I'm not Pregnant

Problems conceiving: Testing

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Many couples nowadays have problems conceiving. Women under the age of 35 who have been trying to conceive for more than 1 year or women over the age of 35 who have been trying for more than 6 months, should consult a doctor. Infertility is not just a female issue. Infertility can affect both partners. Fertility experts agree that, on average, 30% of the cases of infertility can be attributed solely to the female, 30% solely to the male, 30% a combination of both partners, and in 10% there is unexplained infertility.

 

Here are the steps you should take when you have problems conceiving:

Whom should we consult?

Women aged under 35 who have been trying to conceive for more than a year and women aged over 35 who have been trying to conceive for more than 6 months should consult specialists like:

  • Gynecologist
  • Endocrinologist
  • Andrologist
  • Urologist
  • Immunologist

Fertility test for females:

  • Pelvic exam and ultrasound
  • Female Hormone Test (estrogens, progesterone, LH, FSH, prolactin, etc.) + ovarian reserve test (Anti-Mullerian hormone)
  • Microbiological culture and DNA testing of cervical mucus + blood tests for chlamydia
  • Tests for ovarian and anti-sperm antibodies
  • Hysterosalpingography (HSG)

Fertility tests for males:

  • Semen analysis 
  • Semen microbiological culture and blood tests for chlamydia
  • Sperm DNA fragmentation
  • Male Hormone Test
  • Urology consultation

 

Here is additional information about the examinations mentioned above, and what would be the further steps:

Fertility test for females

  1. Pelvic exam and ultrasound – visual and physical examination of a woman’s reproductive system.
  2. Female hormone test – female hormone levels (estrogens, progesterone, LH, FSH, prolactin, etc.) are crucial for defining the next steps. The ovarian reserve test determines the number and quality of your egg cells. The Anti-Mullerian hormone (AMH) is produced by the ovarian follicles. The lower the AMH levels, the lower ovarian reserve you have. Your doctor might run additional tests for thyroid hormone levels and insulin resistance.
  3. Infectious diseases – infections of the reproductive organs can cause infertility. For example, inflammation can lead to blocked fallopian tubes. That is the reason for running a microbiological culture and DNA testing of cervical musuc. The bacteria Chlamydia is known to cause infertility. It causes an infection that is sexually transmitted. The infection causes certain antibodies to raise, which can be determined by running blood tests.
  4. Antibody tests – it is possible that our immune system produces antibodies that attack our reproductive organs and gametes (ovarian eggs and sperm cells). Women get tested for ovarian and anti-sperm antibodies. The ovarian antibodies have a bad effect on ovarian eggs and the development of the embryos. Also, they have a negative impact on ovulation. Antisperm antibodies are secreted in female vagina and harm the sperm cells.
  5. Hysterosalpingography (HSG) – a radiologic procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes. A substance known as contrast material is used in the procedure.

Fertility tests for males

  1. Semen analysis – evaluates the quality of semen. Most important characteristics are volume ejaculated, morphology, motility, vitality, sperm concentration and total sperm count.
  2. Semen microbiological culture for infectious agents and a blood test for chlamydia.
  3. Sperm DNA fragmentation – Sperm cells with fragmented DNA have low fertilization rates. New techniques enable selection of sperm cells with best characteristics.
  4. Male hormone tests – sex hormones and additionally, hormone levels of the thyroid gland.
  5. Urology consultation – if necessary

 

What happens next?

After running the tests, the specialist you are consulting will be able to acknowledge the problem, if there is one. Your options are:

 

  • Natural conception after therapy that solves fertility problems if there are ones.
  • Natural conception after controlled ovarian stimulation

If the options mentioned above don’t lead to pregnancy in less than 6 months, the next step is Assisted Reproductive Technology (ART). It includes:

 

  • Assisted Reproductive Technology – intrauterine insemination. Sperm that have been washed and concentrated are placed directly in uterus around the time of ovulation.
  • Assisted Reproductive Technology – in vitro fertilization. Complex series of procedures, during which mature eggs are retrieved from the ovaries and fertilized by sperm in a lab. After that, the fertilized eggs (embryos) are transferred back to the uterus. Read our blog for additional information about in vitro fertilization.
  • Assisted Reproductive Technology – eggs and sperm donation. If a couple cannot be helped through procedures such as in vitro fertilization, they may want to consider using donor eggs. Donor eggs allow infertile women to carry a child and give birth.

Do not postpone consulting reproductive medicine specialist. There are multiple centres of reproductive medicine with specialists that follow a multidisciplinary approach to treat individual reproductive problems. It is crucial that both partners are being tested for possible fertility problems. Click here for more about the scientific process behind conception.

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