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Diagnosis and infertility treatment
The numbers of couples having trouble to conceive are raising every year. Sometimes a change in pace of life, eating habits, quit smoking or a small medical procedure can help. But in some cases it is necessary to undergo a infertility treatment. Statistics show that every tenth child is born this way in Czech Republic.
Infertility is defined as inability to conceive after a one year of regular unprotected sexual intercourse.
Causes of infertility
IN some couples is the infertility caused by just one factor (lowered sperm count, obstructed fallopian tubes). In others the causes are combined. In about 10% of couples it is not possible to determine the cause.
Male (andrologic) factors:
The number of men with worsened sperm count is raising lately.
- Low number of sperm (oligospermia) – less than 15 mil.sperm in one milliliter of ejaculate.
- Insufficient motility of sperm (astenospermia) – a sperm is unable to move towards the egg and fertilize it.
- The wrong shape (morphology) – sperm is unable to go through the eggs shell.
- The absence of a sperm in the ejaculate ( azoospermia) – caused by disorder in production or transport of sperm.
- Problems with intercourse – could be problems with ejaculation or impotence.
- Genetic disorder- disturbances on chromosomal level, cystic fibrosis, …
- Infertility post infections, operations, trauma, oncology therapy, ...
- The ovarian factor (cause in the ovary) – hormonal disorder. Due to this factor the follicles are unable to mature in an ovary and they are not released- ovulation. With higher age (over 35years) the natural reserve of eggs is lowered. Their volume is highest at birth during they are not produced during life time any more.
- Tubular factor – this is a infertility caused by obstruction of fallopian tubes (most often in women with history of gynecological infections or endometriosis) or missing fallopian tubes altogether.
- Endometriosis – presence of deposits of womb lining beyond its usual localization. This can cause obstruction in f. tubes, adhesions, disturb immunological mechanisms and have negative impact on the fertilization process and embryo implantation.
- Immunological factor – presence of immunological antibodies which have a negative impact on sperm motility but also the fusion of cells during fertilization can be disturbed and can have a negative impact on embryo development.
- Genetic disorders – disturbances in chromosomes.
Diagnosis of infertility
Assessment of the fertility of a couple is a progressive process. Detail evaluation and examination of both partners helps to find the cause of infertility followed by a successful treatment. In some cases the diagnosis is simple in others it needs a deeper and more elaborate investigation.
Evaluation of all of results will give your doctor a good idea about the possible cause of the infertility and then he will be able to help and offer a optimal treatment. At the present time we are able to help up to 95% of infertile couples.
Diagnostic methods for women:
Ultrasound of the lower abdomenThe basic examination of a woman is a trans-vaginal ultrasound of the uterus and ovaries considering the menstrual cycle, followed by gynecological examination. The ultrasound exam helps to evaluate the size and shape of the uterus, presence of any fibroids, thickness and quality of the endometrium. It also provides the information about the shape of ovaries, growth of follicles, and presence of cysts or endometriosis.
Hormones levelsThe blood test during first 3 days of menstruation gives the information on the condition of ovaries, their ability to produce mature eggs and potential answer to hormonal stimulation. Levels of The follicle-stimulating hormone (FSH) and luteinizing hormone are looked at. It is possible to determine a level of Anti-Mullerian hormone (AMH) which also informs about the ovarian reserve. A standard part of hormonal profile is a prolactin level (PRL) and thyroid hormones levels (TSH, FT4).
X-ray of uterus and fallopian tubes – hysteron-salpingography HSGX ray test of the uterus allow us to see the shape of the uterus cavity and patency or obstruction of fallopian tubes. Test is done by gynecologist. A special device is inserted in to the cervix and a dye is slowly injected. Its flow is visible on the x-ray.
HysteroscopyThis is a method that enable us to visualize the uterus cavity and perform a small operation within the cavity and the cervix, removal of polyps, adhesions and septum removal. We do this at our clinic using a special optical device of a 2 millimeters gauge thanks to which we can do most of the procedures without general anesthesia.
LaparoscopyLaparoscopy is a diagnostic method used to carefully look into the abdominal cavity and check the fallopian tubes. Laparoscopy belongs to so called minimal invasive surgery methods. Using special devices and techniques it is possible to visualize the abdominal cavity through few small cuts and perform needed surgery without opening the abdomen itself. Laparoscopy is performed for diagnostic or therapeutic reasons.
Genetic examinationThis is a examination of chromosomes that gives us an idea about the genetic profile of both partners. Abnormal findings could be one of the causes of infertility. They could also lead to a failure of the assisted reproduction methods. It could potentially lead to a repeated abortions. In men with pathological findings a failure in sperm development occurs. In those cases the tests for cystic fibrosis is advised which is often present along with those problems. And also a test for pathological micro deletion of the Y chromosome.
Immunological testsImmunological test is a basic part of fertility testing of women at our clinic. Antibodies against sperm, eggs and embryos are detected as well as anti-phospholipid antibodies. Where indicated (repeated miscarriages, repeated failing of assisted reproduction methods) the cell immunity is tested.
Diagnostic methods for men:
- Sperm analysis.
- Sperm cultivation.
- Andrological test.
- Sperm acrozom testing.
- DNA fragmentation of sperm.
- Immunological tests.
- Hormonal tests.