Frequent questions
Here you can find the answers to the most frequently asked questions of our patients with regard to infertility and reproduction.
1.— What is sterility? And infertility?
2.— When to consult a specialist in reproduction?
3.— What could be the cause of sterility?
4.— What is a reproduction assisted clinic?
5.— What happens during the first consultation on sterility?
6.— Further consultations
7.— Laboratory tests involving the male member of the couple
8.— Tests involving the female member of the couple
9.— Selecting the adequate Reproduction Assisted Treatment (RAT)
1.— What is sterility? And infertility?
Primary Sterility:
When a couple, having sex on a regular basis through one year without using contraceptive methods, but does not conceive (OMS).
Secondary Sterility:
When a couple after having their first child does not succeed in conception again in the next two or three years without the use of contraceptive methods.
Primary Infertility:
Although a couple succeeds in conception, does not succeed in giving life to a new-born.
Secondary Infertility:
When a couple after pregnancy and childbirth with no complication, does not succeed in conception again and does not succeed in giving life to a new-born.
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2.— When to consult a specialist in reproduction?
If after having tried to conceive in a period of one year, provided of course that the couple had sex on a regular basis (2-3 times a week) during this period without the use of any contraceptive method, and does not succeed, it is advisable that they consult a specialist in reproduction. As the age of the woman can influence her fertility in a negative way, if she is more than 37 years old, the couple should not wait more than 6 months before consulting a specialist.
It is estimated that 15% of the couples during their age of fertility have problems with sterility. According to epidemiological data, there are 600.000 or 700.000 couples in Spain who will need certain therapies or assisted reproduction treatments to become pregnant.
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3.— What could be the cause of sterility?
It’s reckoned that 40% of the causes originate from the masculine side: mutation in the sperm, obstruction in the deferent duct, prostatic pathology, alterations in the ejaculation or the erection, etc… Another 40% originate from the female side: ovarian disorder, endometritis, obstruction in the fallopian tube, ovulation problems, etc…In regard with their origin, 10% of the causes are mixed or combined and another 10% of them are unknown..
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4.— What is a reproduction assisted clinic?
It’s a medical centre specialized in diagnostic methods and reproduction treatments, where you can meet a team of highly qualified specialists and with the most modern technology. With fertility problems one should consult with a gynaecologist specialized in this particular field, because the studies of sterility are very complex and require certain tests that are not performed during a conventional gynaecological examination.
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5.— What happens during the first consultation on sterility?
During the first consultation a most detailed medical record is prepared in order to map one’s antecedents and those of the partner as well. At the same time, the environmental and labour factors also have to be taken into account, for example lifestyle, possible exposal to toxics, etc. … which can also be the reason for sterility..
A clinical examination will be carried out on both members of the couple, in order to verify the normal function of their genitals.
With the help of the obtained data the doctor will prepare an initial evaluation of the case and will request the necessary additional tests (hormonal examination, semen analysis, karyotype, etc) to be done in order to finalize the diagnosis. Each case is different and always personal. Therefore it could happen that in certain cases some tests that are usually included in the normal procedure are not necessarily implemented, while other cases require further, more specific testing.
In many cases when the couple has already possessed the result of some examinations, it’s advisable to bring them along to the first consultation, as they can help to focus on the problem and also to accelerate the establishment of the diagnosis. Furthermore this way no examinations are carried out repeatedly, therefore unnecessary.
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6.— Further consultations
Once the couple have the results of all the tests requested by the specialist, a second consultation will take place, where based on these test results the doctor can advise the couple which treatment to undergo, or can request further tests to get an even more reliable diagnosis..
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7.— Laboratory tests involving the male member of the couple
Semen Analysis (Seminograma):
NNormally this is the first test suggested to be done by the male member of the couple. After a period of 3–5 days of sexual abstinence, the man should produce semen by masturbation and leave it at the Semen Laboratory.
With the help of this test, it’s possible to eliminate or not the existence of a male factor. Therefore it’s advisable, especially if the result was not satisfying, to repeat it again as there are circumstances, like fever or certain drugs, which can affect temporarily and in a negative way the results.
The semen analysis evaluates the production of spermatozoon in the testicle, their activity and shape, also the functioning of the additional glandules (such as the prostate and the spermatocyst) and in a certain way, the normality or abnormality of the deferent ducts.
