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Evaluation of fertility

Fertility counseling

Women tend to become interested in their fertility when baby fever strikes or when the desired pregnancy does not start. Before this, the thoughts are primarily concerned with managing contraception – fertility, a question for the future, is not on the agenda.

Fertility counseling is for all women and men who are interested in their fertility. There are no age limits for counseling, and pregnancy does not have to be on the agenda right now; it is possible to have your fertility assessed at any time. You may have an appointment for fertility counseling even if you do not have a spouse in sight or if you are considering having a child as a self-sufficient woman.

The purpose of fertility counseling is to improve and maintain reproductive health, to facilitate pregnancy planning and to evaluate, as early as possible any fertility-related problems.

What affects fertility?

The woman’s age is the most important fertility-determining factor. The fertility of women decreases individually, but already after age 35 the pregnancy prognosis sinks significantly. For couples desiring pregnancy this means that they have to try for a longer period of time, although “everything is in order”. The ova develop in the ovaries of females during fetal development, which means that all ova are just as old as the woman. Over time, the genome of the ova will undergo slight injuries which may impair the development of embryos and their implantation into the endometrium, which ultimately leads to miscarriages. The diet of the woman, her degree of exercise or nutritional supplements do not, regrettably, improve the quality of the ova. Blood sampling of some hormones (e.g., FSH and AMH) and an ultrasound made by a physician familiar with fertility treatments may be used to assess the quantity of the remaining ova.

Males have more years of fertility that females, but, with age, also male reproductive cells (spermatozoa) undergo injuries which affect the genome. The mobility and number of spermatozoa are important determinants of the likelihood of pregnancy. If the number of spermatozoa and their mobility is normal, the capacity for successful fertilization by the male is normal. If the number of spermatozoa and their mobility are reduced, this will affect the likelihood of pregnancy negatively. If there are aberrations in the number, mobility or structure of the spermatozoa, additional examinations may be needed. If the male has had problems with the descent of the testicles in his childhood, the quality of sperm is often reduced. If the male has a varicocele, testicular inflammations or if his testicles have been subject to physical blows or other damage, this will also affect the quality of his sperm. Occasionally and surprisingly, no spermatozoa are found when the sperm is examined. This needs to be investigated further by appropriate blood test and/or a biopsy.If the man takes anabolic (“body-building”) steroids, permanent loss of the production of spermatozoa may result.

Smoking impairs the fertility of women and men.

When should you visit a fertility clinic?

Usually, pregnancy starts soon after contraception is discontinued.  However, up to one fifth of all couples attempt pregnancy for a long time – some have the patience to keep trying for a year or two, some would like to have fertility treatment to speed up pregnancy.  Occasionally the first pregnancy gets started without problems, but the next one takes its time – or vice versa.

You are free to book a visit at Aura Klinikka for examinations as soon as you feel you may have fertility problems. You don’t need any referral. Fertility examinations are indicated, at the latest, if you have had regular intercourse and no contraception for one year. If the woman is over 35 years of age, it is worthwhile to look into fertility problems sooner.

Examinations are indicated at an earlier stage if the woman has some known fertility-inhibiting factors. Such factors include any chronic illness, medication, gynecological infections like Chlamydia, endometriosis, menstruation disorders, ovulation problems, spotting, early maternal climacterium or early climacterium of the woman desiring pregnancy, varicocele and testicle injuries or surgery. Also, if there have been several early miscarriages, examinations are in order. Circumstances that may disturb becoming pregnant include premature ejaculation, insufficient erection and painful intercourse.

Examinations: the woman 

The physician will ask about the menstrual cycle – its duration, regularity or irregularity, number of bleeding days and presence or absence of menstrual pain. Other important questions relate to substantial weight changes, any infections and inflammations like Chlamydia, and operations of the lower abdomen and gynecological operations. The physician needs also to know if the woman has had any pregnancies previously. If needed, the physical may make an ultrasound examination to study if the oviducts are open or not.

Before fertility treatment is started, blood tests are taken to study whether infertility may be related to abnormal levels of thyroid or prolactin hormones. If indicated, other hormonal levels or chromosome aberrations may be examined. The level of the hormones FSH and AMH are usually checked of all women above 40 years of age with fertility problems. These hormones reflect the functional capacity of the ovaries and the remaining number of ova.

Examinations: the man 

The primary examinations related to male fertility problems are a physician’s interview and examination, and a semen analysis. If indicated, hormonal levels in blood samples may also be examined.

The semen is analyzed for the number of spermatozoa, their mobility, their structure and for the presence of antisperm antibodies. If the sample is markedly abnormal, a repeat sample is recommended. Even if the semen is of poor quality, it can often be used for treating the spouse.

If the semen lacks spermatozoa, a testicle biopsy might reveal spermatozoa in the tissue. A lack of spermatozoa may be due to structural causes (e.g., obstructed seminiferous tubules), chromosomal aberrations (e.g., Klinefelter’s syndrome) or retrograde ejaculation (semen enters the bladder and does not emerge through the penis; also called dry ejaculation).