INFERTILITY DIAGNOSIS Article · 14 March 2022

It is been a year and there is still no pregnancy – fertility diagnostics

Infertility can affect anyone, including you! You think, how?! I am young, I feel good, I care about myself … I have control over my life. Nobody expects infertility, and yet it affects about 1.5 million Polish couples every year. Its a lot!

fertility diagnostics

Infertility can affect anyone, including you! You think, how?! I am young, I feel good, I care about myself … I have control over my life. Nobody expects infertility, and yet it affects about 1.5 million Polish couples every year. It’s a lot!


There comes a moment when two people decide to become parents. They start to try for a child and plan a life together. When the following months have no effect, and pregnancy tests invariably show one line, the question arises: “Why can’t we get pregnant?” This is more or less the story of most infertile couples. Suddenly, healthy people, convinced of their reproductive capabilities, discover the reality of patients suffering from chronic disease. Months pass and you do not get pregnant? Sometimes medical support is needed to make a child’s dream come true. Do not hesitate, start diagnostics for fertility!


When to start fertility diagnostics?


As soon as possible! Time is to your disadvantage. The red light should light up when after a year of regular intercourse without using contraceptives it was impossible to get pregnant. Then, it is worth consulting the problem with a specialist in the field of infertility treatment and performing diagnostic tests. If a woman is over 35, she should react faster! Ladies from the age group 35+ should perform fertility tests after 6 months of unsuccessful attempts to become pregnant.


What are the most common causes of infertility?


There are many causes of fertility disorders. Statistically speaking, the problem of infertility applies equally to men and women. The most common causes include:


  • Ovulation disorders
  • Hormonal disorders
  • Low ovarian reserve
  • Endometriosis
  • Tubal obstruction
  • Anatomical defects
  • Incorrect semen parameters


Determining the cause of infertility is the basis for starting treatment. You must know that this is neither a quick nor a simple process. Diagnosis of infertility requires a lot of research and involvement of specialist doctors from various fields of medicine. Fortunately, current knowledge and advances in medicine enable effective diagnosis and treatment of infertility.


It is worth mentioning here that in about 20% of cases it is not possible to clearly determine the cause of fertility problems. This so-called idiopathic infertility. It is not caused by a specific disease or disorder. On the contrary, the test results do not show any abnormalities that could indicate problems with conceiving a child. In this case, specialists focus on solving the problem of non-pregnancy, not on finding the cause. If idiopathic infertility lasts more than 2-3 years, the Polish Gynecological Society recommends the use of assisted reproduction techniques (insemination, in vitro).


Diagnostics first!


Infertility diagnostics always applies to both partners! For an infertile couple to undergo appropriate therapy, they must first undergo comprehensive diagnostics. The idea is to determine what causes her problems with conceiving a child. Therefore, already during the first contact with an infertile couple, the doctor tries to get as much information as possible about the health of both partners. He talks with them about past illnesses, medications taken, asks about diet or type of work performed. In addition, the doctor gets acquainted with the results of tests (if the couple has already started diagnostics) or orders another – e.g. blood counts, hormonal tests, ultrasound of reproductive organs, basic or extended sperm tests. The course of diagnosis depends, of course, on the individual situation of the couple.


Male factor


A basic element of male infertility diagnostics is sperm analysis, which includes:

  • basic diagnostics, which determines the physico-chemical parameters of sperm, assesses concentration, motility, morphology and sperm viability,


  • MAR test, i.e. testing for the presence of sperm antibodies on the surface of a sperm. The presence of anti-sperm antibodies can cause agglutination of spermatozoa, reduce their motility and viability, and also prevent sperm from entering the cervical mucus, preventing fertilization,


  • SCD test, i.e. examination of the structure of sperm chromatin. This test is used to assess the extent of DNA damage to sperm. Damaged sperm DNA reduces the chance of fertilization. It also causes abnormalities in the early stages of embryo development and increases the risk of transmission of genetic defects to a child and miscarriages,


  • semen culture, which is used to detect the presence of bacteria and fungi in the semen.


If necessary, the doctor may recommend further diagnostics, which include, among others:

  • physical examination, consisting of examining the penis, testicles and scrotum. It is performed to determine if a man has any anatomical abnormalities that could reduce fertility,
  • USG, which helps detect, among others varicose veins of the spermatic cord,
  • hormonal tests,
  • genetic tests,
  • immunological tests.


Female factor


The scope of infertility diagnostics in women is definitely wider than in men.


Basic diagnostics includes:

  • medical interview,
  • gynecological and ultrasound examinations,
  • whose task is to detect possible anatomical defects within the uterus, ovaries and fallopian tubes.


The doctor also orders tests:

  • analytical and hormonal tests,
  • including AMH – ovarian reserve examination, TSH, prolactin, anti-TPO antibodies, FSH, LH, estradiol, morphology, urine tests,
  • monitoring your menstrual cycle.


