Infertility diagnostics: specialists and information

If the desire to have children remains unfulfilled, infertility diagnostics can help those affected to find out the cause of the lack of pregnancy. In this way, the chances of pregnancy can be increased with the help of fertility treatment.

Below you will find further information and selected specialists for 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.

A couple is said to be sterile if they do not become pregnant within 1-2 years despite regular sexual intercourse. Sterility therefore refers to the inability to become pregnant at all or to cause a pregnancy. A distinction is also made here between

• primary sterility: there has never been a pregnancy, and
• secondary infertility: at least one pregnancy has already occurred, regardless of whether it was carried to term.

Around 15% of couples in Germany are involuntarily childless. The causes are evenly distributed:

• 30% are due to the man,
• 30% for the woman and
• 30% for both partners;
• In around 10% of cases, no cause can be identified.

Many fertility problems are temporary and generally treatable. Complete infertility is an exceptional case. It occurs, for example, if no sperm cells are produced in the man's body or if the woman's uterus has been removed.

Infertility is the inability to carry a pregnancy to term.

Infertility diagnosis identifies the reason for the inability to conceive. If necessary, fertility treatment can then be initiated with the help of reproductive medicine.

Factors for the unfulfilled desire to have children

Without contraception, the statistical probability of becoming pregnant with regular sexual intercourse is around 25% per month.

The time of ovulation plays an important role, which you should know if you want to have children.

Eggs remain fertile for around 24-48 hours and sperm survive in the woman's body for 2-5 days. The ideal time for intercourse is therefore between two days before ovulation and one, maximum two days after. If this time window is used optimally when trying to conceive, the chances of pregnancy increase.

The best age to get pregnant for women is between 20 and 30. Fertility begins to decline after the age of 30. After the age of 35, the probability decreases rapidly. After the age of 45, the probability of becoming pregnant without assisted reproduction drops to almost zero.

In men, fertility is less age-dependent. However, their sperm quality also decreases significantly after the age of 40.

Stress - and not least "fertility stress" - can affect a woman's cycle. In extreme cases, it can lead to ovulation not taking place. In men, stress can affect sperm production, although this is not as easy to prove as cycle disorders in women.

Being severely overweight or underweight has a lasting effect on a woman's hormone balance. The wrong weight can also be the cause of an unfulfilled desire to have children.

Unhealthy alcohol consumption restricts fertility in both women and men. In men, it primarily leads to disruptions in sperm production and 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 can therefore influence the likelihood of pregnancy. Pay attention to a healthy lifestyle overall:

• Reduce stress through relaxation and exercise, for example,
• reduce alcohol and nicotine and
• try to keep your weight within a healthy range.

The consultation with the doctor to diagnose infertility

Before starting the complex instrumental infertility diagnosis, you will first have a consultation with your doctor. During the fertility consultation, the doctor will ask a few questions about your individual circumstances:

• How long have you wanted to have children?
• Which of you suffers more from the unfulfilled desire to have children?
• How often do you have intercourse?
• Are you satisfied with your sexuality?
• Do you have any idea what the causes of your infertility might be?
• Do you see the limits of fertility treatment?
• What happens if the treatment is not successful?

At the beginning of infertility diagnostics, the couple talks to the doctor © Chinnapong | AdobeStock

Physical examination for female infertility

After these discussions, the physical causes are investigated as part of the infertility diagnosis.

The physical causes of an unfulfilled desire to have children are roughly balanced between the sexes. However, we will concentrate here on the examination process for women.

The physical causes of female infertility are in decreasing frequency:

• Ovarian dysfunction,
• leaking fallopian tubes,
• malformations or diseases of the uterus,
• changes in the mucus of the cervix,
• immunological reactions to the male sperm cells.

Anatomy of the uterus and ovaries © bilderzwerg / Fotolia

Possible causes of ovarian dysfunction are

• a weakness of the corpus luteum (for example, due to an excess of male hormones in polycystic ovary syndrome PCOS),
• a disorder of thyroid function,
• premature onset of the menopause,
• a hormone-active tumor,
• long-term cortisone therapy.

Leaky fallopian tubes can be the result of various previous disorders, such as

• past inflammation,
• ectopic pregnancies,
• operations in the abdominal cavity.

Another possible cause is a dispersed lining of the uterus - so-called endometriosis.

Diseases of the uterus that can cause sterility include

• Myomas,
• adhesions following surgery or inflammation or
• malformations.

Changes to the cervical mucus can be caused by

• reduced production due to hormone deficiency or
• previous operations, such as conization,

be caused.

The immunological cause of infertility also essentially takes place in the cervical mucus. It can then contain antibodies against the man's sperm.

Treatment steps of an infertility diagnosis

At the beginning of infertility diagnostics, a menstrual cycle history and a basal body temperature curve are taken. These can often provide the first important clues.

The post-coital test is also often carried out at the beginning because it is easy to perform - although immunological causes are rather rare. The test is carried out twelve hours after unprotected intercourse: The cervical mucus is examined under the microscope for the number and motility of the sperm it contains. If the man's spermiogram is OK, the test provides an indication of the presence of antibodies if sperm are absent or immobile.

Hormone diagnostics is also relatively simple, in which the above-mentioned hormonal causes can be examined by taking a blood sample.

One way of checking the patency of the fallopian tubes is contrast sonography. After introducing ultrasound contrast medium into the uterus, the path of the contrast medium can be followed by ultrasound. This allows the patency or blockage of the fallopian tubes to be detected. However, this method does not allow any conclusions to be drawn about the functionality or condition of the fallopian tubes.

This is only possible with laparoscopy, the gold standard in clarifying the physical causes of female infertility. This allows

• examine the uterus and fallopian tubes in detail,
• the patency of the fallopian tubes can be checked and
• adhesions or endometriosis lesions can be treated during the same procedure.

treated in the same operation. Usually, the laparoscopy is combined with a hysteroscopy to rule out the uterus as the cause. During the hysteroscopy, the doctor can remove possible causes such as adhesions.

The procedures can usually be performed on an outpatient basis.