Feminine

What basic tests are done to evaluate female fertility?

Basic tests for evaluating female fertility begin with a detailed medical history and physical exam. The main evaluations include the transvaginal ultrasound, which is performed to observe the uterus and ovaries with two main objectives: to check for any uterine malformation or other anatomical complication, and to count antral follicles (RFA) in the first days of the cycle to assess ovarian reserve. Also essential are hormonal analysis which include FSH, LH, estradiol, TSH and prolactin.

La ovarian reserve test is performed through a simple blood test that determines the levels of anti-Müllerian hormone (AMH) and allows us to estimate the quantity and quality of oocytes and the level of fertility of women. Other important tests include the hysterosalpingography (HSG), which evaluates the permeability of the fallopian tubes, and the vaginal cytology to rule out infections or changes in the cervix that could affect fertility.

In specific cases, additional tests may be necessary, such as hysteroscopy Or the laparoscopy to better evaluate the uterine cavity or the presence of conditions such as endometriosis.

How is ovarian reserve evaluated and what does it mean for fertility?

Antimullerian hormone (AMH) is an indicator of a woman's ovarian reserve, and therefore assesses her fertility status at any given time. This hormone is produced by ovarian follicles throughout a woman's reproductive life, from puberty to menopause.

A value between 0.7 and 3.5 ng/ml indicates a normal ovarian reserve; while values lower than 0.7 ng/ml are considered indicative of a low ovarian reserve. These values provide crucial information about the possibilities of natural conception or through assisted reproduction techniques.

In addition to AMH, antral follicle counting (RFA) using transvaginal ultrasound is another important method for evaluating ovarian reserve. If the gynecologist has 5 to 10 antral follicles in each ovary, the ovarian reserve is considered to be normal. Conversely, values below 5 or above 10 antral follicles (per ovary) will be interpreted as a low or a high ovarian reserve, respectively.

It is important to remember that age is the most determining factor in female fertility, because the quantity and quality of eggs decrease significantly after the age of 35. La preservation of fertility freezing eggs may be an option for women who want to postpone motherhood.

What conditions can affect female fertility?

A number of conditions can affect female fertility. Los ovulatory disorders they account for approximately 25% of cases of female infertility and include polycystic ovary syndrome (PCOS), premature ovarian failure, and hypothalamic or pituitary disorders. Los tubal problems as obstructions or damage to the fallopian tubes can prevent sperm from reaching the egg or the fertilized egg from reaching the uterus, often caused by pelvic inflammatory disease, endometriosis or previous pelvic surgery.

Las uterine anomalies such as fibroids, polyps, congenital malformations and intrauterine adhesions also represent significant obstacles. La endometriosis, a condition in which the tissue that normally covers the uterus grows outside of it, can affect the Fertility in a variety of ways, including the formation of scars and adhesions. Finally, the cervical factors as problems with cervical mucus or cervical anomalies can make it difficult for sperm to pass through.

The accurate diagnosis of these conditions is essential to determine the most appropriate treatment, which can include everything from medications to induce ovulation to techniques of assisted reproduction Like the artificial insemination Or the in vitro fertilization.

Masculino

What are the main tests for evaluating male fertility?

The male fertility evaluation begins with a detailed medical history and physical exam. El Seminogram or spermiogram is the primary test for evaluating male fertility. It consists of the analysis of semen to determine various parameters such as sperm concentration, mobility and morphology. According to standards established by the World Health Organization (WHO), normal values include a volume of 1.5-5 ml, concentration of ≥15 million sperm per ml, progressive mobility of ≥ 32% and normal morphology of ≥ 4%.

La physical examination is performed to evaluate both the general state of health of men and their sexual organs, in order to rule out testicular or ejaculation problems. El hormonal analysis Using a blood draw, it measures levels of testosterone, FSH, LH and prolactin, while the testicular ultrasound helps detect varicocele, cysts or other anatomical anomalies.

In specific cases, additional tests such as karyotyping (chromosomal analysis), sperm DNA fragmentation test or sperm FISH may be required to evaluate genetic aspects that could affect fertility.

What information does a seminogram provide and how is it interpreted?

The seminogram, or spermiogram, is a diagnostic test performed on seminal fluid to evaluate its quality and check if there is a male fertility problem that makes it difficult to achieve a pregnancy. This test provides information about:

Macroscopic characteristics:

• Color: It must be homogeneous and opalescent gray
• Volume: Between 1.5 and 5 ml
• Viscosity: Excessive viscosity can hinder sperm mobility
• pH: Normally between 7.2 and 8.0

Microscopic characteristics:

• Sperm concentration: Number of sperm per ml
• Mobility: Percentage of sperm with progressive movement
• Morphology: Percentage of normal-shaped sperm
• Vitality: Percentage of live sperm

Depending on the results, different diagnoses can be established, such as normozoospermia (all normal parameters), oligozoospermia (low concentration), asthenozoospermia (low mobility), teratozoospermia (abnormal morphology) or azoospermia (total absence of sperm).

