Study and diagnosis of sterility

Sterility study and diagnosis

What do we understand by ‘sterility’?

We can define sterility as the difficulty that a couple has in conceiving naturally, after having regular sexual intercourse without using any form of contraception over a period of time.

When do we consider that a couple should begin sterility testing?

As a rule it is accepted that a couple who have been having regular sexual intercourses over a minimum period of one year without using any form of contraception should consult a gynaecologist in order to discover the possible causes of these difficulties. In some cases there may be reasons for recommending a consultation earlier than this. One important factor to be taken into account is the age of the woman, as we know that after 35 years old there is a reduction in women’s reproductive capacity, a reduction that further increases from the age of 40. For this reason, from the age of 35 upwards, testing may begin after a period of 6 months of attempting to conceive.

What tests need to be done?

First of all, it is important to look at the couple’s personal background and family history. It is also necessary to examine lifestyle factors that could have a negative effect on the ability to conceive (exposure to toxins, medication, diet…)

Today, basic sterility testing has been greatly simplified – but there are still a minimum number of essential tests that need to be carried out, on both the man and the woman, and in case that any of these clearly identify a problem, the appropriate treatment will be determined. These tests are:

1. A seminogram (semen analysis): the study of the man’s semen is an essential part of sterility testing.
2. Hormonal tests: anti-Mullerian hormone levels are tested in order to assess the woman’s ovarian reserve. A progesterone test in the second phase of the monthly cycle is used to determine whether or not she is ovulating. If ovulatory dysfunction is suspected, hormonal tests will need to be more extensive, and will also include an assessment of the levels of androgens, prolactin, thyroid hormones, etc.
3. A tubal permeability test: this is particularly important where artificial insemination is advised. This can be done either by hysterosalpingography or by hysterosonography
4. Transvaginal ultrasound: this provides information on the uterine cavity and also on the ovaries. An antral follicle count is important as it is another ovarian reserve marker.

So at the first appointment we will carry out a in-depth lifestyle study: medical history and any prior treatments. We will advise whether or not there are any additional tests that might need to be carried out, together with the recommended treatment and the probability of success.