If the desire to have children remains unfulfilled, those affected can use infertility testing to determine the cause of their inability to conceive. This allows them to specifically increase their chances of pregnancy with the help of fertility treatment.
Below you will find further information as well as a selection of specialists in infertility diagnostics.
What does sterility mean, and when is infertility present?
Sterility and infertility are not synonyms, even though the two terms are often used interchangeably.
Sterility is diagnosed when a couple fails to conceive within 1–2 years despite regular sexual intercourse. Sterility thus refers to the inability to become pregnant at all or to bring about a pregnancy. A distinction is also made here between
- primary sterility: There has never been a pregnancy, and
- secondary sterility: At least one pregnancy has occurred previously, regardless of whether it was carried to term.
About 15% of couples in Germany are involuntarily childless. The distribution of causes is balanced:
- 30% are attributable to the man,
- 30% are due to the woman, and
- 30% are attributable to both partners;
- in about 10% of cases, no cause can be determined.
Many fertility problems are temporary and generally treatable. Complete sterility is an exceptional case. It occurs, for example, when the man’s body does not produce sperm or when the woman has had her uterus removed.
Infertility is the inability to carry a pregnancy to term.
Infertility testing identifies the reason for the failure to conceive. Based on the results, fertility treatment can then be initiated, if necessary, with the help of reproductive medicine.
Factors Contributing to Unfulfilled Desires to Have Children
Without contraception, the statistical probability of becoming pregnant with regular sexual intercourse is about 25% per month.
The timing of ovulation plays an important role and should be known when trying to conceive.
Eggs remain fertile for about 24–48 hours, and sperm can survive in a woman’s body for 2–5 days. The ideal time for intercourse is therefore between two days before ovulation and one, or at most two, days afterward. If this window is used optimally when trying to conceive, the chances of pregnancy increase.
The best age for women to get pregnant is between 20 and 30. After age 30, fertility begins to decline. After age 35, the likelihood continues to decline rapidly. After age 45, the probability of becoming pregnant without assisted reproduction drops to nearly zero.
For men, fertility is less strongly age-dependent. However, sperm quality also declines significantly after age 40.
Stress—and not least the “stress of trying to conceive”—can affect a woman’s cycle. In extreme cases, it can prevent ovulation from occurring. In men, stress can affect sperm production, though this is not as easy to prove as menstrual cycle disorders in women.
Being severely overweight or underweight can cause long-term disruptions to a woman’s hormonal balance. Thus, an unhealthy weight can also be the cause of infertility.
Unhealthy alcohol consumption reduces fertility in both women and men. In men, it primarily leads to disruptions in sperm production; in women, it affects the menstrual cycle.
Smoking disrupts sperm production in men. In women, it not only reduces the chance of becoming pregnant but also increases the miscarriage rate.
These factors mean you can actively influence your chances of getting pregnant. Make sure to maintain a healthy lifestyle overall:
- For example, reduce stress through relaxation and exercise,
- cut back on alcohol and nicotine, and
- try to maintain a healthy weight.
The Consultation with the Doctor for an Infertility Evaluation
Before beginning the extensive instrumental infertility testing, you’ll first have a consultation with your doctor. During the fertility consultation, the doctor will ask you some questions about your personal circumstances:
- How long have you been trying to conceive?
- Which of you is more affected by the inability to conceive?
- How often do you have intercourse?
- Are you satisfied with your sex life?
- Do you have any idea what might be causing your infertility?
- Do you see any limitations to fertility treatment?
- What happens if the treatment isn’t successful?
The first step in infertility diagnosis is a joint consultation between the couple and the doctor © Chinnapong | AdobeStock
Physical examination for female infertility
These discussions are followed by an evaluation of physical causes as part of infertility diagnosis.
The physical causes of infertility are roughly equally distributed between the sexes. However, we will focus here on the examination process for women.
The physical causes of female infertility, listed in descending order of frequency, are:
- Ovarian dysfunction,
- blocked fallopian tubes,
- malformations or diseases of the uterus,
- changes in cervical mucus,
- immunological reactions to male sperm.
Anatomy of the Uterus and Ovaries © bilderzwerg / Fotolia
Possible causes of ovarian dysfunction include:
- luteal insufficiency (for example, due to an excess of male hormones in polycystic ovary syndrome, PCOS),
- thyroid dysfunction,
- early onset of menopause,
- a hormone-producing tumor,
- long-term corticosteroid therapy.
Blocked fallopian tubes can result from various previous conditions, such as:
- past infections,
- ectopic pregnancies,
- abdominal surgery.
Another possible cause is the presence of uterine lining tissue outside the uterus—a condition known as endometriosis.
Uterine conditions that can cause infertility include
- fibroids,
- adhesions resulting from surgery or inflammation, or
- malformations.
Changes in cervical mucus can result from
- reduced production due to a hormone deficiency or
- previous surgeries, such as a conization,
.
The immunological cause of infertility also plays out primarily in the cervical mucus. It may then contain antibodies against the man’s sperm.
Steps in the Diagnosis of Infertility
The infertility diagnostic process begins with a review of the menstrual cycle history and the tracking of basal body temperature. These often provide the first important clues.
The postcoital test is also often performed early on due to its ease of administration—although immunological causes are relatively rare. The test takes place twelve hours after unprotected intercourse: during the test, the cervical mucus is examined under a microscope to determine the number and motility of the sperm present. If the man’s semen analysis is normal, the test can indicate the presence of antibodies if sperm are absent or immobile.
Hormone testing is also relatively simple; it allows the hormonal causes mentioned above to be investigated through a blood draw.
One way to check the patency of the fallopian tubes is contrast-enhanced ultrasound. After injecting an ultrasound contrast agent into the uterus, the agent’s path can be tracked via ultrasound. This allows for the detection of patency or blockage of the fallopian tubes. However, this method does not provide information about the functionality or condition of the fallopian tubes.
This is only possible with laparoscopy, the gold standard for investigating physical causes of female infertility. During this procedure,
- the uterus and fallopian tubes can be examined in detail,
- the patency of the fallopian tubes can be assessed, and
- any adhesions or endometriosis lesions can be treated during the same procedure
. Laparoscopy is usually combined with a hysteroscopy to rule out the uterus as a cause. During the hysteroscopy, the doctor can remove any potential causes, such as adhesions.
These procedures can generally be performed on an outpatient basis.