It is important to perform two seminograms separated in time (between one and three months) to confirm the results, as there may be variations. La Adequate interpretation on the part of a specialist is essential to determine the most appropriate treatment.

What factors can affect male fertility?

A number of factors can affect male fertility. Los genetic factors are very important; karyotyping is performed routinely in cases of both male and female infertility, because if the parents have any chromosomal abnormality, it is quite possible that this is the cause of their problem conceiving. El Varicocele (dilation of the veins of the spermatic cord) can increase testicular temperature and affect sperm production, while infections such as orchitis, epididymitis or prostatitis can impair seminal quality.

Los hormonal disorders that involve imbalances in testosterone, FSH or LH can alter sperm production, and obstructions in the tubes that carry sperm, they can prevent their exit during ejaculation. Los environmental factors and lifestyle such as exposure to excessive heat, alcohol and tobacco use, stress, exposure to environmental toxins and obesity have a significant impact. Finally, the Age it also plays an important role; although in males there is never a cessation in gamete production, numerous studies have shown that there is a decline in sperm quality directly related to age, beginning between the ages of 40 and 70 a gradual process of decline in testosterone production.

Early identification of these factors through appropriate fertility tests makes it possible to implement specific treatment strategies, which may include lifestyle changes, medical treatments, or treatment techniques assisted reproduction when necessary.

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Procedures

How do patients prepare for fertility tests?

Proper preparation for fertility tests is critical to obtaining accurate results. Women should consider the time of the cycle for certain tests: hormonal tests such as FSH and estradiol are recommended between the second and fifth day of the menstrual cycle, while the ovarian reserve test using anti-Müllerian hormone has the advantage of being able to be performed at any time during the cycle. For hysterosalpingography, it is scheduled between the end of menstruation and before ovulation (approximately between days 6-12 of the cycle). It's also important to avoid sexual intercourse 24-48 hours before some tests and to report any medications you're taking.

In the case of men, for the seminogram it is essential to have between 3 and 5 days of sexual abstinence, since less time could result in a reduced volume, while longer could affect mobility. It is recommended to avoid alcohol, tobacco and other substances that may affect seminal quality during the previous weeks, as well as exposure to high temperatures (saunas, hot baths) in the previous days. As with all medical procedures, it is essential to inform about the medications being taken.

In both cases, it is important to follow all specific instructions provided by the medical facility where the tests will be performed, as well as to report relevant medical history and known allergies.

Where and how are these tests performed?

Fertility tests can be performed in different medical settings:

1. Gynecological or urological consultations: For initial evaluations, medical history, physical exams, and some basic tests.
2. Specialized assisted reproduction centers: These centers carry out comprehensive female and male fertility studies, carrying out all the necessary tests to reach the correct diagnosis. They have multidisciplinary teams of specialists in reproduction, embryology and genetics.
3. Clinical laboratories: For hormone tests and other specific blood tests.
4. Diagnostic Imaging Centers: For tests such as hysterosalpingography, MRI, or specialized CT scans.

As for access to these tests, they can be performed both in the public health system and in private centers. In the case of Social Security, it is necessary to meet certain requirements to access assisted reproduction. Waiting times can be considerable, so many couples choose private centers where the process is usually faster although it involves an economic cost.

It is advisable to consult with the general practitioner or gynaecologist to obtain an appropriate referral according to each particular case. In Avida Fertility we have specialists trained to carry out all the necessary tests in a comfortable and professional environment.

What's next after fertility tests?

Once all fertility tests are completed, the process continues with:

1. Search for results: The specialist analyzes the results obtained in the different tests and establishes a diagnosis.
2. Personalized treatment plan: The tests are part of an analysis and research protocol that, once completed, allows the specialist to guide the couple regarding the possibilities of pregnancy based on the different assisted reproduction techniques.
3. Treatment options depending on the diagnosis:
   • Drug treatments: To correct hormonal imbalances or induce ovulation.
   • Surgical Procedures: To correct anatomical problems or conditions such as varicocele or endometriosis.
   • Assisted Reproductive Techniques:
     • Artificial insemination: Suitable for mild cases of infertility.
     • In Vitro Fertilization (IVF): For more complex cases that require direct manipulation of eggs and sperm.
     • IVF with ICSI: When there are significant problems with sperm quality.
     • Egg donation O spermatozoa: When own gametes are not viable.
     • Other advanced techniques according to specific needs.
4. Monitoring and adjustments: The treatment plan may require adjustments depending on the initial response, so it is essential to maintain regular follow-up with the specialist.
5. Psychological support: The process of diagnosing and treating infertility can be emotionally challenging, so many clinics offer specialized psychological support to help couples cope with this situation.

