Infertility examinations
Infertility examinations are easily available without a referral. Infertility studies begin with a first appointment with an infertility specialist.
Seeking infertility examinations
The purpose of infertility examinations is to determine whether the childlessness is caused by infertility or impaired fertility. Based on the results, we can assess the prognosis of the onset of pregnancy and plan the best and most suitable fertility treatment for you. The lack of egg cells, bilateral obstruction of the fallopian tubes and the lack of sperm in the semen require fertility treatment in order to begin the pregnancy. In other situations, pregnancy can begin naturally, but the treatments are aimed at improving the likelihood of pregnancy.
When should I seek infertility examinations?
Infertility examinations should be started no later than after one year of attempting to become pregnant without success. It is advisable to seek these examinations earlier if there is a known factor that lowers fertility or complicates pregnancy or the onset of pregnancy. These circumstances include, for example, the woman being over 35 years of age, known endometriosis, irregular menstrual cycle, absence of menstrual bleeding or abnormal structure of the uterus. It is advisable to seek these examinations without delay if there is known damage to the fallopian tubes. Correspondingly, a man should undergo a sperm analysis already when planning a pregnancy, for example, in the case of untreated or treated undescended testes or some other genital surgery, inflammation or trauma. Previous cancer treatment of the woman or man is a reason to seek infertility studies at an earlier stage.
Learn more about female infertility and fertility
Learn more about male infertility and fertility
Felicitas Mehiläinen provides easy access to infertility examinations
Infertility examinations are easily available without a referral. In addition to the online booking service, you can also book an appointment by phone. If you wish, you can ask to see a specific doctor. Infertility studies begin with a first appointment with an infertility specialist.
Book a free appointment with an infertility nurse to get valuable information about your fertility. The cause of infertility can be identified already at the first appointment with an experienced doctor. It is advisable to come to the first appointment together with your partner, if you have one.
Learn more about the specialists of Felicitas Mehiläinen.
Basic infertility examinations include:
- Examination of the woman’s hormonal activity, i.e. studying the menstrual cycle
- Examination of the anatomy of the uterus and fallopian tubes
- Sperm analysis
In every other couple, the cause of infertility is identified in either the woman or the man and, in a quarter of couples, it is identified in both. Infertility remains unexplained after the basic studies in about a quarter of couples.
We always begin to determine the cause of infertility with a careful interview, which provides the basis for infertility diagnostics. It is important to reserve enough time for this so that we can go through the important aspects and prepare an individual plan. The baseline interview includes, for example, questions about the general state of health, diseases, surgeries, current and previous medication and previous pregnancies. Previous infertility treatments are carefully reviewed and the necessary special examinations are planned.
The interview asks questions about your relationship and sexual life, such as the duration of the relationship, the frequency of intercourse and any history of sexually transmitted diseases. Matters related to lifestyle are also discussed. The interview also includes questions about smoking, substance abuse, weight, eating habits, eating disorders, stress, potential exposure agents in the workplace and physical activity. We advise the customer(s) to quit smoking and manage their weight, as smoking and obesity are the most important individual factors affecting fertility and infertility treatment outcomes.
The treatment of chronic diseases should be in balance at the beginning of pregnancy, preferably even before stopping the use of contraception. Medications used by the woman as well as those used by the man should be safe and suitable for pregnancy. It is particularly important to have a good treatment balance of diabetes and appropriate medication for epilepsy in the woman. People with diabetes and epilepsy should use high folic acid supplementation already when planning the pregnancy to prevent neural tube defects in the foetus (diabetics 4 mg/day and epileptics 1 mg/day).
