Infertility

What is infertility?

Infertility is often and doesn’t concern only the woman or the man, but the couple as a whole. According to statistics, 12% to 18% of couples encounter some sort of difficulties associated with conception.

A couple is considered as subfertile when they have regular sexual intercourse without taking protection and have not achieved pregnancy during:

• 12 months if both of them are younger than 35
• 6 months if only the woman is older than 35

This doesn’t necessarily mean that these couples will be in need of assisted reproduction treatments. However, it is recommended that they visit a gynaecologist in order to discuss, get informed and undergo the necessary examinations.

What are the causes of infertility?

In order to investigate the causes of infertility, we should not focus only to the woman or to the man, but to both of them, i.e. to the couple.

According to statistical data of HFEA (Human Fertilisation & Embryology Authority), the causes of infertility are the following:

• Male infertility: 29.8%
• Female infertility: 28%
• Multiple factors (both male and female): 10.3%
• Unexplained infertility in the remaining cases not attributed to a specific reason

Fertility tests for women

The main examinations for evaluating fertility on women are:

• Hormonal exams
  At the beginning of the cycle a test of the FSH, LH and oestradiol levels help us evaluate the proper function of the ovaries. At the 21st day of a 28- day cycle a progesterone test takes place in order to evaluate ovulation. According to the patient’s history, tests of the function of the thyroid gland, prolactin and androgen tests may also be given.
• ΑΜΗ
  AMH (Anti Mullerian Hormone) is produced by the primordial follicles and is indicative of the remaining ovarian reserve. The level reduces gradually as a woman grows older. ΑΜΗ can be measured at any day of the cycle.
• Ovulation tests
  Women with regular cycle between 26-28 days ovulate in 90% of cases. Women with cycles longer than 35 days and shorter than 25 days, usually have ovulation problems. Evaluation of ovulation can be accomplished with the ovulation test, sonographic examination, measurement of the level of progesterone in the blood and other natural methods (e.g. taking body temperature).
• Ultrasound
  Gynaecological ultrasound is used for the examination of the morphology of the uterus and the number of follicles in the ovaries. Moreover, pathological cases like fibroids, hydrosalpinx, endometriosis and congenital anomalies of the uterus that affect fertility, can also be diagnosed via gynaecological ultrasound.
• Fallopian tube patency test
  Fallopian tube patency examination is performed via a hysteronsalpingo-graphy that is a radiologic examination of the uterus and the tubes with the use of a radiographic contrast medium. It can be also performed via a hysteronsalpingo-foam sonography that is a sonographic examination of the tubes after the use of a special foam gel. The test is performed in order to find out whether the fallopian tubes are open and to asses that the uterine cavity is normal.
• Laparoscopy
  Αποτελεί μια χειρουργική επέμβαση που επιτρέπει την άμεση εξέταση και τον πλήρη έλεγχο των εσωτερικών γεννητικών οργάνων της γυναίκες (ωοθήκες, μήτρα, σάλπιγγες), αλλά και άλλων ενδοκοιλιακών οργάνων (έντερο, ήπαρ, χοληδόχος κύστη κλπ.) προκειμένου να ανιχνευθεί και να αντιμετωπισθεί πιθανό πρόβλημα. Η λαπαροσκόπηση είναι το τεστ εκλογής για τη διάγνωση και τη θεραπεία της ενδομητρίωσης.
• Hysteroscopy
  It is a surgical operation that allows for the direct examination of the cavity of the uterus. Potential polyps, fibroids or adhesions can be detected and removed hysteroscopically.

Fertility examination for men

Male fertility is rather simple to assess. Most of the times, it takes only one type of examination i.e. sperm analysis of at least 2 samples between a period of 20-30 days. Sperm analysis evaluates the number of sperm, mobility and the percentage of sperms that have abnormal morphology. More specialized examinations are applicable when the sperm analysis is abnormal.