Infertility Investigation

Female Evaluation

The evaluation of female fertility must be done according to the age group, considering the fact that the older the patient, the greater the difficulty in becoming pregnant. Thus, women up to the age of 28 years should begin investigation after a spell of one year trying to conceive with no success. Between the ages of 29 and 35 years, investigation must begin after 6 months trying with no success, and from this age on, three months should be the maximum waiting time.

The main causes for female infertility are:

Ovulatory dysfunction:

This is one of the most common reasons for female infertility. Total absence of ovulation may occur or an irregular ovulation, followed by the absence or irregularity of menstruation. One known cause is the Polycystic Ovary Syndrome, where the eggs are retained in the ovaries forming micro cysts which may be seen through ultrasound scanning.

How to research?

  • Hormonal dosage, including thyroid hormones.
  • Transvaginal ultrasound scanning.

Abnormalities in the fallopian tubes:

The tubes may be damaged or blocked (partially or totally) hindering or deeming it impossible for the sperm to meet the egg.

How to research?

  • Evaluation of the permeability of the tubes through exams: hysterosalpingography, or in some cases through videolaparoscopy.

Abnormalities in the cervix mucus:

During the ovulation period, there is a production of mucus in the cervix which helps the passage and survival of the sperm, enabling them to reach the egg and fertilize it.

How to research?

  • Observing the mucus during the ovulation period and analyzing:
  • The interaction between mucus and semen.
  • Collecting cytology material to search for any infection.
  • Through video-hysteroscopy, with analysis of mucus.
  • Searching for any alteration in the mucosa which covers the cervix and produces the mucus.

Anatomical abnormalities of the uterine cavity:

Some pathologies such as myomas and polyps may alter the uterine cavity hindering pregnancy.

How to research?

  • Transvaginal ultrasound scanning.
  • Video-hysteroscopy.

Endometriosis:

Endometriosis occurs when the cells of the endometrium (the layer which lines the uterine cavity and produces the baby’s “nest”) become implanted in the pelvic region, close to the tubes and ovaries. This results in anatomic abnormalities and inflammation which hinders pregnancy.

How to research?

  • Videolaparoscopy.

Male Evaluation

Importance of the exam

In 60% of infertility cases, abnormalities may be found in the man, more specifically, in the semen. It is necessary to perform a spermogram in order to determine the shape, number and degree of sperm motility.

After adequate examination, the physician may solve or counsel a great deal of couple infertility cases that come to the office. Even though the exam is not a complex one, it requires extreme care. As a result, few laboratories are prepared to do them correctly.

Spermatic Capacitation

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For the exam, a small amount of semen isexamined in special counting chambers under the microscope.

The semen laboratories inside fertility clinics usually include spermatic capacitation in the seminal exam which consists in separating the sperm with rapid progressive motility.

Sperm are classified according to motility into four different types: those with rapid directional motility (type A), those with no specific direction or low directional motility (type B), sperm that move but go nowhere (type C), and finally, those that do not move at all (type D). The only sperm capable of spontaneously fertilizing the egg are the type A. These are able to reach and penetrate the egg, thus fertilizing it.

 

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Spermatic capacitation is a preview of what will be done during the couple’s treatment in case Assisted Reproductive Technology (ATR) becomes necessary. This exam informs the physician which technique will be employed depending on how many types A sperm are found and collected from the fresh semen. The retrieved sperm are placed in a nutrient culture medium similar to the fluid found in the fallopian tubes. This culture is incubated under adequate conditions, similar to those in the human body, when it becomes possible to verify the sperm’s life expectancys.

What precautions must be taken with your exam?

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Semen collecting, for most men, is an embarrassing experience. With this in mind, Vida – Centro de Fertilidade sets up a discreet location that provides the necessary comfort for the patient.

When scheduling the exam, the patient is asked to abstain from sexual intercourse between 2 and 7 days. Respecting this interval is important since it represents the habitual period between intercourses in most couples. Futhermore, collecting a specimen within 24 hours since the last sexual relation reduces the number of sperm, whereas a spell of more than seven days may increase the number of immobile or dead sperm.