The diagnostic tests (seminogram, sperm survival test, biochemical test or semen culture) provide us with information about the quality of your sperm and its capacity to fertilise an egg. That information, together with the results of the gynaecological examination of your wife, will allow the gynaecologist to recommend the most suitable assisted reproduction technique (Artificial Insemination, In Vitro Fertilisation and Intracytoplasmic Sperm Injection) for you.
Ovulation disorders are often the cause behind fertility problems. In women with regular cycles (every 26 to 30 days) ovulation occurs half-way through the cycle, around the 12th or 14th day. However, if the time between periods is long, over 35 days, ovulation may or may not occur during the cycle, or may occur 20 to 25 days after the last period. The solution to this problem is the stimulation of the ovulation through medication, in al cases strictly controlled through ultrasound scans and, if there are no other related problems, sexual intercourse can simply be planned when the ultrasound shows that the woman is about to ovulate.
The fallopian tube is the place where the egg and the sperm meet, which is why if both the left and the right tubes are blocked the chances of a spontaneous pregnancy are slim. In the past, the solution to blocked tubes used to be surgery; these days in vitro fertilisation (IVF) provides a far more efficient solution.
The causes of endometriosis are unknown. It occurs when endometrial tissue (which is a tissue inside the uterus) is located outside the uterus. It is not known with certainty how that tissue gets outside the uterus. The endometrium may be located in places other than the pelvic cavity. For some patients surgery is a solution, whereas for others it is safer not to undergo surgery, depending on the location and extent of the endometriosis.
Women with endometriosis may have more trouble getting pregnant. About 30 to 40% of women with endometriosis have fertility problems. The precise causes of the infertility are not known, although it is thought that the endometriosis triggers a hostile environment for the implantation of the embryo. Some women with endometriosis need to undergo a fertility treatment in order to become pregnant.
It is not uncommon for men or women who in the past decided to undergo surgery as a method of contraception to decide later in life that they want a baby. In those cases the Assisted Reproduction Techniques provide an efficient and prompt solution in comparison to reversal surgery, which is not always an option.
Couples in that situation are increasingly opting for In Vitro Fertilisation or the Intracytoplasmic Sperm Injection technique. Which one of the treatments to choose will depend on whether or not the couple suffers from any other fertility problems, which will be diagnosed through the tests carried out prior to the treatment.
If the man had a vasectomy carried out he must first undergo a small operation known as TESA. The TESA is a testicular biopsy carried out to try and retrieve sperm from the testicle, epididymis or vas deferens.
Under Spanish legislation on Assisted Reproduction Techniques any woman without a male partner is entitled to have recourse to these techniques in order to become a mother. If the woman does not have any fertility problems, which will be checked through prior tests, the assisted reproduction technique most frequently recommended is Artificial Insemination with donor sperm. If a fertility problem is discovered, In Vitro Fertilisation may be used, again with Donor sperm. Under current legislation the medical centre may not reveal the identities of the donor and the recipient. The sperm donors have to pass a strict selection process and undergo extensive health checks.
In order to achieve a pregnancy eggs must come out of the ovaries. When the ovaries stop working sooner than expected, and the menopause starts, the only way of becoming pregnant is by using the eggs (or, failing that, the embryos) of another woman. Since the eggs are donated by young women without fertility problems, this In Vitro Fertilisation technique has a high success rate.
If a seminogram shows a complete lack of sperm, a second seminogram is first done to confirm the result. Next, a sperm capacitation test is carried out to try and isolate sperm in the sample, even if only in small quantities, and, where possible, the sperm is frozen.
If the absence of sperm is confirmed, your urologist will carry out a study to determine the possible causes. The study will involve a series of tests including a genetics test and hormone analysis. If all the parameters turn out to be normal we will carry out a testicular biopsy with the aim of retrieving sperm from the testicular tissue and, if possible, freezing it. It is then possible to try and achieve a gestation through in vitro fertilisation with an intracytoplasmic sperm injection, using the previously frozen sperm.