In Spain, according to a study by the Spanish Fertility Society, it is estimated that almost 15% of couples of reproductive age have infertility problems and that there are nearly one million couples seeking reproductive assistance. Given these figures, it is logical that, when thinking about becoming a mother or father, you may ask yourself something along the lines of “how do I know if I can have children? Infertility affects men and women equally, so both members of the couple should be given an in-depth assessment, which is why in this article we will explain what the different fertility tests available at our clinics consist of.
A fertility problem is said to exist when a couple under 35 years of age has been trying to get pregnant for a year, having had frequent unprotected sex, but has not been able to do so. In this case, a fertility study is recommended. If the couple is over 35 years of age, the recommendation is not to actively seek to get pregnant for more than 6 months, since fertility, especially in women, decreases considerably after the age of 35, and if there is a problem, it is of vital importance to solve it as soon as possible.
Female fertility tests to find out if you can have children
The first step when considering how to know if you are unable to have children is always to have a complete medical check-up to verify if there are ovulation or menstrual cycle problems and the necessary laboratory tests to know your state of health and to assess your hormone levels.
But there are other female fertility and diagnostic tests that help identify possible causes of infertility in women
Transvaginal ultrasound
One of the first tests to be performed is a transvaginal ultrasound. This is an ultrasound (image produced by an ultrasound echo) of the woman’s pelvic area so that the fertility specialist can determine any problems affecting her fertility, such as an abnormally shaped uterus, fluid in the fallopian tubes, or cysts on the ovaries.
If you make an appointment with Eugin, this is one of the tests included on your first visit, where you will also receive a medical consultation with a specialist, as well as an assessment of the medical tests you provide, a medical diagnosis and personalised advice, all free of charge.
Anti-Müllerian hormone (AMH)
In addition to the basic hormonal study of the ovaries with the hormones FSH, LH, oestrogens and androgens, it is often necessary to complement the fertility study by measuring another hormone, the anti-Müllerian hormone (AMH). This test serves as a measure of possible signs of low ovarian reserve, i.e. the number of follicles in the woman’s ovaries, which contain eggs. The ovarian reserve measurement determines approximately how many eggs are present. This female fertility test is recommended if a woman is at high risk of having a low ovarian reserve, as can happen in these situations:
- Diagnosis of unexplained infertility
- Aged 35 years or older
- Family history of early menopause
- Previous reproductive surgery
- Having only one ovary
- Previous unsuccessful ovarian stimulation with gonadotropin.
- Previous treatment involving toxic agents such as chemotherapy.
Hysterosalpingography
Hysterosalpingography is a procedure that uses an x-ray image of a woman’s fallopian tubes and uterus. The fertility specialist will insert a catheter (small tube) containing a dye into the cervix that will help the structure of the uterus and fallopian tubes show up on the x-ray. This procedure can help locate blockages in the fallopian tubes or uterine cavity, such as polyps and fibroids, and detect an unusually shaped uterus.
Hysterosonosalpingography
This involves introducing a contrast medium through the cervix which, when it passes through the fallopian tubes, enables an ultrasound scan to determine whether they are permeable.
Hysterosonography
This procedure involves inserting physiological saline solution through the cervix using a catheter and makes it possible to assess the shape of the cavity and whether there are polyps or myomas by means of an ultrasound scan.
Hysteroscopy
A hysteroscopy is a minimally invasive procedure in which, by inserting a small camera into the cervix, it allows the specialist to view, diagnose and sometimes repair on the spot abnormalities in the uterine cavity, such as polyps, fibroids, septate uterus (split uterus) and adnexal tissue.
Endometrial biopsy
An endometrial biopsy involves scraping and examining a sample of tissue from the lining of the uterus (endometrium). The procedure enables the specialist to determine whether ovulation has occurred and whether the lining of the uterus has undergone the changes needed for the implantation of a fertilised egg and thus support an early pregnancy. An endometrial biopsy can also detect an infection or inflammation of the sub-endometrial area that needs to be treated.
Karyotype
This test analyses the size, shape and number of your chromosomes (the parts of your cells that contain your genes) in order to establish whether or not there is a chromosomal defect preventing a woman from getting pregnant or if the defect is causing miscarriages.