Semen Capacity or RMS:
A complementary examination to the semen analysis is the Test of capacity or RMS, during which the seminal plasma is eliminated and the retained spermatozoon is left in a medium of culture rich in nutritive. The Recount of the Mobile Spermatozoon (RMS) obtained by this test, reveals the number of those spermatozoon that can be used in the reproduction assisted treatments and thus also helps to select the most suitable treatment.
Complementary examinations:
Depending on the results of the above mentioned examinations and laboratory tests, or the anamnesis of the patient, it could be advisable to perform some of the following tests as well:
- Bacteriological and biochemical examination of semen in search for infection, seminal culture.
- Karyotype in search for chromosomal anomaly and/or genetic analysis
- Serologic to investigate the immune-body.
- Hormone level in FSH, LH, Testosterone, E2, PRL and Inhibin B.
- Biopsy of the testicle.
- Ultrasonography of the prostate.
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8.— Tests involving the female member of the couple
- BASAL HORMONAL TEST: (Estradiol, FSH, LH, PRL).
Evaluation of the condition (normality or abnormality) of the ovarian and hypophyseal mechanism. It has to be performed in the beginning of the menses, between the first 2nd – 4th days.
- POSTCOITION TEST:
It is performed more or less in the moment of ovulation (between the 10th – 12th days of the 28 day long cycle). The couple is supposed to have a sexual act the night before the scheduled consultation. In the clinic a sample of mucus is taken from the cervical canal and it’s observed under microscope. In this way both the quality of the cervical mucus (ovarian mechanism) and the number and mobility of the spermatozoon can be evaluated.
- VAGINAL ULTRASONOGRAPHY:
Examination with supersonic waves which gathers information about the morphology of the uterus, the ovaries and occasionally the tubular pathology. Besides, it facilitates the recognition of the reaction of the ovary and the endometrium during the process of ovulation.
- HORMONAL TEST IN THE SECOND PHASE:
Taking a sample of blood in order to measure the progesterone that is produced by the corpus luteum of the ovary. This test reveals the quality of the process of the ovulation. For example, an abnormal value would indicate the failure of ovulation. This test has to be performed between the 20th – 24th days after the commencement of the menses.
- BIOPSY OF THE ENDOMETRIUM (Biopsy through sampling):
Facilitates the recognition of how the ovulation influences the endometrium. It’s performed by sampling the endometrium through a canula that is inserted into the cervical canal. It has to be performed between then 20 th – 24 th days. At present the application of this type of test is exceptional.
- CLOMIPHENE TEST:
or dynamic test to evaluate the ovarian reserve.
- HYSTEROSALPINGOGRAPHY (HSG):
It’s a radiographic examination through the cervix, applying a contrast medium which let us evaluate the normality of the interior of the uterus and also the penetrability of the fallopian tubes. An obstacle in any of these two would prevent the natural fecundation to take place. It is performed during the 6th – 7th days of the cycle, provided that there is no risk of genital infection.
- LAPAROSCOPY:
It is a surgical intervention with the use of an optical instrument that enables us to have an instant sight of the genital organs by entering the body through the zone of umbilicus. A coloured liquid injected through the cervix facilitates the recognition of the penetrability of the fallopian tubes. Therefore at present it’s considered a complementary method to HSG. In addition, in certain cases this surgical intervention can be used for removing ovarian cysts, uterine myomas and adhesions of the fallopian tube that can all cause sterility.
- HYSTEROSCOPY:
It is also a complementary examination to HSG as it enables us to have an instant sight of the interior of the uterus. The use of an optical instrument through the cervical via facilitate the identification of abnormality and in many cases of their treatment.
- KARYOTYPE:
Examination to diagnose chromosomal abnormality.
- CYTOLOGY AND CULTURE OF BACTERIA:
Examination in order to eliminate the possibility of cervix cancer and also the suspicion of infectious diseases, which would be confirmed by the culture of bacteria.
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9.— Selecting between the Reproduction Assisted Treatments (RAT)
Once the appropriate RAT has been selected, the gynaecologist explains the couple the essence of the treatment, what kind of risks it involves, the expectable percentage of success, and asks for their written approval so that the treatment should legally be able to commence.
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Sterility treatments
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