The knowledge of Poles about infertility and its diagnosis is still at a low level. Meanwhile, this is a problem that even every fifth couple in Poland has to face. Professional diagnostics and appropriate treatment significantly increase the chance of the desired parenthood.

Consultation with a specialist and appropriate tests should be carried out at the right time. Age is of great importance for fertility, therefore diagnosis should not be delayed, especially if the woman is over 30 years of age. For women up to 35 years of age, it is recommended to consult a specialist after a year of unsuccessful efforts for a child, and for women over 35 - after six months. The same is true for couples in which the man is over 40 years old.

Men's business

When a couple is trying to conceive, the woman is usually diagnosed and treated first. When the cause of the woman is ruled out, only then is the man referred for research. This is a fairly common mistake. Statistically, infertility affects men and women equally. It should also be remembered that although the diagnosis of men is much less complicated than that of women, their treatment often takes much longer.

Where to start? At the beginning, the doctor directssemen analysisto

, including the assessment of, inter alia, the number of sperm, their concentration in 1 ml of ejaculate, as well as mobility and structure. The ejaculate parameters such as the liquefaction time, volume, viscosity, appearance, pH, and possibly the degree of agglutination, i.e. sperm clumping, are also important. The man submits his semen for analysis after he has been sexually abstinent for 3 to 5 days. The test results are consulted with a urologist or andrologist who performs an ultrasound examination of the testicles and prostate and possibly also orders other tests, e.g. hormonal.

Extended semen analysis allows you to assess the structure of sperm and determine the proportions between those that are built properly and structurally damaged sperm. Semen parameters are assessed against the standards set by the World He alth Organization (WHO).

Worth knowing

WHO standards from 2010 are:

  • ejaculate volume: ≥ 1.5 ml,
  • total sperm count in ejaculate: ≥ 39 million,
  • sperm concentration (numbersperm in 1 ml of semen): ≥ 15 million,
  • overall percentage of motile sperm (progressive and non-progressive movement): ≥ 40%,
  • percentage of sperm in progressive movement: ≥ 32%,
  • sperm viability (percentage of live sperm): ≥ 58%, pH: ≥ 7.2,
  • sperm morphology (percentage of completely normal sperm): ≥ 4%.

When things get complicated

Some men should undergo theSCD testto assess the ability of sperm to fertilize. It happens that the parameters of sperm (sperm count, structure and mobility) are not too low, and yet conception does not take place. The SCD test then shows that the sperm cells have normal DNA. When the test result shows otherwise, fertilization may occur, but the embryos are not developing properly. Semen analysis including the test should be performed by men whose cause of infertility in both partners is unknown, as well as those over 40 years old, even if they had children before. The risk of damaging sperm DNA is greater not only in older men, but also in those who are exposed to toxic substances or have varicocele.

In the case of lowered semen parameters, men are recommendedMSOME test . The MSOME technique (Motile sperm organelle morphology examination) allows the observation of the structure of a living sperm at a magnification of 6600 times. This makes it possible to determine if the internal structure of the sperm is normal and which sperm is best for fertilizing an egg.

Testicular biopsy is performed in patients with no sperm in their semen (azoospermia). A biopsy is a surgical procedure that involves collecting sperm directly from the testicle or epididymis.

Ladies for diagnosis

Basic diagnosis of the causes of infertility in women includes the determination of hormone levels, ultrasound of the reproductive organ and cycle monitoring. It is a way of observing the regularity of the phases of the menstrual cycle and confirming the presence of ovulation. It allows you to determine the days of fertility and ovulation - the day when a mature egg is released by the ovary. Ovulation monitoring is carried out using a vaginal ultrasound machine, by performing several tests on appropriate days from the beginning of the cycle. Anovulatory patients require pharmacological ovulation stimulation. Then they take hormonal drugs from the first days of the cycle.

Fertility hormones

Testing the level of AMH(Anti-Müllerian Hormone) from the blood allows you to assess the condition of the woman's ovarian reserve and- thus - assess its potential fertility. It can be performed at any stage of the cycle - the amount of the hormone remains constant all the time. Hormone or contraceptive therapy has no effect on the level of AMH. A very low level of AMH (below 0.5 ng / ml) is an indication for taking appropriate action quickly.

The diagnosis of women should also include the examination of the hormone FSH and LH produced by the pituitary gland. It is responsible for the proper functioning of the reproductive system. The test reports on pituitary or hypothalamic insufficiency. It also helps in the diagnosis of polycystic ovary syndrome. It is recommended when looking for the causes of irregular cycles. The hormone level is measured from a blood sample at the very beginning of the cycle.

Sono-HSG study and hysteroscopy

The sono-HSG test , or ultrasound hysterosalpingography, is a safe and effective method of assessing the patency of the fallopian tubes. The fallopian tubes can be obstructed if the woman has undergone surgery in which they may have been damaged or has had frequent infections in the pelvic area. Hysteroscopy, in turn, is a test that allows you to assess the structure of the uterine cavity. It is carried out using a special instrument called a hysteroscope, which allows the doctor to look inside the uterine cavity and detect anatomical abnormalities. The procedure also enables the removal of intrauterine adhesions, polyps and fibroids, which may be an obstacle in getting pregnant.

Genetic research for couples

Genetic tests are aimed at determining the cause of infertility and checking whether the cause of the lack of pregnancy is not carrying genetic diseases in one or both partners. Genetic disorders cause infertility in up to 4% of couples struggling with this problem.

A basic and simple blood test is thekaryotype . It allows you to exclude abnormalities in the structure and number of chromosomes that may cause infertility or recurrent miscarriages. Early diagnosis of this type prevents the transmission of genetic defects to the offspring. The karyotype test should be performed by both partners.

Another genetic test detects a male Y chromosome gene mutation in AZF regions. This mutation is based on the lack of a specific region of the Y chromosome, which disrupts the process of spermatogenesis, i.e. the process of sperm formation and maturation. It occurs in 10% -15% of men with a high or no sperm deficiency in donated semen.

Another test detects amutation in the CFTRgene, responsible for cystic fibrosis and some forms of infertilitymale, e.g. bilateral absence or obstruction of the seminal ducts or obstruction of the sperm discharge pathways (obstructive azoospermia).

Correct genetic diagnosis involves many laboratory tests that allow you to confirm or exclude congenital, genetic defects in both partners. However, it should be remembered that in some cases genetic defects do not appear until the offspring.

Where to go for help

The diagnostic process of couples who fight infertility is a difficult, time-consuming and stressful moment … However, it is not worth getting discouraged in the event of an unsuccessful result, because it is usually not a sentence and the chances for a child still exist. Infertility is a reversible condition. Properly conducted diagnostics and specialized treatment give a good chance for parenthood.

There are more and more places in Poland where full diagnostics of people struggling with infertility, both women and men, can be carried out. One of them are InviMed clinics.

InviMed clinics are modern infertility treatment centers. There are currently 5 of them in Poland - in Warsaw, Wrocław, Gdynia, Poznań and Katowice. They employ doctors and embryologists who have been successfully treating people struggling with infertility for almost 20 years. The clinics helped over 8 thousand to be born into the world. children, incl. thanks to in vitro programs, the effectiveness of which reaches 43%. To learn more about InviMed clinics, just visit www.invimed.pl.

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