From the beginning, both partners should be involved in the conversation and the diagnostic process. Taking a history and medical history are part of this, as is an initial general examination.
- In the woman, various methods are used to check whether she is ovulating and whether the fallopian tubes are clear. This is done by means of contrast medium and ultrasound, sometimes a laparoscopy is also necessary.
- In men, reduced fertility is usually due to changes in the sperm. Therefore, it is often sufficient that he gives a sample of his semen, which he obtains after about three to five sexually abstinent days by means of masturbation. The semen is usually collected undisturbed in shielded rooms of the practice. The sample can also be collected at home and delivered to the laboratory as soon as possible. Prerequisites for this, however, is that the man is previously explained by the doctor exactly about extraction and storage.
What happens to the semen sample?
From the ejaculate is made in the laboratory as soon as possible a so-called spermiogram. Verified are:
- Color,
- Odor,
- Volume,
- PH of the semen,
- Its sugar content (fructose index),
- Its viscosity (viscosity).
- Under the microscope, the mobility, number and shape of the sperm are then assessed.
In a normal volume of 2-6 ml should be a total of at least 40 million, per milliliter 20 million sperm cavorting. Of these, more than 65% should be normal in shape and movement, of which at least 25% should be clear. If all or part of these values are abnormally altered, the ability to conceive is diminished, and in rare cases nonexistent.
What happens if the spermiogram is altered?
If the result is not normal, at least a second examination should be performed at intervals of one month, since the values can vary greatly from sample to sample.
If few or few active sperm are again shown, additional examinations are necessary. In addition to an ultrasound of the testicles and prostate, which can reveal tissue changes caused by a tumor, for example, hormone tests are performed. Tissue samples under local anesthesia are only taken if extremely few sperm are found in the spermiogram. This makes it possible to check whether sperm cells are being produced at all. A blood sample may be taken to look for genetic abnormalities. This is especially recommended before artificial insemination (in both partners).
What happens next?
In most cases, the cause is found and the infertility can thus be targeted medically. The spectrum ranges from successful hormone treatment of the woman or – in the case of a poor spermiogram – of the man to artificial insemination with, unfortunately, a lower success rate and a higher complication rate. Experts estimate that – including all measures – in about 60-70% of initially infertile couples the desire to have a child is fulfilled after all with medical support and targeted treatment. On average, they need about a year of patience and perseverance to do so.
