What is subfertility?
Subfertility is often and doesn’t concern only the woman or to the man, but the couple as a whole. According to statistics, 12% to 18% of couples encounter some sort of difficulties during conception.
A couple is considered as subfertile when it has regular sexual contacts without taking protection and has not achieved pregnancy during:
- 12 months if both of them are younger than 35 years
- 6 months if only the woman is older than 35 years
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 subfertility?
In order to investigate the causes of subfertility, 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 subfertility are the following:
- Male subfertility: 29.8%
- Female subfertility: 28%
- Multiple factors (both male and female): 10.3%
- Unexplained subfertility 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 estradiol 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, an exam of the function of the thyroid gland, prolactin and androgens may also be given.
AMH (Anti Mullerian Hormone) is produced by the primordial follicles and is indicative of the remaining ovarian follicles. 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 have ovulation 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. examining body temperature).
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 which 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 which 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.
This is a surgical operation allowing the direct and complete examination of female internal genital organs (ovaries, uterus, fallopian tubes), as well as other intra-abdominal organs (intestine, liver, etc) in order to detect and treat a possible problem.
It is a surgical operation in order to examine directly the cavity of the uterus via a hysteroscope. 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 with an anomalous morphology. More specialized examinations are applicable when the sperm analysis is abnormal.