Dr. Hernandez of the FIV Clinic Madrid details the different tests that women and men must undergo to evaluate their fertility. For couples seeking to have a child with help, it is important to know the requirements to begin fertility treatment. If the woman is under 35 years of age, the couple must have been having unprotected sex for two years without achieving pregnancy; and if over 35 years of age, the waiting time is reduced to one year.
The first test to be performed, in the case of a heterosexual couple, is a semiogram that will be performed on the male partner. It is a non-invasive test performed on semen. The results, which are obtained in two hours, will make it possible to know if the cause of the infertility problems is in the male. The microscope analyzes the number of spermatozoa, their motility and motility.
With the same sample the sperm recovery test will be performed, to analyze the semen in a culture medium. If the result of the test is very negative, a testicular biopsy may be prescribed, which requires sedation to extract a small piece of testicle.
This biopsy evaluates whether there is an absence of vas deferens, i.e. the sperm cannot join the semen during ejaculation. It is a test that only 1% of men who consult a fertility specialist undergo.
If these tests attribute the problem of infertility to the man, the ideal option is in vitro fertilization or ICSI, the improved version of this technique, in which the best sperm are selected and, one by one, fertilized with the woman’s oocytes.
When the problem is not in the male
In the event that infertility is not attributed to the male, a blood test is performed on the woman, for which it is necessary to wait until the third day after the arrival of her period. FSH, LH and estradiol are three hormones that allow us to know which stimulation is necessary for in vitro fertilization.
If both this test and the male’s tests are successful and the couple is still unable to have children naturally, then a hysterosalpingogram will be performed on the woman to observe the patency of the fallopian tubes. Performed by a radiologist, it consists of introducing a contrast agent vaginally and seeing by image how it moves through the tubes. The objective is to see if artificial insemination can be performed. After two to four unsuccessful attempts at artificial insemination, in vitro fertilization will be performed, with or without ICSI.
For the woman who comes alone or with a partner of the same sex, the same hormone and permeability tests must be performed to determine whether to resort to insemination or in vitro fertilization with donor sperm. Once the treatment has been decided, the first ultrasound will be done, to observe the number of antral follicles.
This is the end of medical tests for most patients. But there are other tests which, although they provide more information, do not result in an improvement in the diagnosis or in the success of the therapies.
This is the case of karyotype analysis, which tries to locate aneuploidy in embryos already fertilized in vitro and is recommended for women who suffer repeated miscarriages or who do not achieve, for unknown reasons, success with IVF. Other of these tests look for coagulation problems with blood tests of up to 15 variants. There are also in utero implantation investigations, which include a biopsy and analysis of genes that are expressed as the endometrium prepares to receive the embryo.