Modern methods of infertility diagnosis

Modern methods of infertility diagnosisWhen a couple sees a single line on a test for months on end, their first reaction is usually one of alarm. However, in modern medicine, infertility is not regarded as a definitive diagnosis, but rather as a temporary condition of the reproductive system that requires expert ‘tuning’. According to WHO guidelines, doctors begin investigating the causes if conception does not occur within 12 months of regular unprotected intercourse.

For couples where the woman is over 35, this waiting period is reduced to 6 months. This is a pragmatic medical assessment. After the age of 35, the quality and quantity of eggs begin to decline more rapidly, and every year lost significantly reduces the chances of success. This article serves as a roadmap for those planning an evidence-based medical assessment.

Why diagnosis begins with a couple’s assessment

The most common mistake in clinical practice is the long-standing practice of examining only the woman. This creates a false sense of control over the situation, whilst time slips away.

The biological reality is that the male factor is responsible for the lack of pregnancy in approximately 50% of cases. Moreover, one in three couples is found to have combined infertility, where both partners have specific difficulties. This is precisely why modern reproductive medicine insists that diagnosis must be conducted in parallel. This is the only way to avoid a situation where a woman undergoes complex procedures, whilst the main problem lies hidden in her partner’s semen analysis results.

How the first stage of examination and clinical assessment takes place

The first visit to a specialist is not merely a formality, but a search for objective causes. The doctor analyses the couple’s lifestyle, as the reproductive system is the first to react to adverse conditions.

For women, the regularity of the cycle and the presence of pain are of key importance. Particular attention is paid to any previous surgery on the pelvic organs. Any past intervention could have left a trace in the form of adhesions, which obstruct the fallopian tubes.
For men, past infections and lifestyle are important. Regular exposure to high temperatures, such as frequent visits to saunas or working in hot workshops, as well as the use of muscle-building supplements, are often causes of temporary male infertility.

Practical conclusion. An individualised approach begins with an analysis of all medications taken and previous surgeries, as these can distort the results of hormone tests and affect fertility.

Modern diagnosis of female infertility

Ultrasound examination

Ultrasound is now a highly accurate monitoring method. Specialist equipment helps the doctor assess three critical factors:

Ovarian reserve. Counting antral follicles provides an understanding of the body’s current supply of eggs.
Condition of the endometrium. This is the mucous membrane in which the embryo must implant. Its thickness, structure and correspondence to the phase of the cycle are assessed.
Absence of pathologies. Fibroids, polyps and cysts can act as physical barriers, preventing the fertilised egg from implanting in the uterine cavity.

Assessment of ovulation and hormonal status

Hormones act as signals that regulate egg maturation. The main focus is on the following indicators:

FSH and LH show how effectively the brain stimulates ovarian function.
Prolactin and TSH often block ovulation when levels are abnormal, even if other indicators are normal.
Anti-Müllerian hormone (AMH) serves as a marker of follicle count. It does not determine egg quality, but indicates how much time a woman has left before her reserve is depleted.

Checking fallopian tube patency

The fallopian tubes act as a transport corridor. If they are blocked by adhesions following inflammation or surgery, natural conception is impossible.

Hysterosalpingography (HSG). This is the least invasive method. Patency is checked by injecting a solution under ultrasound guidance. The procedure takes about 20 minutes and does not require anaesthesia.
HSG (X-ray) is used to obtain detailed images of the tubes’ structure if the ultrasound method has not provided a clear answer.

Hysteroscopy and laparoscopy

These are surgical methods of direct visualisation. If standard tests do not provide an answer, the doctor uses microcameras.

Hysteroscopy allows the inside of the uterine cavity to be examined and polyps or adhesions to be removed immediately.
Laparoscopy detects endometriosis and adhesions in the pelvis that cannot be seen on a standard ultrasound scan.

Modern diagnosis of male infertility

Semen analysis as a fundamental diagnostic method

This test is considered essential for assessing male health. It shows the concentration, motility and morphology (structure) of the sperm.

Important to remember: sperm parameters can vary under the influence of stress or a recent bout of flu. Therefore, a diagnosis is never made based on a single test – at least two samples are required, taken 2–3 weeks apart.

MAR test and immunological tests

Sometimes sperm are active but are found to be bound together by specific proteins – antisperm antibodies. This is an immunological factor in infertility. The MAR test identifies such cases, explaining why pregnancy does not occur despite an apparently normal semen analysis.

Genetic testing

In cases of serious abnormalities in the semen analysis, the cause may lie in genetics. Chromosome analysis helps rule out hereditary factors that may prevent conception or affect the health of the foetus.

Artificial intelligence and digital technologies

In modern embryology, technology helps minimise errors:

CASA. Computerised sperm analysis systems provide mathematical precision in assessing cell movement trajectories.
Time-lapse systems. In IVF laboratories, special incubators with cameras monitor embryo development around the clock. Software analyses the rate of cell division and helps select the embryo with the highest potential.

Diagnosis of unexplained infertility

In approximately 10–15% of cases, standard tests reveal no abnormalities in either partner. This is referred to as unexplained infertility. Most often, this masks underlying issues at the molecular level. In such cases, the approach becomes more proactive to overcome the invisible obstacle.

What factors particularly affect fertility

The reproductive system is sensitive to the condition of the whole body:

Weight. An excess or critical deficiency of adipose tissue equally effectively blocks ovulation and reduces sperm quality.
Smoking. Nicotine causes DNA damage in gametes. A cell may appear normal, but its genetic code may be damaged.
Stress. Prolonged psychological stress affects hormonal balance, suppressing functions that are not vital for the individual’s survival at that moment.

When to consult a specialist

Medical practice recommends consulting a reproductive specialist in the following cases:

Age under 35 with no pregnancy for a year.
Age over 35 with no result for six months.
Menstrual cycle disorders (absence or irregularity).
Two or more previous pregnancy losses.
Previous groin surgery in men.

Modern diagnosis is not about finding someone to blame, but about piecing together a puzzle. The sooner a couple begins testing, the wider the range of treatment options available. Technology can overcome almost any cause of infertility, provided diagnosis is carried out systematically and in a timely manner. Time is considered the most important factor in family planning.

FAQ: Answers to frequently asked questions

If AMH is very low, is there no chance of getting pregnant naturally?

There is still a chance as long as ovulation is occurring. Low AMH is not considered a barrier to pregnancy; it is a signal that action needs to be taken quickly, as ovarian reserve is limited.

Why is it important to have tests on days 2–5 of the cycle?

During this period, hormone levels are at their baseline. This allows the doctor to assess the true potential of the ovaries before they begin preparing for ovulation.

Can an infection from many years ago prevent me from getting pregnant now?

Yes. Past infections can leave adhesions in the fallopian tubes or cause chronic changes in the endometrium, even if the infection itself was treated long ago.

Does a man’s excess weight affect the chances of conception?

Directly. Excess body fat alters a man’s hormonal balance, lowering testosterone levels and impairing sperm quality.

What is the implantation window?

This is a short period of time, usually 2–3 days, when the uterus is most receptive to an embryo. If the hormonal balance is disrupted, this window may shift, and conception will not occur.

How painful is a fallopian tube patency test?

The modern procedure, performed under ultrasound guidance, feels like brief discomfort in the lower abdomen. It lasts about 15 minutes and allows you to return to your normal routine straight away.