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Infertility testing
Infertility testing begins with a consultation of both partners with a gynecologist.
First, a detailed interview is conducted, followed by a gynecological examination and a vaginal ultrasound, which can be supplemented with a three-dimensional (3D) ultrasound examination.
Ovarian reserve is assessed by ultrasound examination and analysis of anti-Müllerian hormone (AMH) from the blood.
Thyroid hormone analysis and a test for chlamydia and gonococcus are also performed.
Fallopian tube patency is examined by 3D transvaginal ultrasound by injecting contrast into the uterus and following the movement of the contrast through the uterus and fallopian tubes.
In case of suspicion of fallopian tube obstruction or changes in the uterine cavity, laparoscopy can be performed or hysteroscopy .
In males, the semen analysis is analyzed first. When there are deviating values, an andrological examination, hormonal analyses and possibly genetic analysis are performed.
Before IVF, both partners must be tested for hepatitis B and C, HIV and syphilis.
Definition of infertility
Infertility is defined as the absence of pregnancy after twelve months of active trying to conceive, i.e. sexual intercourses without the use of protective methods.
Contact with a specialized institution is recommended even before the completion of one year of the attempt if there is any risk factor (menstrual cycle disorder, women older than 35 years, operations on the ovaries and testicles, radiation or chemotherapy treatment).
Probability for conception and types of infertility
The probability that a couple will achieve pregnancy is 20 % per menstrual cycle. Approximately 85% of couples get pregnant within twelve months, while 15% have problems with infertility. Infertility can be primary or secondary.
Primary infertility is when a woman has never got pregnant after trying for twelve months.
Secondary infertility is the absence of pregnancy after one year of active trying, in women who have been pregnant before.
Difference between infertility and sterility
Infertility is used today instead of the term sterility. However, these two terms are not equivalent in the medical sense.
Sterility is interpreted as complete impossibility of pregnancy, while under infertility implies reduced possibility of conceptionwhich can be corrected by medical procedures.
Causes of infertility
Conception, that is fertilization, is a very complex process and is still not fully understood.
Current analyses show that in 30% of cases the cause of infertility is a female factor, in 30% it is a male factor, in 30% it is the cause of both the woman and the man, and in 10% of couples the cause cannot be found (unexplained infertility).
The female factor
- A woman's age is an important prognostic factor for achieving pregnancy.
- A girl at puberty has about 400,000 egg cells on both ovaries. Egg cells are located in the so-called "primordial follicles “. The process of development and maturation of egg cells is called folliculogenesis, which lasts for six months. In this process, about 1000 egg cells begin the process of development, so that only one matures and ovulates, so that a woman has 350-400 ovulations in her life.
- With ageing the quality of egg cells also decreases.
Ovulation means the release of a mature egg cell from the ovarian follicle, which then enters the fallopian tube where it meets spermatozoa and fertilization occurs. Ovulation occurs after the coordinated action of hormones of the central nervous system and ovaries. Ovulation does not occur when the balance of hormones is disturbed.
Causes of ovulation disorders can be:
- weight loss and eating disorders;
- strenuous physical training;
- obesity;
- severe psychological stress;
- polycystic ovary syndrome (PCOS).
PCOS is the most common hormonal imbalance in women, affecting 10% of the female population. In women with PCOS, the ovaries produce an excess of male hormones that prevent ovulation, resulting in irregular periods. Acne and increased hairiness also occur in women with polycystic ovary syndrome. Absence of ovulation leads to infertility.
The fallopian tube is a "channel" that is the connection between the ovary and the uterus. The ovulated egg cell "travels" through the fallopian tubes to the uterus, while on the other hand, spermatozoa come from the direction of the uterus. Fertilization occurs in the fallopian tube, from where the fertilized egg cell "travels" to the uterus with the help of a "transport mechanism" located in the fallopian tubes. Infertility occurs when the mucous membrane of the fallopian tubes is damaged, most often after infection with chlamydia and gonococcus. Impaired fallopian tube function can also occur after a pelvic infection or endometriosis.
IVF is used today as the method of choice in the treatment of infertility caused by ovarian dysfunction, although in selected cases it can also be treated surgically.
- Myomas are benign changes in the uterus, which are located in the uterine cavity and possibly in the wall of the uterus and can be the cause of infertility.
- Approximately 8% of women between the age of 33 and 40 have myomas. Some congenital anomalies of the uterus and adhesions, that is, scar tissue in the uterine cavity, reduce the possibility of pregnancy.
- 1 out of 4,000 women is born without a uterus, while a number of women have their uterus surgically removed during their reproductive years due to malignant diseases, myomas, and childbirth complications.
- Endometriosis is a disease where the lining of the uterus is located outside the uterine cavity, most often in the abdominal cavity and on the ovaries.
- Women with endometriosis usually have painful periods, painful intercourse, and chronic abdominal pain.
- Endometriosis leads to infertility by preventing ovulation, negatively affecting fertilization, creating adhesions in the abdominal cavity and disrupting the function of the fallopian tubes.
The prolactin hormone and impaired thyroid gland function lead to ovulation disorders and thus infertility.
