Here is a general description of infertility examinations which may vary in individual cases.
For men, the most important examination is the semen analysis – spermiogram. The analysis always needs to be done after several days of sexual abstinence (minimum of 2, maximum of 7 days). Semen is obtained by masturbation in a special room designated for this purpose near our laboratory. It is also possible to analyse a sample which you bring with you; however, we do not recommend it because there might not be optimal conditions during the transport.
A definite conclusion cannot be reached after one negative finding; the test needs to be repeated after a time (4 - 6 weeks). In serious cases it is necessary to determine the levels of sex hormones in blood; in extreme cases the testicle biopsy may be needed. The microscopic analysis can reveal whether the production of sperm takes place or what development forms of sperm are present (TESE). Using micromanipulation methods (ICSI) it is then possible to use even the thus-obtained sperm for assisted reproduction. Severe cases of male fertility disorders require genetic tests to exclude some inherited diseases.
Part of the semen analysis is the examination of a large number of parameters, most important of which is the count of sperm, its motility and morphology (i.e. the correct form). The reference values are standardized by the World Health Organization (WHO) and listed in the table below. Part of the examination is also determination of white blood cells. In case of their increased occurrence a culture test that may detect infection should be carried out.
Beyond the normal testing, we also offer optional examination including DNA fragmentation of sperm. This examination gives us more information about the quality of sperm, which can be used to plan the next treatment steps. After previous phone call, we also offer the sperm analysis to the patients who are not treated in our clinic.
Semen analysis (spermiogram)
The reference values of sperm analysis according to the current WHO Manual (2010). As a matter of interest, they are compared to the values from 1999.
|Semen parameters||Low reference limit (WHO 2010 - current)||Low reference limit (WHO 1999)|
|Volume of ejaculate [ml]||1,5 ml||2 ml|
Sperm count [mil/ml]
|15 mil/ml||20 mil/ml|
|Sperm motility (progressive movement) [%]||32%||50%|
|Sperm morphology (normal forms) [%]||4%||15%|
For women, the emphasis is on proving the ovulation. The most accurate method is repeated ultrasound examination - folliculometry, which enables us to monitor the growth and bursting of a follicle. Sometimes, we need to assess the results in connection with the analysis of hormone levels in blood. It should be emphasized that calculation of ovulation by measuring the basal temperature is very inaccurate. Femal hormonal profile test together with determining the ovarian reserve, in particular by AMH (antimullerian hormone) is really important. We test the right thyroid function. Fallopian tube patency is diagnosed with the ultrasound test during which the uterus and fallopian tubes are filled with a contrast agent - HyCoSy. This testing is the least intrusive of all possible tubal patency examinations. In case of suspection of a uterine polyp or other atypical findings in the uterine cavity we perform hysteroscopy. It is a surgery under general anaesthesia, during which the abdominal cavity is monitored by thin optics inserted into the cervix uteri. The most accurate information about the condition of inner genitals, including evidence of potential endometriosis, adhesions of the uters, etc., is provided by laparoscopy. The immunological cause of infertility can be found by the presence of antibodies in sperm or blood of one or both partners. In some cases, genetic test or, possibly, testing for thrombophilia is needed. After repeated IVF failures we can do the ERA test (endometrial receptivity array) to be able to examine whether the endometrium is receptive on the day of embryotransfer, i.e. able to receive the embryo.
We also care for women with recurrent miscarriage, because as reproductive gynaecologists we have rich experience in this field.