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Detection of ovulation and studying the menstrual cycle
Other blood tests used in the examination of infertility
Thyroid disorders and excess production of prolactin (hyperprolactinemia) interfere with the normal development of the ovarian follicle and investigating these conditions is part of the basic studies (thyroid stimulating hormone (TSH) and prolactin, or milk hormone (PRL)). If the TSH level is abnormal, thyroid function is examined in more detail. In women with fertility problems, even mild and asymptomatic hypothyroidism is treated with a low dose of thyroxine administered throughout the pregnancy. Hyperprolactinemia is the most common hormonal abnormality that can cause menstrual cycle disorders. In the early stages of the cycle, we also examine anti-Muller hormone (AMH), which indicates the ovarian reserve (egg count).
Anaemia can be a symptom of a general illness or a condition that affects fertility. Therefore, a basic blood count is part of the basic infertility studies. For example, coeliac disease, inflammatory bowel disease with mild symptoms, heavy menstrual bleeding, hypothyroidism, excessive physical activity or an eating disorder can cause anaemia. Infertility patients suffering from anaemia should always be screened for coeliac disease. The possibility of coeliac disease must also be investigated if no cause for infertility has been identified or if infertility has lasted for a very long time. We treat iron deficiency anaemia associated with heavy menstrual bleeding with iron supplements. Iron deficiency is assessed with ferritin tests, which, in addition to vitamin D level tests, are today part of basic infertility studies.
The fasting blood sugar level is examined if the woman is overweight and, if necessary, glucose tolerance is investigated by other studies.
Uterus and ovary structure ultrasonography and tubal patency test
In the ultrasonography examination, we study the structure of the uterus, the endometrium, the size of the ovaries and the number and functional stage of ovarian follicles. A small size of the ovaries and a low number of follicles may indicate impaired functional capacity. Multifollicular (MFO) or polycystic ovaries (PCO) are often associated with the occurrence of ovulation disorders. Ovarian tumours, cysts and endometriomas are detected in the ultrasonography, but superficial endometriosis of the abdominal cavity cannot be determined with this study. However, endometriosis within the muscular wall of the uterus, or adenomyosis, may be detected in the study.
Healthy fallopian tubes are not shown in the ultrasonography, but chronically inflamed or clogged, fluid-filled fallopian tubes may appear. A natural intrauterine pregnancy can begin if at least one of the fallopian tubes is open and functioning normally. The tubal patency test is based on a hysterosalpingosonography (HSSG) examination. We carry out the study early in the cycle after the end of menstruation and before ovulation. The study can be performed while assessing the development of the ovarian follicle. The examination is especially important if there is a known infection of the genitalia, for example, chlamydia, ectopic pregnancy or other suspicion of a possible occlusion. It is not part of the basic examinations in the case of brief infertility and if the woman has no known pre-existing fallopian tube injury or anatomical history thereof. In the examination, a thin catheter is inserted into the uterus to inject a mixture of air and saline into the uterus. If the fallopian tubes are open, the passage of air bubbles to the ovaries can be seen. The structure of the uterine cavity is also studied in this examination. The possible occlusion of the fallopian tubes can also be determined in an abdominal endoscopy, or laparoscopy, if endoscopy is necessary, for example, in the treatment of endometriosis. The tubal patency test shows whether the fallopian tubes are open or blocked, but it is not possible to determine their function in this study.
The situation of the uterine cavity is also examined in a hydrosonography. This study allows for internal uterine cavity myomas, polyps, the uterine cavity septum and adhesions to be seen better than in a normal ultrasonography. All of these can reduce the chances of embryo implantation and complicate fertility.
Semen analysis and other studies on men
Sperm analysis is a basic study in determining male infertility. If the semen is found to be normal, no further studies are usually required. The sample is recommended to be provided by masturbating in a specially designed sample container one to three days after the previous ejaculation. The sample should be examined within one hour of sample administration and should not be exposed to temperatures below 20°C or above 40°C. The analysis is based on the sperm count, motility and structure. Sperm sticking together (agglutination) can impair fertility and be a sign of antisperm antibodies. The amount of antibodies of the IgG and IgA class on the surface of sperm is measured with a mixed antiglobulin reaction (MAR) test, which is automatically included in sperm analysis. Diseases and lifestyle factors can increase the amount of oxygen radicals in sperm, that is, cause so-called oxidative stress, which means an imbalance in the oxidation-reduction state of cells. Minor oxidative stress is required for normal sperm function, but excessive stress can cause damage to the sperm’s surface, motility and genetic material, i.e. DNA, and may impair fertility. Antioxidant formulations specially developed for this can remedy the situation, but ensuring proper lifestyles is always the preferred option.
