Feature
One step before IVF
One of the most frequent issues a gynaecologist now faces at the practice is that of the infertile couple.
A couple is described as infertile when they have been trying for more than a year without achieving a pregnancy, while being of reproductive age. These couples are directed towards in vitro fertilisation and to assisted reproduction units.
In vitro fertilisation means that, instead of the egg being fertilised by the sperm in the fallopian tube, this takes place in the embryology laboratory by clinical embryologists, and the resulting embryos are transferred into the uterus.
The success rate of the pregnancy depends on many factors, such as the number and quality of the embryos, the woman's age, the sperm and the cause of the infertility, and of course on the expertise of the doctors and the quality of the laboratories. In Greece, in recent years, there are many excellent assisted reproduction units with outstanding medical and laboratory staff and very good success rates.
The couple's first step is a visit to the gynaecological practice, so that an attempt can be made to find the cause of the infertility and the appropriate tests can be carried out without delay.
When should a couple seek medical advice?
- If the woman has not become pregnant after a year of regular intercourse (half of women conceive within 6 months and 80% within a year).
- If there is already a known problem in the woman, such as endometriosis or previous surgery on the ovaries and/or the fallopian tubes, and in the man, correspondingly, surgery on the testicles, an injury or a varicocele.
- If the woman is over 35 years of age.
- If there are already symptoms, such as a change in the woman's cycle (infrequent or painful periods, or pain during intercourse) or, in the man, pain in the testicles.
Which tests are carried out to investigate infertility?
For the woman: transvaginal ultrasound, hysterosalpingography, hormone tests. For the man, the most important test is semen analysis (spermiogram, sperm activation test, semen culture), accompanied by a full andrological assessment (testicular triplex scan and hormone testing). Other tests that may be needed are laparoscopy or hysteroscopy.
Laparoscopy
The laparoscope is a small telescope, no thicker than a pen, which is inserted into the abdomen through a small incision and allows the abdominal organs to be observed; it is performed under general anaesthesia. It helps us examine the uterus, the fallopian tubes and the ovaries and is essential for diagnosing endometriosis, adhesions of the tubes and ovarian cysts.
In all of the above cases, if such findings are confirmed, there is at the same time the possibility of immediate surgical treatment (cauterisation of endometriotic lesions and removal of endometrial adhesions, as well as adhesions of the tubes and other pelvic adhesions, along with the laparoscopic removal of ovarian cysts and of fibroids). In fibroids and adenomyosis in particular, laparoscopy provides the solution.
If the laparoscopy is purely diagnostic, no hospital stay is required. If it is operative, a stay of at least 24 hours may be needed. The risks of laparoscopy have now been reduced and it is considered a routine procedure. It also contributes to the diagnosis and treatment of congenital anomalies of the uterus (such as a bicornuate uterus).
Hysteroscopy
This is the examination of the cavity of the uterus with an extremely fine telescope, which passes through the cervix. A small amount of gas or fluid is passed through it to distend the uterine cavity. This makes visible conditions such as endometrial polyps, submucosal fibroids, anomalies in the shape and size of the uterus, and adhesions. The patency of the tubal openings is checked and, where there is a problem, it is corrected immediately (removal of polyps, submucosal fibroids, adhesions, uterine septum). And in cases where an endometrial biopsy is needed, hysteroscopy makes it possible.
Hysteroscopy and laparoscopy are two extremely important examinations for diagnosing the cause of infertility.
Diagnostic semen tests
- Spermiogram
- Sperm vitality test (HOS test)
- Antisperm antibody test
- Trial preparation - sperm activation
- Microbiological and biochemical testing
- Oxidative stress testing
- DNA fragmentation testing
- Hyaluronic acid binding assay
- Acrosome reaction testing
- Identification of round cells
- NBT test
- Chromatin integrity testing - aniline toluidine staining
- Vitrification as a cryopreservation method for low sperm counts
The aim of the above tests - each on its own or in combination - is to obtain as much information as possible about male infertility due to a disorder of the sperm. This makes it possible to choose the appropriate treatment method, tailored to each man individually.
This testing is carried out only in properly organised andrology laboratories.