If necessary, the doctor may recommend further diagnostics, including:

  • sono-HSG, so-called ultrasound hysterosalpingography, is used to detect possible irregularities in the structure of the uterus and obstruction of the fallopian tubes,


  • diagnostic hysteroscopy, that is, an examination of the uterus that allows a precise assessment of its interior in the conditions of a gynecological office,


  • laparoscopy – a commonly used diagnostic and surgical method for assessing abdominal organs. During laparoscopy, it is also possible to perform gynecological procedures,


  • endometrial scratching,


  • genetic testing,


  • immunological testing.


How to choose a fertility clinic?


The choice of the clinic is a very important stage in the infertility treatment process. In Poland, there are several dozen facilities dealing with infertility treatment in various areas. It is therefore worth considering which center will provide you with the best care. Where to start?


The choice of the clinic is a very important stage in the infertility treatment process. In Poland, there are several dozen facilities dealing with infertility treatment in various areas. It is worth considering which, First of all, answer the question, what is the most important for you: treatment costs, clinic location, offer, experience, quality and effectiveness of treatment? Then analyze what the clinic has to offer. Do research on the Internet (there are many forums where infertile couples exchange advice and opinions about clinics and the course of treatment). Perhaps there is a couple in your environment who already have experience in this field. There is probably no more reliable and credible source of knowledge on this subject.


What to pay special attention to?


Diagnosis and treatment is best carried out in a specialized infertility treatment center. Choose the one that has many years of experience, a comprehensive offer and laboratory facilities to enable full diagnostics and treatment with the latest methods. It is also important that specialists and physicians in reproductive medicine (gynecologists, endocrinologists, urologists, embryologists, androologists, immunologists, geneticists and a psychologist) are available on site in the clinic. Time for the first visit! The scope of work of the infertility treatment clinic is very wide and is not limited to performing in vitro procedures. The couple who are taken care of by a specialist facility is covered by detailed diagnostics and, if necessary, treatment. Before a proposal is made about in vitro fertilization, the doctor always tries to use all possible solutions. In vitro is reached as a last resort – when the applied methods of treatment do not bring results.


First visit to the fertility clinic


For many couples, the first visit to a fertility clinic is associated with tremendous stress. To minimize this tension, prepare for your visit accordingly. The problem of infertility can result from both the female and male factors. Therefore, it is important for the doctor to be able to have a medical history of each partner at the first visit.


In order for the visit to run smoothly and be valuable, remember the history of your efforts, tests and treatments carried out so far. Take the current medical documentation (tests results, hospital discharge, etc.) with you to visit.


Medical interview


During the first visit, the doctor conducts a detailed medical history. The questions may relate to:

  • menstrual history (date of first menstrual period, date of last menstrual period, regularity of cycles)
  • for how long are you trying to conceive
  • used contraceptive methods
  • frequency of sexual intercourses
  • previous pregnancies (if any)
  • your state of health and the medicines you take,
  • lifestyle (stress, alcohol consumption, smoking)
  • history of chronic diseases,
  • previous infectious, cancer and gynecological diseases,
  • previous operations, especially in the genital area,
  • cases of infertility and birth defects in the family.


Course of visits


First, the doctor will conduct a medical history and perform a gynecological and ultrasound examination. It will also analyze the history of previous treatment. Then, based on the information obtained, it will assess your health and discuss the possibilities of additional diagnostics and treatment methods. The first visit is also a great opportunity to ask your doctor questions and clarify any doubts.


Feritlity testing


Determining the causes of infertility requires conducting the necessary tests. The basic fertility test for women is AMH and sperm testing for the partner. Testing the concentration of AMH, i.e. the level of anti-Mülller hormone, allows you to accurately determine the state of female fertility and the state of the eggs. On this basis, you can consciously plan the moment of trying for a child, as well as choose the appropriate method of treatment in case of problems with pregnancy. Ovarian reserve assessment also signals the problem of premature ovarian failure and allows predicting the time of entry into menopause.


AMH should be done by women over 30, and sometimes they are also ordered for women over 20. This is due to the fact that increasingly younger women have a fertility problem. Although the decrease in AMH level with age is a natural phenomenon, it is not to such a drastically low level and not on such a scale as we are observing now.


– This test should be done by every woman at least once in her life. Ovarian reserve assessment allows you to recognize the problem of premature ovarian failure, so it is able to protect us from a situation in which we decide to have a baby too late. The test also allows for quick diagnosis of the problem, and thus the implementation of appropriate treatment – explains Dr. Dariusz Mercik, specialist gynecologist, endocrinologist at the Gyncentrum Clinic.


