue.
- Diagnostic hysteroscopy.
- Diagnostic laparoscopy.
Sperm DNA fragmentation test: This technique allows study of genetic material in sperm by testing for broken DNA fragments within the sperm cell.
Certain factors such as oxidative stress, toxin exposure, heat exposure, etc. can damage sperm DNA to the extent of causing its inability to achieve pregnancy. This kind of alteration usually takes place in the epididymes, a body attached to the upper part of each testicle, within which spermatozoa are stored.
On average, about 500-800 spermatozoa are analysed. A DNA fragmentation index below 25% is considered normal.
Sperm FISH (Fluorescent In-Situ Hybridization) analysis: By using fluorescence in situ hybridization (FISH) we can determine chromosome abnormalities in sperm. Only 5 (13, 18, 21, X, Y) of the total 23 pairs of chromosomes of the spermatozoon can be studied with this technique. Nevertheless, it helps to detect the presence of defects in the chromosome structure of sperm cells. Chromosome abnormalities in sperm may create defective embryos which fail to implant or which may even initiate a pregnancy likely to result in miscarriage.
Study of meiosis in testis tissue: Meiosis is the process by which a cell divides its chromosome constitution to produce gametes like eggs and sperm. If, due to genetic or environmental factors, meiosis does not occur properly, no sexually competent gametes are produced and fertility may be compromised. This study consists in obtaining some parenchyma from the testis by means of a biopsy, and analyse the process of meiosis to check that chromosome segregation happens accurately and efficiently.
Karyotype test: A kariotype is a test to identify and evaluate chromosome count and structure. Lymphocytes from a sample of blood are cultured and then selected in order to analyse their nucleus.
This screening test is recommended in case of conditions associated to low sperm count. It allows for detecting abnormalities which may cause low sperm count.
Diagnostic hysteroscopy: This procedure allows your fertility specialist to screen out any abnormalities in the uterus, such as polyps, fibroids, endometritis. It is also used in cases of recurrent miscarriages. A thin hollow tube, the hysteroscope, is inserted through the cervix into the uterus to obtain a detailed view of the inside of the uterus.
Diagnostic laparoscopy: With this surgical procedure any pelvic adhesions due to endometriosis or infections are removed. Laparoscopy is also indicated in cases of unexplained sterility.
If you do not live in Spain, please see First Consultation in International Coordination