How long should a couple try to conceive before receiving help from a specialist?
To increase the chances of conception, the couple needs to have free and complete intercourse every 2-3 days. When there is no previously known reason for infertility and the woman is under 35 years of age, an infertility check will be performed after one year of trying to conceive. However, if she is older than 36 years of age, they should visit a specialist after six months of trying to conceive unsuccessfully.
What tests are needed in these cases?
Both the woman and the man are tested.
Tests for the woman:
- Obtain personal and family medical history, with questions focusing on gynecological and obstetric issues, surgeries, pediatric diseases, and any other history of hereditary diseases in the family.
- A gynecological examination and transvaginal ultrasound is performed. The anatomy of the uterus is checked for possible fibroids, endometrial polyps, and uterine malformations. We determine if ovarian cysts are present, and ovarian volume is calculated.
The test is completed by measuring antral follicles, which are very small, about 2-8 mm in diameter.
- The basic hormonal test is performed on the 3rd day of the cycle, measuring FSH, LH, estradiol, AMH, TSH, and prolactin.
- In special cases of polycystic ovaries, testosterone (total – free), 17-hydroxyprogesterone, DHEA-S, Δ4 – androstenedione and in the luteal phase progesterone are additionally measured.
- On the 8th-10th day of the period, a hysterosalpingography (HSG) is performed to determine the anatomy of the intrauterine cavity and fallopian tubes.
Tests for the man:
A semen analysis is scheduled after 2-3 days of abstinence.
About 40-50% of infertility cases are of male origin either exclusively or coexisting with other factors.
What is the “reserve” of the ovary?
The “reserve” of the ovary is the number of eggs in the ovary that will develop in the future; an indicator of the reproductive future of the ovary.
This is determined by the number of antral follicles in combination with the measurement of FSH and AMH hormones on the 3rd day of the period. That can help estimate the number of eggs that are left in the ovary and will develop in the future, but not their quality. The ovary has a rich reproductive future when the value of FSH is low, the value of AMH is high, and the number of antral follicles is satisfactory.
Furthermore, ovarian reserves determine the ovarian response to infertility treatment. The larger the reserves, the more follicles mature in an ovarian stimulation treatment.