Standard fertility assessment explained

Emma Maria Adsuar, MD
Fertility gynaecologist , UR Vistahermosa

Fertility Assessment, Male Factor

From this video you will find out:
  • How can I check my fertility?
  • When should I consider my first visit with an Infertility Doctor?
  • What is the definition of infertility? What causes infertility?
  • What are the basic diagnostic tests of infertility for females?
  • What are the basic diagnostic tests of infertility for males?

What tests are done for fertility check in female and male?

In this session, Dr Emma Adsuar, Gynaecologist at Pregen (UR Vistahermosa) has explained how standard fertility assessment should look like, what to check, when and why.

- Questions and Answers

What do you consider irregular menstrual formula?

As I said, 2-3 days more is completely normal. Irregularity means that it doesn’t follow any pattern. The pattern can be, for example, every 25 days, this is regularity, or if the patient has a period sometimes every 28 days, some other time every 40, this is irregularity.

I missed the definition of the two types of infertility.1 – can’t conceive, 2 – can conceive with no live birth as yet. How do you name these to differentiate?

We use this in Spain. Infertility happens when you can conceive, but you are not able to have a live birth. Sterility is when you cannot conceive at all, you haven’t had any pregnancy.

We have been trying for two years and have had two ectopic pregnancies. Does having an ectopic pregnancy count as infertility within 12 months?

Yes, it counts as infertility. The most important thing is if those ectopic pregnancies were in the same tube or not. If its different tubes, I would recommend trying for six more months, but not longer. It also depends on age, but not more than six months, and if it doesn’t happen naturally, then I would visit a fertility doctor.

Do you also request DNA fragmentation analysis in sperm samples?

DNA fragmentation is supposed to be recommended in patients wherein the sperm test, you can see less than 4% of normal sperm.

We have been trying for three years, but when we were trying actively, we conceived twice. We had a miscarriage and an ectopic – should we just keep trying, or should I go for an extensive fertility checkup?

The most important thing is what do you understand about trying actively because some patients get it wrong when they think that, for example, they have been not using any protection for five years, but in the last year, they wanted to have a baby, so they might think they have been only trying to conceive for one year –  but they’re wrong. They have been trying to conceive for five years. You should go to the fertility doctor because if you had three years of unprotected sexual intercourse, even though you were not concerned about your cycles, not thinking that when you were ovulating, and you haven’t had any baby, then I would recommend you to go and visit the fertility doctor.

If we know one tube does not work: how can we progress with only the correct tube?

One is enough. Sometimes, you can see that the patient ovulated in the right ovary, and she got pregnant with the left tube. Nature is really smart, and with one tube, you can get pregnant.

Do you recommend doing REM to the sperm samples? In all the cases before the treatment of fertility?

It depends on if you are thinking of IUI, then yes. It will also give us more information, but if you are going to go directly to IVF, I think it’s not necessary.  REM is done when you are thinking of starting insemination, not when you are thinking of um in vitro.

We have had 2 IVF-ICSI, PGT-A cycles, and they were unsuccessful, both times no pregnancy. Our doctor didn’t find any reason for failure both times. He just asked to try again. In this situation, are there new recommended steps going forward before we embark on a new IVF journey, as we just don’t want to keep repeating the same thing?

I would like to tell you that the success rate is 100 %, but it’s not true. Even with PGT-A sometimes,  the success rate is like 60-70%.  I’m sure your doctor did everything he could. You can use corticoids, you can use intralipids, heparin. There are some therapies that you can add in the following IVF. The most important thing I would say is for the patient to be relaxed and positive because that helps a lot.

If we can conceive naturally but with no live birth, should we look at IVF?

Yes, in my slides, I was talking about specific blood tests for infertility. For example, if you have an autoimmune disorder, thrombophilia, or any of you are a carrier disease, it will not allow you to have a live birth.

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Emma Maria Adsuar, MD

Emma Maria Adsuar, MD

Dr Emma María Adsuar is a fertility specialist at UR Vistahermosa. Graduated in Medicine and Surgery from the University of Elche in Alicante. Trained in Obstetrics and Gynaecology. Dr Adsuar specializes in treating the diseases of the female reproductive organs and women's health during their pregnancy and just after the baby is born. The author of multiple scientific publications and attendee of international congresses in the field of reproductive medicine.
Event Moderator
Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.