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There may be different causes of infertility, such as genetic disorders, lifestyle, diet, age. It is also confirmed that quality of oocytes and semen decreases through the age. Even though most men remain fertile into old age, more often their problems with fertility start in early adult life.
In general, infertility is defined as the inability to conceive after one year of unprotected sex. It may be caused by a single factor either your or your partner, or combination of factors that may prevent a pregnancy from occurring or continuing, therefore, it is so important to diagnose the causes of fertility problems and introduce the suitable treatment plan.
- since few months you are trying to get pregnant, however, unsuccessfully
- you would like to postpone the decision of having the baby and you want to know how much time you still have
- you want to estimate and improve your semen parameters
- you want to ensure that you are fertile
Several clinical markers are used to estimate woman's ovarian reserve which plays a crucial role in achieving pregnancy. Ovarian reserve is a term which determines the capacity of the ovary to produce egg cells that are capable of fertilization. Every woman is born with determined size of ovarian reserve which gradually declines over years.
Methods of assessing woman's fertility:
- Antral Follicle Count by ultrasound estimates numbers of antral follicles. Antral follicles are small (about 2-8 mm) follicles that can potentially develop and ovulate in the future. The examination should be done between the 2nd and 4th day of the cycle. When there are less than 5 antral follicles visible, it may indicate a poor ovarian reserve and a poorer respond to stimulation during IVF treatment is expected.
- AMH (Anti-Müllerian Hormone) – it's a marker which precisely determines ovarian reserve. AMH is a substance produced by granulosa cells in ovarian follicles. Estimation of AMH level allows to plan getting pregnant beforehand and helps to choose the best treatment method in case of having problems with fertilization. AMH test reflect also the size of the remaining eggs supple and helps predict the onset of menopause. AMH level does not depend on menstrual cycle and can be done on any day.
- FSH (Follicle-Stimulating Hormone) – a hormone involved in producing mature eggs in ovaries. It is responsible for regulating the production of progesterone and estrogen within the ovaries which regulate woman's menstrual cycle. In conjunction with other tests, such as luteinizing hormone (LH) an estradiol, the FSH level test helps determine a woman’s ovarian reserve and diagnose conditions associated with dysfunction of the ovaries.
- Inhibin B – an indicator which helps to determine ovarian reserve. The amount of inhibin B measured at the beginning of a new menstrual cycle is directly related to the number of growing follicles. It allow also to diagnose Premature Ovarian Aging. The test should be done on the 2nd day following the start of menstruation cycle.
The main method of testing male fertility is a Semen Analysis which determines the number and quality of sperm. It estimates semen parameters and diagnose abnormalities which may have influence on conceiving the baby.
Type of tests:
A Basic Semen Analysis which allows to estimate:
- Sperm Count/Concentration
- Sperm Motility (the percentage of moving sperm in a sample)
- Semen Volume
- Semen Viscosity
- Semen pH
Other tests which are recommended:
- Morphology– the study of the size, shape and appearance of the sperm cells
- Sperm Viability – to determine the percentage of sperm alive, a special staining technique using eosin is applied
- POX test used for quantitative detection of leukocyte concentration
- MAR-TEST IgG (Mixed Antiglobulin Reaction ) – Anti-sperm antibodies present on the surface of sperm cells
- Sperm DNA fragmentation test
- Bacteriological analysis
> Evaluation of ovarian reserve