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Here you will find answers to the most common questions about fertility checks and fertility evaluations at Medicus — what is examined, when you should seek help, and how age affects fertility.
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You can have your blood tests done at our office, at your GP's office or at the hospital laboratory. It is not normally necessary to make an appointment to have your blood tests done.
How long it will take before you get a final answer will depend on where the woman is in her cycle. Usually it will take about 1-4 weeks before we have all the answers and can recommend a treatment method.
Which tests you will take will be determined based on the information you have submitted in advance, for example about your menstrual cycle.
If we cannot find any other cause for the infertility problem, it is possible that the cause is damage to the woman's fallopian tubes. We will then examine the uterine cavity and fallopian tubes with an ultrasound contrast examination.
If the check shows another explanatory reason for the infertility that indicates that you need IVF treatment to get pregnant, we may refrain from examining the fallopian tubes. The reason for this is that in that case, it will be irrelevant for the choice of treatment whether the fallopian tubes are normal or blocked.
The questions asked may vary somewhat from doctor to doctor, but normally the following issues will be addressed:
The woman:
Common personal information such as name, age and occupation
Whether you have been pregnant and whether this was with a previous or current partner
Whether you have given birth to a child and whether the child's father is a former or current partner
If it took a long time to get pregnant in the past
How long have you been trying to get pregnant now?
What contraception you have used and when you last stopped using it
Whether you have regular sex or whether one of you is away for extended periods of time
Your age at first menstruation
About your menstrual cycle: how often it comes and how long it lasts
If you have pain during menstruation
If you have pain during intercourse
About previous pelvic diseases
About other previous illnesses
If you have any illnesses now
Whether you use regular medications and if so, which ones
Men:
Whether you have children from a previous or current relationship
Whether you have known pelvic disease or injury from the past, e.g. testicular or prostate inflammation, or whether you have any other previous disease that is of significance for infertility
If you have had surgery for a hernia or undescended testicles
If you have had mumps as an adult with swelling and pain in the scrotum
Both:
How often do you have intercourse?
Whether you have tried to coordinate intercourse and the estimated time of ovulation
Whether there are problems with having intercourse or problems with ejaculation during intercourse
In addition to asking questions, the doctor will perform some simple examinations on you.
The woman:
Hormone test (blood test)
Gynecological examination and ultrasound examination of the uterus and ovaries
Often the fallopian tubes will also be examined.
Men:
Semen examination at a sperm laboratory
In case of reduced sperm quality, hormone tests are also taken.
Sometimes, an examination of the external genitalia, especially the testicles and spermatic cord, as well as the prostate gland, will also be performed to look for infection or nodules.
We normally have a short waiting time for the fertility check. With us, you can start whenever you want.
Men also become less fertile with age, but their fertility decreases more slowly than in women and only begins to decline in later life. After the age of 45, we increasingly find chromosomal damage in sperm cells. This can lead to reduced fertility, to the eggs stopping developing before pregnancy occurs, or very early in pregnancy. We can detect such genetic errors with the Comet test, which examines the genetic content of each individual sperm cell.
There is no solid evidence that stress causes infertility, other than that it can lead to reduced sex drive and decreased frequency of intercourse. Stress is certainly an important factor in those experiencing infertility problems, especially before an explanation for the problem has been found. In some women, stress can lead to ovulation disorders and a reduced chance of getting pregnant.
Some women need a few months to achieve regular ovulation after stopping the pill. Otherwise, previous pill use does not cause reduced fertility. If the woman started taking the pill because of hormonal disorders, these can manifest themselves again when she stops using the pill and cause reduced fertility. Taking the pill reduces the risk of contracting infections that can later cause infertility problems.
A retroverted uterus is not a cause of infertility. About 70% of all women have a uterus that is tilted forward. The rest have a uterus that is tilted backward. This is as normal as most people being right-handed while some are left-handed.
No. Only a few of the eggs in the ovaries undergo natural ovulation during a woman's fertile period. Most of them die due to atresia (programmed cell death). In vitro fertilization uses several of the eggs that are starting to develop. The stimulation allows more than one egg to develop and mature. In a natural cycle, many eggs start to grow, but only one is allowed to mature and ovulate.
A woman between the ages of 25-35 is at her most fertile age. After that, fertility gradually declines towards the age of 40, and then it declines rapidly.
The woman is born with a given number of eggs in her ovaries. The eggs do not renew themselves and age with the woman. Older eggs will be less fertile than younger eggs. Older women have a greater chance of developing genetically abnormal fertilized eggs. These have a reduced ability to attach to the uterus, giving rise to an increased number of early miscarriages.
With increasing age, the number of cycles without ovulation increases. The uterine lining is less receptive to fertilized eggs in older women. The incidence of endometriosis increases with age and may be a contributing factor to reduced fertility in some. It is important to note that these are general considerations, and that many women become pregnant and give birth even in adulthood.
There may be genetic causes, such as Turner syndrome (X0), or that the ovaries are damaged as a result of radiation therapy or medical treatment for cancer with chemotherapy. In some, it may be due to autoimmune disease, and in many cases there is no explanation for why premature menopause occurs, but there may be a familial predisposition to this.
The absolute age limit for embryo transfer or insemination is 46 years by law. Medicus has an upper age limit of 43 years. This means that treatment is not offered to couples or singles where the woman is 44 years or older. However, we do make individual assessments for women who are 44-45 years old. We do not have a defined lower age limit. Read more about this in our blog.
Premature menopause is present if menstruation stops before the age of 40, hormone tests show elevated levels of the hormones FSH and LH along with low levels of the hormone estradiol, and ultrasound shows small ovaries with few follicles and a thin uterine lining. The same changes are found in natural menopause, but 10–15 years later.
If you already know or suspect a cause of reduced fertility, you should start investigating earlier. It could be that:
The woman has very long or very irregular cycles
The woman has had a previous pelvic infection
The woman has been treated for a ruptured appendix.
Abnormally much pain around the menstrual period or during intercourse, which suggests that endometriosis may be present
The man has had surgery to move his testicles back into their scrotum.
The man had mumps as an adult with swelling and pain in the scrotum.
One of the parties has lived in a previous childless relationship for no known reason
If you do not suspect that there is something wrong, you should not worry about infertility until after one year of regular intercourse without contraception.
Infertility is a problem that affects both partners in a relationship. The cause may lie with the woman, the man, or both. Therefore, it is important that you carry out the investigation together.
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