Female infertility, the first tests to be done to find out the causes

Female infertility, the first tests to be done to find out the causes
Source: Alfio Finocchiaro / Alamy / IPA

Months and months of trying, but nothing happens: that much-desired pregnancy does not come, and the suspicion creeps in that there is something wrong. In these cases we then proceed with a series of investigations to try to identify any causes of reduced fertility, according to a protocol that is approximately standard for many centers.

“As for the woman, first of all the specialist doctor collects one of his own complete medical history (i.e. her medical history) and submit her to one first visit”Explains the Bolognese gynecologist Carlo Flamigni. This is to be able to detect any signs of any condition that could cause infertility or sterility ”. Depending on the case, a series of increasingly sophisticated investigations may then be requested.

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The exams that may be required in a first phase of the investigation are:
- urinalysis or urethral swab to search for the presence of infections, in particular from chlamydia and mycoplasma.
- blood tests for hormone measurements, to see if the woman is ovulating (e.g. LH, FSH, AMH) and to evaluate thyroid function (TSH and anti-thyroid antibodies). On this occasion the coverage or not with respect to rubella, toxoplamosis and other infectious diseases that could represent a cause of fetal malformation is also evaluated.

- cervical smear (Pap smear), if it hasn't been done recently. "In reality it is not useful for the purpose of diagnosing infertility, but every gynecological visit is taken advantage of to perform very important operations and which women also tend to forget", Flamigni points out.

The doctor will refer the woman for further tests if she has a cycle of less than 21 days or more than 35, has been trying to conceive for more than 18 months, or has had any gynecological disease or condition in the past, such as pelvic infection, endometriosis or a ectopic pregnancy.

Infertility or sterility

Today we hear about infertility much more frequently than infertility, and the two terms are generally used interchangeably. To be precise, however, they indicate slightly different conditions and the use of the term infertility has been prompted by the fact that sterility in English is called infertility.

Technically, for sterility is meant the inability to conceive, while for infertility we mean the inability to carry a pregnancy to term and to give birth to healthy children capable of surviving: in this case there may also be conception but, for example, there is no engraftment of the embryo or repeated abortions.

(Revised by Valentina Murelli)

With the advice of Prof Carlo Flamigni, surgeon, lecturer in the obstetric and gynecological clinic, member of the National Bioethics Committee

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