In Avida Fertility we understand that each case is unique and we accompany our patients throughout this process with a personalized and compassionate approach.

Treatment

What treatment options are there based on test results?

Diagnostic evaluations allow the development of personalized therapeutic strategies adapted to each identified infertility factor.

For ovulatory disorders, options include:

• Ovulation-inducing medications such as clomiphene citrate, letrozole, or gonadotropins
• Management of underlying conditions such as polycystic ovary syndrome using insulin sensitizers
• Laparoscopic surgery for ovarian drilling in selected cases

For tubal and uterine factors:

• Reconstructive surgery for proximal or hydrosalpinx obstructions
• Hysteroscopy for polyps, submucosal fibroids, or intrauterine adhesions
• In vitro fertilization when surgical repair is not feasible

For male factors:

• Hormonal treatment for endocrine imbalances
• Surgery for varicocele or reconstruction of blocked ducts
• Assisted reproductive techniques such as artificial insemination o intracytoplasmic sperm injection (ICSI)

For cases of unexplained infertility:

• Controlled ovarian stimulation with intrauterine insemination
• In vitro fertilization with embryo transfer
• Study and treatment of immunological or genetic factors

Dr. Javier Ramírez, a specialist in reproductive medicine at the National Institute of Medical Sciences and Nutrition Salvador Zubirán, points out that “the personalization of treatments based on accurate diagnosis has significantly improved success rates, reducing both the emotional and economic costs associated with infertility” (Ramírez, 2023).

When are assisted reproduction techniques recommended?

Assisted reproduction techniques (ART) represent advanced alternatives when other interventions are insufficient or inadequate.

Intrauterine insemination (IUI) is recommended as a first line in cases of:

• Cervical factor that prevents sperm from passing
• Ejaculatory dysfunction or inability to have sexual intercourse
• Unexplained infertility in couples with less than 3-4 years of evolution
• Mild male factor with reduced but functional seminal parameters

La in vitro fertilization (IVF) it is mainly indicated for:

• Bilateral tubal obstruction or severe tubal damage
• Moderate or severe endometriosis
• Low ovarian reserve with preserved ovarian function
• Failure of less invasive treatments after 3-4 cycles
• Severe male factor that requires specific techniques

Intracytoplasmic sperm injection (ICSI) is especially indicated for:

• Severe oligasthenoteratozoospermia
• Previous fertilization failure in conventional IVF
• Use of surgically obtained sperm
• Need for preimplantation genetic diagnosis

Donated gamete options are considered when:

• There is a complete absence of egg or sperm production
• The quality of own gametes is incompatible with embryonic development
• Presence of serious genetic diseases with a high risk of transmission

The selection of the appropriate technique must consider not only the medical factors identified through diagnostic tests, but also aspects such as age, duration of infertility, personal preferences and financial considerations.

What role does fertility preservation play after testing?

Fertility evaluations provide crucial information for making informed decisions about preservation of fertility, especially relevant in certain contexts.

Egg cryopreservation is a valuable option for women with:

• Adequate ovarian reserve who want to postpone motherhood
• Diagnosis of diseases requiring gonadotoxic treatments
• Progressive medical conditions that will impair ovarian function
• Need for surgeries that could compromise reproductive function

AMH and antral follicle count tests are essential to determine the optimal time for oocyte vitrification, since they provide information on the number of eggs that can be obtained per cycle.

La sperm freezing is recommended for men who:

• They will face potentially sterilizing cancer treatments
• They have progressive deterioration in sperm quality
• They require surgical procedures that could affect ejaculation
• They work under conditions of exposure to reproductive toxins

The semen analysis prior to cryopreservation determines the number of samples needed to guarantee sufficient genetic material for future treatments.

La embryo cryopreservation represents a consolidated alternative for couples in similar situations. The prior evaluation of both members allows us to estimate their reproductive potential and the chances of success with this technique.

These preservation options should be discussed when tests indicate a risk of impairment in reproductive capacity, offering proactive protection of future fertility potential.

How are genetic tests integrated into fertility evaluation?

Genetic evaluations complement the conventional fertility study, identifying inherited factors that influence reproductive capacity.

Karyotyping detects numerical or structural chromosomal abnormalities that can cause infertility, implantation failure, or recurrent pregnancy loss. This test is especially indicated in cases of non-obstructive azoospermia, severe oligozoospermia or a history of multiple spontaneous abortions.

The analysis of Y chromosome microdeletions evaluates specific regions (AZFa, AZFb, AZFc) critical for spermatogenesis. Approximately 10-15% of men with azoospermia or severe oligozoospermia have these deletions, whose identification allows for appropriate genetic counseling and selection of optimal assisted reproduction techniques.

