Study and diagnosis of sterility

What is understood by sterility?

Sterility can be defined as the difficulty that a couple has in order to achieve pregnancy naturally after a period of regular sexual relations without the use of contraceptives.

When should a couple begin a sterility study?

Generally, a couple who have been having sexual relations without contraceptive measures for at least one year without achieving pregnancy should consult the gynaecologist to determine the possible causes for this difficulty. In some cases the study could be advisable even before the period above mentioned.

The woman’s age is a very important factor to take into account, since it is known that after the age of 35 women’s reproductive capacity decreases and it is even lower after the age of 40.

What tests must be done?

Nowadays, the sterility study include less tests than it used to, however, there are a minimum of tests that are essential in both men and women. In cases of clearly pathologic results, a treatment will be indicated. The study includes:

  1. Seminogram: The study of the characteristics of the semen is essential to evaluate the man in a sterile couple.

  2. Blood hormone determinations: The ovarian reserve is studied on the third day of the cycle with the determinations of the FSH, LH and estradiol. It allows the evaluation of the response capacity to an ovarian stimulation, in case an assisted fertilization was needed. The determination of progesterone in the second phase of the cycle establishes whether the cycles are ovulatory or not. In case of suspicion of ovaulatory dysfunction, in women with very long cycles or absence of menstruation, hormone studies are more complete and also include determinations of androgens, prolactin, thyroid hormones, etc.

  3. Hysterosalpingography: It is a radiology study that allows visualization of the uterine cavity and the permeability of the fallopian tubes. A iodine contrast is injected through the cervix and flows through the uterine cavity and the fallopian tubes. If there is any octruction, the contrast flows out at the end of the tube to the abdominal cavity.

  4. Transvaginal echography: Although it does not provide direct information of the reproductive capacity, this gynaecological check up enables to diagnose the existence of any disease either in the uterus or in the ovaries.