Ideally the sterility assessment involves both partners from the beginning and begins with a detailed discussion.
Of course, any results from previous tests are considered where appropriate and do not always have to be repeated, so it would be a good idea if you could bring them with you.
I usually reserve one hour for this initial assessment. We will then try together to determine how to proceed. In most cases, the first step is to complete the assessment.
We will also talk about an optimal preparation for the pregnancy. Among else, this is about vaccination protection, so please bring your vaccination card if available.
If you are not taking it already, you should remember to take folic acid (0.4 mg per day). If you start taking this dietary supplement 4 weeks before conception, it drastically reduces the infant’s risk to have an open back.
The assessment, as well as most other treatment steps, take place in the protected atmosphere of my practice for reproductive medicine. If necessary, I can perform surgical procedures at Hirslanden Salemspital in Bern or Andreasklinik in Cham
Causes of failure to conceive or infertility are found in 30% in men, 30% in women and 30% in both partners. For the remaining 10% no cause can be determined.
However, the assessment is not about assigning blame, but about being able to obtain a basis for drawing up a treatment concept that considers all factors as far as possible.
Basically 3 basic conditions must be fulfilled for a pregnancy:
- Regular ovulation
- Sperm with sufficient fertility capacity
- Fallopian tube patency
At the beginning of the cycle, in a so-called test cycle, the most important hormones (hormone status), antibodies (infection protection) and other values that are important in connection with pregnancy are determined in the blood. In addition, the functional reserve of the ovary can be estimated with ultrasound at the beginning of the cycle and the ovulation and the structure of the uterine lining (endometrium) can be checked from the 12th day of the cycle. Further blood samples in the second half of the cycle provide information on the quality of ovulation and the function of the corpus luteum.
Usually, male fertility is also tested at the same time using a spermiogram (microscopic examination of a semen sample).
It is also possible to check fallopian tube patency during the test cycle. This is usually done by ultrasound (contrast medium sonography) or laparoscopy.
The spermiogram assesses the number of sperm in the ejaculation, the percentage of moving sperm and the percentage of normally shaped sperm. The corresponding standard values are: at least 12 million sperm per millilitre of ejaculate, at least 32% forward moving sperm and at least 4% normal forms. Since the values can also vary considerably during normal fertility, depending on the result, we recommend two separate tests at intervals of at least 3 months. If the spermiogram is significantly restricted, we recommend further examination by a specialist (urology or andrology).
Testing the potency of the Fallopian tubes
Ultrasound (contrast Echography)
Carried out between the 8thand 12thday of the cycle. After looking at the cervix with a vaginal mirror (as in the annual gynaecological examination), a fine catheter is inserted into the uterine cavity. A contrast medium is given through this catheter, which can then be followed by ultrasound on its way through the fallopian tubes into the abdominal cavity. The examination can cause menstrual-like lower abdominal cramps, but anaesthesia is not required. Sometimes nausea or a drop in blood pressure also occurs immediately afterwards. If the fallopian tubes cannot be clearly assessed with this technique, we usually recommend laparoscopy.
Carried out between the 8th and 12th day of the cycle, outpatient under general anaesthesia. Through a small incision in the belly button, an optic is inserted into the abdomen with which the entire abdominal cavity can be viewed on the screen. The patency of the fallopian tubes is tested by injecting blue colour into the uterine cavity, the exit of which can then be followed directly on the screen. We particularly recommend this examination if there are indications of endometriosis (severe pain during menstruation and/or sexual intercourse), scars or adhesions (abdominal surgery in the past, inflammation of the fallopian tubes, ectopic pregnancy, chlamydia antibodies) or if the contrast medium ultrasound examination was not clear. Usually a hystersoscopy is performed at the same time.