At the initial consultation, you will discuss your medical history with an expert and have an initial examination, consisting of ultrasound, smears and blood tests. If you need to minimise your days away from home, you can also undergo the examinations in your home country and send the results to us through our secure patient portal. The results will help us learn more so the doctor can assess your fertility and develop an individual treatment plan.
Personal medical history
At your first consultation you will have a conversation with your doctor, who needs to know your detailed personal, family and gynaecological history to identify the most appropriate treatment. The doctor will ask you questions about the course of your cycle, significant illnesses you may have had, surgeries, allergies and any medications you are taking. This allows the doctor to identify any possible causes of infertility and plan any further appropriate investigations.
An ultrasound examination is one of the first steps that you will take during the process of female infertility testing. Using the ultrasound machine, the doctor will assess the size and shape of the uterus and the uterine cavity, including the height of the uterine lining. The doctor will also examine the condition of the ovaries and fallopian tubes. This non-invasive imaging method can reveal possible causes of conception problems.
During the gynaecological examination, the doctor will also perform a cervical smear screening to rule out typical sexually transmitted diseases, such as chlamydia, ureaplasma and mycoplasma. Such conditions need to be cured before treatment can begin, as untreated infections can cause problems that can prevent pregnancy.
The sampling and examination of blood can reveal several possible causes that lead to conception problems. General health and potential venereal diseases are checked, as well as gauging the hormonal profile and the presence of antibodies that can cause infertility. The level of AMH (Anti-Müllerian hormone), which indicates the egg reserve, and the status of thyroid hormones are also checked.
Examination evaluation and planning for the next steps
Examination of fallopian tube patency
A common cause of infertility in women is the obstruction of the fallopian tubes. The obstruction prevents eggs from travelling to the uterus and the eggs, therefore, cannot be fertilised. Fallopian tube obstruction is typically caused by gynaecological inflammation, infections, adhesions or endometriosis and can be diagnosed by ultrasound or laparoscopy. If an obstruction is confirmed, pregnancy can only occur through IVF treatment; insemination is not an appropriate method in these cases.
Up to 10 % of couples cannot get pregnant due to the resistant reaction of the woman’s immune system. The immune system can produce antibodies against sperm and her own eggs and embryos, which can result in miscarriage and failed IVF attempts. Another reason for reproductive immunology testing, which is done simply by extracting blood, is to detect the presence of autoimmune disease in one of the partners.
Our doctors carry out genetic testing in case their medical history reveals possible genetic issues which can make conception difficult. Genetic testing prior to treatment is carried out in cases when a couple’s medical history reveals potential genetic issues. Genetic testing is also appropriate when a woman cannot conceive over a long time or has had repeated miscarriages without a clear explanation.
Examinations after repeatedly failed IVF attempts
The ERA test can be described as the fertility window test and can be used to determine the receptivity of the endometrium to progesterone. The ERA test facilitates the estimation of the moment when the lining of the uterus is utmostly ready to receive an embryo, at a much more accurate level than using ultrasound. This test is usually recommended for women who have had repeated failures in embryo implantation.
The EMMA test is used to determine the condition of the uterine mucosa (endometrium), specifically its microbiome, which consists of microbes that are both helpful and potentially harmful. In the event that deviations are detected, the doctor will propose an individual procedure for its return to an optimal state. Depending on the values found, treatment with antibiotics and/or probiotics may help. The EMMA test can be recommended in cases of repeated miscarriages and failed implantations.
The ALICE test detects pathogens that cause chronic inflammation of the uterine lining, even if only very small amounts of bacteria are present. These inflammations occur in up to a third of women who are unable to conceive and they can cause repeated miscarriages or embryo failure. Appropriate treatment, prescribed by your personal doctor, can address this problem.
The beReady test, like the ERA, determines the receptivity of the endometrium. Its results can be used to determine the ideal time to perform the embryo transfer given the optimal state of the uterine lining. Many women have a delayed implantation window, and resultantly they can experience a failure to conceive. The beReady test indicates whether it is appropriate to delay the transfer relative to this window.
The main factor in female fertility is age as both egg supply and fertility decline with age. If you are planning a pregnancy later, it is recommended to get your eggs frozen.
One factor that can negatively affect a woman’s fertility is smoking. It is also a possible cause of miscarriages and premature births.
Alcohol should be avoided or greatly reduced not only during pregnancy but also when you are trying to conceive.
Being overweight and also being underweight can be an obstacle when trying to conceive. In this case of weight issues, the focus should be on changing your lifestyle and diet.
A lack of physical activity negatively affects your overall health, which in turn affects your fertility. You should therefore incorporate regular exercise into your lifestyle.
Excessive stress negatively affects both physical and mental health, and coupled with a lack of rest, can also contribute to poor fertility. To optimise your chances of conceiving, try to get more rest.