Infertility, according to the definition of the WHO (World Health Organisation) and the ESHRE (European Society for Human Reproduction and Embryology), is “a failure to achieve a clinical pregnancy after twelve months or more of regular unprotected sexual intercourse”.
For women under 35, we should consider the problem of conceiving infertility after trying for approximately one year. Unfortunately, the infertility rate among women has increased over the last few years, given the fact that women has postponed childbearing further and further.
We consider it to be normal if a woman takes up to one year to get pregnant. This may seem a long time, but this is the reality as seen in fertility studies.
One of the determining factors in women’s fertility is age. At the end of the first year, between 80% and 90% of women under 35 has achieved pregnancy. However, between 35 and 40 years, at the end of the first year, the percentage of pregnant women does not exceed 70%. When the woman is over 40, this percentage further decreases to 20%. When a woman exceeds the amount of time mentioned above, we can speak of the existence of feminine infertility and a specialist should be consulted.
The difference between ‘sterility’ and ‘fertility’ can be explained by the fact that in the first case, the woman has never achieved pregnancy. On the contrary, a patient suffering from infertility can or cannot achieve pregancy, but this pregnancy has not ended in a live child being born (as is the case for example with repeated miscarriages).
Infertility and sterility are two terms that even thoughthey might have the same result -the couple is unable to have a baby- they are completely different and the causes and treatments are, too.
This is not the same problem, and although in both cases you do not have a baby, the causes are different. In fact, the studies and treatments for each case are completely different.
Generally, a couple has a 25% chance of achieving pregnancy each month they try. After 6 months, 60% of couples has achieved pregnancy and this percentage increases to 80% after a year.
Therefore, it is recommended to consult a specialist in assisted reproduction if pregnancy is not achieved after one year of unprotected sexual intercourse.
In general, a woman who has tried to get pregnant during one year (obviously, having sexual intercourse with a certain regularity) without achieving this, should initially ask her gynaecologist for advice. If the woman is over 35, it is recommended to see her gynaecologist after 6 months of trying to achieve pregnancy.
The causes of infertility vary greatly; it is estimated that approximately 40% is due to a fertility issue in women, another 40% to infertility issues in men, and the final 20% to mixed issues.
The right doctor to assess, diagnose and treat infertility is a gynaecologist specialised in Reproductive Medicine. After a detailed clinical history, in the majority of cases a basic fertility study is carried out, or if the diagnosis can be clearly deducted from the clinical history, other complementary tests can be done.
A physician specialised in Reproductive Medicine will be the indicated person to determine the causes of the infertility or sterility and conclude if this is a problem of the woman, the man or a mixed problem. Once diagnosed, he will prescribe the most adequate treatment, based on the detected causes of infertility or sterility.
At AMNIOS we offer you a basic fertility study in which we analyse, in a single visit, all elementary factors that are needed to produce a pregnancy.
Through transvaginal ultrasonography we check on any abnormalities of the internal female reproductive system. With this ultrasound, we study the morphology of the uterus (to discard many uterine malformations, or the existence of endometrial hyperplasia, myoma, etc.); the ovaries are also visualised (size, characteristics, presence of ovulation if the ultrasound is carried out in the middle of the menstrual cycle, etc.).
Through this analysis, we can detect specific diseases or different types of cysts, some of which (like endometriosis) can negatively affect fertility.
Furthermore, the ultrasound allows us to determine the number of antral (or secondary) follicles, in which the egg cells are located, and thus obtain information about the ovarian reserve.
Hormonal determinations in the fertility study are done at two points of the cycle: day 2-3 of the cycle and day 19-20. The levels of ovarian and pituitary hormones undergo a series of changes throughout the woman’s cycle and in order to determine if these are normal or not, they should be measured at the same times to compare them. Normally we measure the Follicle Stimulating Hormone (FSH), the Luteinizing Hormone (LH), prolactin and the Thyroid Stimulating Hormone (TSH). The tests done in the first days of the cycle allow us to obtain information about the ovarian reserve. The hormones studied on day 21 of the cycle allow us to know if ovulation is produced or not.
This test also allows us to detect some anomalies like Hyperprolactinaemia.
The semen analysis is a very simple test through which we carry out a basic analysis of the semen. Fundamentally the following parameters are measured: number of sperm cells, mobility and the percentage of sperm cells with morphological anomalies.
With the results of these tests we are able to determine the cause of the infertility in approximately 80% of couples. At the same time, this simple study allows us to orientate the couple towards the most adequate assisted reproduction treatment for their case.
In other cases, complementary tests may be necessary before initiating a treatment.
In case the results of the previous tests -which we consider routine or common for all patients- were not concluding, the study continues through realisation of different types of complementary tests. The variety of complementary tests is huge. Many of these are very complex and specific tests that are only used for diagnosis of few cases.
Usually, physicians prescribe these complementary tests according to the clinical situation of the patients and based on the needs and circumstances of each individual case, due to the detection of a specific pathology or to clarify the result of a basic study.