What types of examinations are carried out in a sterility study?

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What are the basic, common examinations?

The diagnosis consists of looking for the causes of the sterility in both members of the couple, as the analysis of only one of its components may be insufficient to issue a diagnostic orientation. These tests form part of a protocol that, once concluded, allows the specialist to orient the diagnosis and the possibilities of pregnancy with respect to the proposed treatment.

The first step in the first visit is to draw up a detailed clinical history, taking into account personal and family background, as well as those environmental or work factors and toxic habits that can influence fertility.

We will also carry out a basic blood analysis on both members (group and Rh factor, biochemical and coagulation, serology to rule out infectious diseases…)

What are the examinations for the woman?

  • Basal hormonal study: a blood analysis for ovarian and hypophysary function is carried out. It should be done at the start of the cycle, ideally on day 3 of the menstrual cycle.
  • FSH, Estradiol: LH: Progesterone: These hormones are produced by the hypophysis or pituitary gland (FSH, LH) or by the ovaries (estradiol,progesterone). According to the day of the cycle when they are studied, they will give us different information, but for the basic study it is necessary to study FSH, LH and estradiol between days 3 and 5 of the cycle.
  • Transvaginal ultrasound: Ultrasound examination providing vital information on the morphology of the uterus and the ovaries and allows us to see the changes to the ovaries and the endometrium during theovarian cycle.
  • Hysterosalpingography: This is a radiological test involving a contrast liquid being injected into the neck of the uterus and which allows us to evaluate the uterine cavity and the permeability of the Fallopian tubes. A blockage in both tubes would impede the process of natural fertilisation. This test is carried out after menstruation has finished but before ovulation. It is a very important test especially before artificial insemination is carried out.
  • Hysteroscopy: A hysteroscopy is an endoscopic examination where an optical tube is inserted through the neck of the uterus in order to visualise the uterine cavity (hysteroscope = mini camera), and provides a direct and precise view of both the cervical canal and the inside of the uterus.The hysteroscopy is carried out in order to diagnose possible alterations to the inside of the uterus and in some cases it explains why the embryos do not attach to the uterus, or the reason for repeated miscarriages.
  • Biopsy of the endometrium: This is carried out by the aspiration of the endometrial mucous using a tube which is inserted unto the uterus via the cervical canal. It is sent to the laboratory and studied to see if there are any infections or anomalies of the endometrium.
  • Karyotype: This can reveal chromosome anomalies and explain the sterility or infertility. It is done from a blood analysis.

What are the examinations for the man?

  • Seminogram (analysis of the semen): Due to its simplicity, this is the first test carried out on the couple.The seminogram evaluates the production of sperm in the seminiferous tubules of the testicle. In the seminogram the parameters of quantity (concentration), quality (motility) and morphology are studied.
  • Capacitation test (or MTC): This is a study which is complementary to the seminogram and consists of “washing away” all the fluids and substances from the semen and leaving only the sperm, which are then put in a medium rich in nutritional substances. The number of motile sperm obtained (MSC) in this test allows us to know how many of them will be viable for the Assisted Reproduction techniques.
  • Bacteriological and biochemical examinations: A more detailed examination (semen culture or blood analysis) to detect infections which alter the quality of the semen.
  • Testicular biopsy or epididymal punction: These techniques are used to collect the sperm found in the testicles. They are used when the semen cannot be obtained by ejaculation.
  • Hormonal: Used to detect anomalies in the hormone levels using blood analysis (FSH, LH, testosterone).
  • Karyotype: This can reveal chromosome anomalies or damage and thereby explain the sterility or infertility.

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