On many occasions, and erroneously, two terms that are different concepts are used synonymously: infertility and sterility. Thus, sterility is defined as the inability to conceive a baby, i.e. to fertilize. Infertility, on the other hand, is the ability to carry a pregnancy to term, as may occur in cases of repeated miscarriages.
In the first consultation, a clinical history of the patients is completed, taking into account age, history of previous pregnancies (or with previous partners), possible hereditary diseases and consanguinity, and history of gynecological pathology. The characteristics of menstruation, whether there is intravaginal ejaculation and the frequency of sexual intercourse are also analyzed. In the male, toxic habits, occupational history, medications, and medical and surgical history are studied.
What tests will be performed to study a possible case of infertility?
As for the medical tests, they will depend on the situation of each case. In the case of women, fertility decreases over the years, and the fertile capacity can be studied through the concentration of anti-Müllerian hormone (AMH). For this reason, patients undergo a blood test to determine their level of this hormone, which is the best option to determine their real ovarian age. The results are compared with the values of anti-Müllerian hormone established as normal for each age range. Thanks to a study we carried out at Institut Marquès, we can now compare the results of the analysis performed on patients with a table based on values for the Spanish population. An ultrasound is also performed during the first visit.
On the other hand, at Institut Marquès, specialists in Assisted Reproduction, we have an Andrology service and we perform an examination to all our male patients. The first test performed is usually a semen analysis.
When will it be considered a real fertility problem, and how can it be treated?
It is considered that if a couple, after a year of unprotected intercourse, is unable to get pregnant, either the man or the woman may have a fertility problem.
It is necessary to make a diagnosis and determine if ovulation does not occur or if the oocytes are not suitable (capable of giving rise to an evolving embryo); if the semen is fertile, that is, if it contains spermatozoa capable of reaching from the vagina to the tubes and fertilizing the oocyte; if the tubes are capable of transporting and nourishing the gametes (oocytes and spermatozoa) and the embryo; if the uterus is capable of receiving the embryo; whether the tubes allow the transport and nourishment of the gametes (oocytes and sperm) and the embryo; whether the uterus is able to receive the embryo; or whether the embryos have the appropriate genetic endowment to develop.
Once the diagnosis is determined, treatment is prescribed or alternatives to achieve pregnancy through Assisted Reproduction techniques are proposed.
How to find out if it is a male or female problem?
When a couple has difficulties in achieving pregnancy, in more than half of the cases the male factor is involved. This is very important since the male is often “the great forgotten one”.
At Institut Marquès we are experts in male factor and we give great importance to the study of male infertility. To this end, in the Andrology Department we carry out a diagnostic visit.
The first tests that are requested to couples with infertility problems are: ultrasound, hormone analysis, seminogram and tubal test. Based on the results of these tests, treatment or additional tests will be ordered.
If these tests are normal, the morphology of the oocytes, the quality of the embryos and the fertilization rates of the semen will still need to be studied. Based on the results of these tests, a diagnosis will be made.
How to deal with fertility problems and help parents in their desire to conceive?
Knowing that there is a fertility problem can generate in the couple a setback in their lives, which can cause emotions and symptoms to appear that compromise individual and social well-being, self-esteem and the couple’s relationship. In some cases, professional psychological support may be necessary to face with guarantees each of the stages related to the processes of Reproduction: to become aware that there is a problem and to detect it; to face the diagnosis established by the specialists and to follow the treatment, all this with minimum levels of stress and/or anxiety.
To help our patients during the treatment we advocate personalization and accompaniment at all times. Our principles include transparency and the effort to always offer an excellent service tailored to each person. For our international patients we have a team that attends and accompanies them at all times in their language. We have also implemented advances such as the embryomobile to follow the development of embryos online and the Freezekit so that patients do not have to travel to the clinic to leave their semen sample. In addition, in our clinics, the semen sample collection rooms have been adapted to be comfortable, fun and suggestive. We also want to take care of the male during this process. We have personalized the moment of embryo transfer and all our facilities have been designed to make our patients feel at home.