Tests for specific monogenic mutations are indicated based on family history or suggestive clinical findings. For example, mutations in genes such as CFTR (associated with cystic fibrosis and congenital absence of vas deferens), FMR1 (related to premature ovarian failure) or BRCA1/2 (linked to cancer and decreased ovarian reserve).

Genetic carrier screening identifies recessive mutations that, although they do not directly affect an individual's fertility, can cause serious diseases in the offspring when both partners are carriers. This evaluation allows for options such as pre-implantation genetic diagnosis or gamete donation when significant risks are identified.

The integration of these tests into the fertility study provides crucial information for reproductive counseling, optimizing results and preventing the transmission of serious inherited conditions.

Prevention

How to maintain fertility based on test results?

Fertility evaluations not only identify current problems, but they provide valuable information to preserve future reproductive capacity.

Periodic monitoring makes it possible to establish personalized baselines and detect early changes in key indicators such as AMH levels or seminal parameters. This individualized follow-up facilitates preventive interventions before significant impairment of reproductive function.

The identification of modifiable risk factors through specific tests allows the development of personalized preventive strategies:

• Nutritional adjustments based on metabolic profiles
• Specific supplementation with antioxidants according to levels of oxidative stress
• Modification of environmental exposures identified as harmful
• Early treatment of conditions such as endometriosis or varicocele

The proactive preservation of genetic material Through egg freezing o sperm at optimal times, determined by reproductive function tests, provides “fertility insurance” for those who plan to postpone paternity or face factors that will progressively compromise their reproductive capacity.

Optimizing general health based on biomarkers identified during fertility evaluations (thyroid function, insulin resistance, inflammatory markers) benefits not only fertility but overall reproductive health.

According to Dr. Méndez (2022), “approximately 30% of cases of impairment in fertility could be prevented through early interventions based on periodic evaluations, especially in individuals with identified risk factors.”

What habits and lifestyles can improve fertility?

Lifestyle modifications can have a significant impact on reproductive function, complementing specific medical treatments.

Optimizing body weight through balanced diet and regular exercise significantly improves reproductive parameters. In overweight women with ovulatory disorders, a 5-10% reduction in body weight can restore spontaneous ovulation. In men, obesity is associated with hormonal changes and increased scrotal temperature that compromise the sperm quality.

Fertility-specific nutrition includes:

• Diet rich in antioxidants (vitamins C, E, zinc, selenium) that protect gametes from oxidative damage
• Omega-3 fatty acids that reduce inflammation and improve endometrial receptivity
• Reduction of processed foods and refined sugars that alter hormone balance
• Adequate hydration that optimizes the production of reproductive fluids

Effective stress management using techniques such as mindfulness, yoga, or moderate exercise reduces cortisol levels that interfere with normal reproductive function. Studies have demonstrated improved fertility parameters and higher treatment success rates when implementing stress management strategies.

Eliminating reproductive toxins includes:

• Cessation of smoking and alcohol consumption
• Minimizing exposure to endocrine disruptors in plastics and chemicals
• Reduction of exposure to excessive heat in the testicular area (saunas, laptops)
• Avoid medications that interfere with fertility when possible

These lifestyle changes can be implemented independently or as a complement to specific medical treatments, improving outcomes and reducing the need for more invasive interventions.

When are preventive fertility tests recommended?

Preventive evaluations make it possible to detect subclinical disorders and to act proactively before the development of manifest infertility.

Baseline evaluations at the beginning of reproductive age provide valuable information about individual reproductive potential. This initial assessment, usually between the ages of 25-30, establishes personalized baseline parameters that facilitate the interpretation of future changes and allow us to identify congenital conditions that could affect fertility.

Women with specific risk factors may benefit from early evaluations:

• Family history of premature menopause
• History of pelvic surgery or ovarian cysts
• Persistent menstrual disorders
• Autoimmune or endocrine diseases

For men, preventive evaluations are recommended when they have:

• History of cryptorchidism or testicular trauma
• Occupational exposure to reproductive toxins
• History of genitourinary infections
• Chronic use of medications that affect reproductive function

Regular monitoring after 35 years of age in women and 40 years of age in men can detect age-related changes and facilitates informed decisions about preventive strategies such as preservation of gametes.

These preventive evaluations not only benefit those who plan to postpone parenthood, but they allow for early interventions that can preserve long-term reproductive function, reducing the future need for complex and costly treatments.

References

1. Gonzalez, M. (2023). Advances in infertility diagnosis: Latin American perspectives. Mexican Journal of Reproductive Medicine, 15 (2), 78-92. Trusted Source.
2. Mendez, C. (2022). Male factors in infertility: Diagnostic and therapeutic update. Contemporary Urology, 36 (3), 145-160. Trusted Source.
3. World Health Organization. (2020). WHO laboratory manual for the examination and processing of human semen (6th ed.). Geneva: WHO Press. Trusted Source.

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