As mentioned earlier, fertility is a condition that needs to be assessed as a couple, which is why there are also male fertility tests.
Male fertility tests to find out if you can have children
Like women, men should also be tested. Male factor can determine up to 33% of infertility problems, through a thorough medical background check and an initial physical examination. The former enables us to find out about hereditary disorders, chronic health problems, illnesses, injuries or any surgery that might affect fertility. The specialist may ask about sexual behaviours and sexual development during puberty.
The physical examination is useful, for example, to determine the presence of a varicocele (abnormal vein formations above the testicle), which could be affecting fertility, and can be corrected with surgery. However, the specialist will keep on studying fertility status through other additional tests.
Seminogram (semen analysis)
The seminogram is a test that is also covered during your first visit and allows you to know the number of spermatozoa, as well as their shape and motility. In general, the higher the number of spermatozoa you have, the higher your fertility. But there are many exceptions to this. Many men with low sperm counts or abnormal semen are still fertile.
If the first semen analysis is abnormal, your doctor may order a second test to confirm the results, as semen production and semen characteristics may vary from the first measurement to the second.
Sperm capacitation test (or REM)
Another male fertility test that can be performed as a complement to the seminogram is the motile sperm count or capacitation test (REM).
The ejaculate sample is subjected to a process called sperm capacitation and the most appropriate assisted reproduction technique is then determined based on the number of motile spermatozoa obtained.
Sperm DNA fragmentation test
It is estimated that up to 30% of couples with unexplained infertility show high sperm DNA fragmentation using the COMET technique. High levels of oxidative stress can lead to sperm DNA breakage in the case of disease (including varicocele), high fever, drugs, smoking, chemo- or radiotherapy, environmental toxins or caffeine.
Hormone tests (blood tests)
Hormones produced by the pituitary gland, hypothalamus and testes play a key role in sexual development and sperm production, so the presence of hormonal abnormalities can contribute to infertility.
Ultrasound examination
Scrotal ultrasound is recommended in cases of scrotal mass palpation, or in cases of seminograms with very low volume or alterations in the hormonal profile.
Karyotype
A very low sperm concentration may be due to a genetic cause. This test can reveal from the cells whether there is a genetic problem that may be associated with male infertility.
Y-chromosome microdeletion study
The Y chromosome (which only males possess) is divided into regions. Progress has been made in the genetic study of this chromosome and regions called AZFa, AZFb and AZFc that are involved in sperm production have been identified.
In cases where a low sperm count or total absence of sperm is found, it is likely that there is a leakage in one or more of these regions. This study determines the presence or non-presence of these regions.
Cystic fibrosis mutation screening test
This DNA test determines whether a person carries a faulty gene (mutation) that can cause cystic fibrosis in their child. Cystic fibrosis is a serious disease that causes thick mucus in the lungs, pancreas and other organs. It can be treated, but it is a disease that cannot be cured.
For the disease to develop in your child, he or she must have inherited one abnormal gene from each parent. If you have only one copy of the cystic fibrosis gene, they will not have the disease, but they can pass it on genetically, which is why we believe this study is so important.
Semen and urine culture
The semen culture test helps to identify the causative agent (bacteria) or microorganism causing an infectious condition (pathogen) in a man’s semen. This test can also be used to check if the patient has a sexually transmitted disease (STD) and also in the diagnosis and treatment of bacterial prostatitis or any infection of the male reproductive gland.
This test is beneficial for couples undergoing infertility treatment and also for monitoring a man’s reproductive health.
Testicular biopsy
This test is carried out when the seminogram is highly abnormal. It involves taking a sample from a testicle with a needle. If the results of the testicular biopsy show that sperm production is normal, it is likely that your problem is due to a blockage or other problem related to sperm transport.
Having children requires analysing the couple’s health
Dealing with fertility problems can be a stressful experience, especially when you don’t know why you are having problems. Even if you consider yourself healthy, it is possible that there is something wrong, either hormonally or physically, which may be affecting a couple’s ability to have children.
These tests can help you eliminate uncertainty or feelings of helplessness when trying to conceive. If you have any doubts or need help you can contact our fertility specialists. You can choose, whether online, by phone, or in person in Madrid or Barcelona. We are more than happy to meet you personally and introduce you to the entire medical team at our facilities.