Semen analysis


The semen analysis is the basic examination assessing a man’s fertility and necessary in case of problems with getting pregnant. Doctors recommend taking a seminogram usually after about 1 year of fruitless efforts for a child. In the so-called seminological examination semen quality is assessed according to criteria proposed by the World Health Organization (WHO). The semen analysis consists of two stages. In the first, the male ejaculate is subject to andrological macroscopic evaluation. It includes such parameters of the donated sperm sample as: volume of ejaculate, liquefaction time, color and smell, viscosity and pH. The second stage, i.e. microscopic evaluation, determines the total sperm count in sperm, in 1mm, motility, viability and structure (morphology).


Basic semen testing is done using CASA (Computer Assisted Semen Analysis) technology. Semen is analyzed in cooperation with an automatic computer system SCA (Sperm Class Analyzer). To assess oxidative stress in semen, a very accurate and fast MIOXSYS test is used. Oxidative stress is currently one of the most important factors of male infertility. It is based on an imbalance between the amount of free radicals (harmful products of metabolism) and the body’s ability to remove them. MIOXSYS allows you to evaluate this ability.


Further analysis for semen evaluation is enabled by the MSOME test, which tests sperm at an magnification of 6000-8000 times and the SCD test. The study of sperm DNA fragmentation, however, allows you to assess damage to their genetic material. This is a very important parameter because the presence of any abnormalities in the germ cell DNA significantly reduces the chance of fertilization, and also increases the risk of pregnancy loss and the birth of a child with a genetic defect.


– The quality of semen changes over time and under the influence of various external factors (stress, illness, diet, stimulants, low physical activity, harmful factors related to work, etc.). Therefore, sperm diagnosis should be based on several results obtained. A single sperm test result does not entitle the patient to be classified as infertile – emphasizes Dr. Biol. Wojciech Sierka, senior clinical embryologist of ESHRE, specialist at Gyncentrum.


Cycle monitoring


Its purpose is to accurately determine the date of ovulation so that the couple can have sex at the time when fertilization is most likely. Such monitoring involves observing the maturation process of ovarian follicles in the ovaries. It does not guarantee success, but it significantly increases the chances of conceiving a child naturally.


Hormonal therapy is often helpful


Hormone therapy is primarily used in women whose fertility problems are the result of menstrual cycle disorders – the cycles are irregular or anovulatory, or corpus luteum failure has been diagnosed. The clinic also offers hormone therapy to women diagnosed with endometriosis or thyroid disease. The purpose of hormone therapy is to restore the proper level of hormones in the body. Such therapy can last up to several months, and hormones are taken in the form of tablets or injections, most often for self-injection. It is also worth mentioning about men in whom the wrong level of hormones can disrupt spermatogenesis, i.e. the process of sperm formation and maturation. Men’s hormonal disorders are most often the result of hypothalamic-pituitary failure. Just like women, they are treated pharmacologically by supplementing with missing hormones.


Sometimes surgery is necessary


Endometrial polyps, intrauterine adhesions, uterine septa, fibroids – these are just some of the possible causes of infertility. In most cases, these conditions require surgery. Fortunately, thanks to the intensive development of endoscopy, minimally invasive techniques, e.g. hysteroscopy or laparoscopy, are used to remove this type of lesion. They are able not only to diagnose pathologies within the reproductive organs, but also to remove them.


Consultation with a psychologist


Trying for a child can cause a lot of stress, especially when it lasts for months or years. At first, the couple are optimistic about the matter. However, when subsequent attempts to conceive a child prove no success, doubt and anger come. Close-ups no longer bring so much satisfaction. There is helplessness, sadness and regret. Partners have reduced self-esteem and blame themselves for failures. Most often, however, they do not realize how important their mental state is when seeking a child. The more pressure they exert on them, the harder it will be for them to conceive a child. In such situations, they can use the support of a psychologist who will help them deal with negative emotions. After a series of meetings with a psychologist, the couples regain their mental balance and finally manage to wait for the longed-for offspring.


Change of diet frequently solves the problem


I guess no one needs to be convinced of the existence of a relationship between diet and fertility. A rational, properly balanced diet not only ensures well-being, but also supports the proper functioning of the reproductive system. Deficiencies of vitamins and minerals impair reproductive processes, including spermatogenesis and oogenesis, fertilization and normal embryo development. However, a dietitian can help an infertile couple compose a menu that will promote their fertility and increase their chances of having a child.


Have you been trying for a child unsuccessfully for over a year? Do not hesitate to visit a reproductive medicine specialist! The sooner the cause of infertility is diagnosed, the sooner your dream of a child will come true. Specialist infertility treatment centers have a lot to offer infertile couples, and in vitro fertilization is not the first method to be used. Before an in vitro decision is made, the clinic tries to exhaust all available methods. The couple meet with many specialists, undergo a series of tests, receive pharmacological treatment or minimally invasive surgery. Only when it does not help, the attending physician proposes the use of such methods as intrauterine insemination or in vitro fertilization (in vitro).