Excess white blood cell count or high viscosity of semen may indicate inflammation, such as prostatitis. Blood in the seminal plasma is usually a normal finding in young men. The significance of the result of the sperm analysis is wholly clear only if no sperm is detected in the semen (azoospermia). In any other case, the results should be interpreted with caution. The quality of sperm varies even in fertile men on a daily basis and an abnormal sperm sample must be controlled to ensure the result.
The cause of abnormal semen is first examined based on the man’s medical history and a clinical examination. As additional studies, it is often useful to find out whether there is damage to the sperm’s DNA strand, i.e. DNA fragmentation, or whether there is an imbalance in the oxidation-reduction state of the cells, i.e. oxidative stress. These disorders can be corrected by improving lifestyles or targeted vitamin therapy. Severe sperm disorders always require further studies, which include hormonal and genetic examinations. Most commonly, the hormones checked include FSH and LH, which control the function of the testicle, as well as testosterone, which indicates the functioning of the testicle. TSH and PRL levels are also examined. An elevated FSH value indicates testicular sperm production disorder. In connection with severely impaired sperm production, testosterone production may also be reduced, which should be taken into account with regard to the man’s overall health. Genetic studies include a chromosome analysis and the determination of Y chromosome microdeletions. The most well-known chromosomal disorder is Klinefelter syndrome (46, XXY). Testicular ultrasound is always performed in the case of severe sperm production disorders. A sample is taken from the testicle (testicular biopsy) if no sperm are found in the semen or if there are only a few sperm. The sperm extracted in the biopsy can be used in fertilisation to initiate a normal pregnancy. The biopsy may also reveal the cause of a low sperm count.
Special infertility examinations
Repeated unsuccessful infertility treatments may be associated with rare disorders that can be investigated through a variety of studies. As a rule, these special examinations are not recommended in the early stages of infertility treatment, since the majority of those receiving treatment achieve pregnancy with the help of the basic examinations and most common infertility treatments. However, it is worth expanding the studies at an earlier stage if the background information indicates this.
The special examinations include autoimmune disease examinations, coagulation factor examinations, chromosome examinations, examinations of rare diseases, compatibility examinations (male-female immunological compatibility) and endometrial examinations.
Endometrial immune profile and microbiome
The aim of endometrial examinations is to determine both the potential for endometrial receptivity and the best time for the implantation of the embryo. The endometrium must have an immune profile that supports the implantation of the embryo. Based on a mucous membrane sample, we can study the immunological activity of the endometrium and try to influence the possible rejection of the embryo or stimulate the excessively passive mucous membrane accordingly. The endometrial sample can also be used to determine the possibility of latent infections. Proper endometrial bacterial balance contributes to the implantation of the embryo. The microbial strain of the endometrium is also called the microbiome. The sample is used to determine whether there are suitably beneficial bacteria (lactobacilli) for proper endometrial function and whether there are too many potentially harmful, i.e. pathogenic, inflammatory bacteria. Based on the results, treatments that affect the bacterial strain can be proposed.
Embryo transfer timing
The best time for the embryo implantation may not be the same as in a normal menstrual cycle, when the most suitable time for implantation is about six days from ovulation. Certain genes begin to appear on the endometrium at this time. We can determine the proper time for embryo transfer by taking a mucous membrane sample from the uterus on the expected date of embryo implantation and examining its genetic profile. The embryo transfer time is moved, if necessary, on the basis of the result.