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Infertility : Causes and Tests to check it

After two years of infertility, 10% of couples remain infertile. On the other hand, up to 25% of infertility cases remain unexplained. To understand the causes of infertility, we must first bear in mind that fertilisation is the result of a complex process involving many factors.

Indeed, each stage of determinism, gametogenesis and fertilisation involves innumerable bodily mechanisms. This article is divided into two parts: the causes and tests that can be prescribed to check fertility in a woman and then in a man.

Understanding infertility in women

If a woman is unable to get pregnant after more than a year of trying or if she is suffering from a sterility problem, a fertility test should be considered. Note first of all that age can indeed affect a woman's fertility. Indeed, it is recommended that a 35-year-old woman take a fertility test if she is unable to become pregnant after six months of testing. Fertility tests to diagnose the cause of infertility in women are often accompanied by a discussion of medical history and blood tests. When the tests fail to identify a specific cause of fertility, the diagnosis is that of "unexplained infertility", which affects about 15-30% of infertile couples, according to the National Institutes of Health (US government agency responsible for biomedical and public health research).

How can infertility be detected in a woman?

Fertility tests for women help to identify the cause(s) of infertility in order to treat the disease properly and give the couple the best chance of conceiving a child. Fertility tests for women often involve :

• A discussion of the medical history, especially to check for ovulation or problems related to the menstrual cycle ;
• Blood tests to check hormone levels and ovarian reserve (the number of eggs remaining in a woman's ovaries);
• A pelvic examination;
• Procedures such as ultrasound imaging and surgery to check for structural causes of infertility.

When to consider a fertility test (for women)?

• If you have been unable to get pregnant for more than a year (six months if you are over 35 years old);
• If you have heavy, irregular (more than 35 days between periods) or absent periods.
• In case of recurrent miscarriages ;
• If you have a history of pelvic inflammatory disease, pelvic pain or endometriosis ;
• If your partner has suspected or identified male infertility;

What are the fertility tests for women?

Assessing medical history

At the first visit, your gynaecologist will ask you questions about your health and sexual history. Knowing the patient's history is an essential part of how the doctor diagnoses the cause of the infertility. For example, a previous sexually transmitted infection or infrequent periods of ovulation/menstruation could be the cause of the infertility. The first appointment will provide information to the doctor to determine if further tests need to be carried out.

Ultrasound

After the first consultation the specialist may perform an ultrasound scan of the woman's pelvic area to determine if there is a problem affecting her fertility (example: cysts in the ovaries).

Blood hormone tests

Blood tests are done at different times in a woman's menstrual cycle to measure hormone levels in the blood. For an egg to mature and for the ovaries to release an egg, a woman must have balanced hormone levels. The doctor who performs the hormone blood test determines whether the woman is producing high-quality eggs and whether the brain is sending hormonal signals to the ovaries correctly. An assessment of follicle stimulating hormone (FSH) levels, carried out on the third day of the cycle (three days after the start of menstruation), is a common test for women.

Ovarian Reserve Test

The ovarian reserve test assesses the potential number of eggs a woman has in her ovaries. The ovarian reserve test may involve ultrasound or blood tests. These tests are recommended if a woman is at high risk of having a depleted ovarian reserve. These risks are :

• Be 35 years old or older ;
• Have a family history of early menopause;
• Previous reproductive surgery;
• Have only one ovary.
• Laparoscopy

Laparoscopy is a medical endoscopy technique in which the doctor inserts a camera and small surgical instruments into the abdominal cavity through a small incision in the navel. Laparoscopic surgery is used to assess and treat endometriosis and to remove uterine fibroids, ovarian cysts and scar tissue.

• Sonohysterogram

Sonohysterography uses a saline solution to fill the uterine cavity and transvaginal ultrasound to create a clear image of the uterus. This procedure is used to diagnose uterine lesions and irregular growths, such as fibroids or polyps.

• Hysterosalpingography

Hysterosalpingography is a procedure using an X-ray image of a woman's fallopian tubes and uterus. The fertility specialist inserts a catheter (small tube) containing a dye into the cervix, which allows the structure of the uterus and fallopian tubes to appear on the X-ray.

• Hysteroscopy

This minimally invasive surgical procedure allows polyps and fibroids in the uterus to be visualised and diagnosed. It is carried out using a small camera inserted into the cervix. Hysteroscopy can also be used to repair abnormalities in the uterine cavity, such as polyps, fibroids, uterine septa (divided uterus) and scar tissue inside the uterine cavity.

Understanding male infertility

Men are most affected by infertility, but usually have no symptoms, so tests are needed to diagnose the cause of the infertility. Male infertility plays a role in about 40% of all infertility cases, according to the American Society for Reproductive Medicine (ASRM). Male fertility tests usually include a medical examination and semen analysis to determine sperm count and movement.

How do you detect infertility in a man?

Infertility is usually diagnosed when a couple is unable to have children after a year or more of regular unprotected sex. Male fertility tests focus on the main causes of male infertility, which are abnormalities in a man's sperm or in his sperm delivery system (reproduction). Semen analysis allows a thorough investigation of problems related to the semen itself, as well as anomalies in a man's sperm. Damaged sperm cells are the most common cause of male infertility. Other factors that can affect male fertility include :

• Chromosomal or genetic disorders that affect sperm production or delivery;
• Retrograde or "dry" ejaculation that prevents sperm from ejaculating normally;
• An obstruction in a man's reproductive system that prevents sperm from leaving the penis during ejaculation;
• Psychological, emotional or spinal conditions that cause impotence;
• Cancer treatments such as chemotherapy and radiation that disrupt sperm production and viability.

When should a fertility test be considered?

If a woman does not become pregnant after one year of testing (or after six months of testing when the partner is over 35 years old), both the man and the woman must undergo a fertility test. A man may consider having a fertility test earlier if he has a previous medical condition or history that can cause infertility, such as :

• Testicular lesions ;
• Erectile dysfunction;
• Previous cancer treatment;
• Previous mumps infection;
• Prior urinary tract surgery.

Fertility tests for men

• Assessment of medical history

The doctor will explain the causes of male infertility such as accidents, illnesses, operations or existing conditions, and discuss anything that may have happened in the man's medical history to cause the infertility. The doctor will also discuss other topics such as lifestyle factors, including obesity.

• Semen analysis

A semen analysis will show the quantity of semen that the man produces as well as the shape of the sperm (morphology), their quantity and quality of movement (motility). In some cases, multiple sperm tests are performed, as sperm levels can fluctuate from one test to the next. Men should plan to give samples on two visits to the doctor at least two weeks apart.