Before proceeding with any medical therapy, an adequate diagnosis must be formulated. This is the first fundamental step of your desire to conceive a child.
In our center, before proceeding with the therapy, our doctors will perform an accurate diagnosis, which will allow you to put together the most suitable solution for your problem.
To understand the different possibilities offered by the diagnosis of infertility, we will provide you with an overview of the many causes related to this problem.
The term "infertility"
A couple is called infertile or sterile when no pregnancy occurs after one year of intended intercourse. According to studies, about one in six couples cannot conceive a child and this trend is increasing. The causes can be attributed equally to both sexes, often for both partners there are biological difficulties.
Causes of infertility in men
In men, the possible reasons for reduced fertility are found in the parameters of his spermiogram.
Oligozoospermia: Reduced number of sperm, i.e. when the sperm concentration is lower than 15 Mil./ml (reference values ËHO 2010).
Asthenozoospermia: A condition characterized by poor mobility (<40% according to ËHO 2010) of spermatozoa, which in this condition have difficulty reaching the oocyte.
Teratozoospermia: Indicates that more than 96% of the spermatozoa present in known pathologies are attributable to genetic damage and therefore unsuitable for fertilization.
Azoospermia: Total absence of spermatozoa in the seminal fluid.
Causes of infertility in women
Ovarian factor: The cause is a pathology in the ovaries. Due to altered hormone levels, the glands do not mature, so no oocytes are produced.
Hormonal disturbances: prolactin, thyroid-stimulating hormone (FSH), luteinizing hormone (LH), androgenic hormones, estradiol hormones and the thyroid gland are essential for conception and continuation of a pregnancy.
Tubal factor: due to a stenosis of the tubes, the egg cannot reach the uterus and therefore be fertilized.
Endometriosis: the presence of the endometrium (the tissue that surrounds the uterus) is found outside of its natural position, usually in the abdominal area. This mucous membrane acts as if it were in the uterus, is controlled by hormones and follows the female cycle. Since the blood produced fails to flow or this happens incorrectly, cysts can form, leading to lumps or blockage of the ovaries, which negatively affects fertility.
Immunoinfertility: in rare cases, an immune reaction from the woman can negatively affect the movement of sperm, adversely affecting fertilization.
Genetic factors: due to chromosomal abnormalities, fertility disorders or inherited diseases may occur.
Asherman's syndrome: indicates the presence of scar tissue in the uterine cavity, which is usually the result of operations performed on the abdominal cavity. The consequences can be: amenorrhea, hypomenorrhea, spontaneous abortions and secondary sterility.
Overview of infertility diagnosis
History
Before starting a therapeutic course, a complete medical history is taken, during which information is obtained about the health condition of the couple, as well as about the relatives. It is important for the attending physician to know what therapies have already been carried out, if there are diseases or, for example, cycle abnormalities, or if in the past one has undergone operations or interventions other than those of a gynecological nature.
Hormonal analysis
As part of taking blood samples, a specific analysis of the hormones responsible for the conception and continuation of a pregnancy is performed. In particular, the following parameters are evaluated:
Androgen hormones: an irregular cycle can be caused by an abnormality of androgen hormones. The most important are testosterone and DHEA (dehydroepiandrosterone). High levels of these hormones can negatively affect egg maturation and therefore fertility. The causes of this increase may be the dysfunction of the adrenal cortex or obesity.
Gonadotropins: Gonadotropins consist of luteinizing hormone (LH) and gland-stimulating hormone (FSH). Both hormones are produced by the adenohypophysis and controlled by the hypothalamus. In humans, LH and FSH are responsible for the production of sex hormones and the functioning of the testicles, thus the maturation of the sperm. In women, they are responsible for the production of estrogen and progesterone. In addition, luteinizing hormone is important for stimulating ovulation and generating the corpus luteum. Rather, gland-stimulating hormone is involved, as the name suggests, with the necessary maturation of the egg.
LH-FSH ratio: the relationship between LH and FSH illustrates possible hormonal diseases, such as polycystic ovary syndrome (PCOS).
In PCOS there is often an unbalanced LH-FSH ratio in favor of LH.
Thyroid hormones: those who wish to become pregnant should rule out or treat possible hyperthyroidism or hypothyroidism. Both diseases can negatively affect fertility.
Anti-Mullerian hormone (AMH): measuring this hormone in the blood allows to determine the ovarian reserve. Therefore, AMH represents both an indicator for the success of hormonal stimulation, and the possibility of obtaining enough follicles for a subsequent IVF / ICSI.
3D sonography
3D sonography allows you to see the depth of the image and thus, for example, represent the volume of an organ. This allows a more accurate diagnosis of malfunctions or to see, during stimulation, the structure of the follicles.
Hysterosalpingography (HSG)
A possible cause of infertility may result from abnormalities of the uterus or blocked fallopian tubes. To investigate these issues, you can have a radiological examination of the uterus and tubes. Using a contrast medium, it is possible to observe the exact distribution of fluids in the abdominal cavity, thereby assessing the patency of the ovarian tubes. The examination also allows any abnormalities of the uterus to become visible.
Spermiogram
In the analysis of seminal fluid, the following criteria are taken into account: volume, pH, concentration, mobility, morphology, etc.
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