If couples remain involuntarily childless, this can have many different reasons. In about 30 percent of cases the cause is only due to the man or only due to the woman. Both partners are affected in 15 to 30 percent of cases. In the other 10 percent of cases, the cause of the unfulfilled desire to have children cannot be identified despite extensive diagnostics.
In the consultation your doctor will ask you about your history (e.g. Ectopic pregnancies, previous operations, cycle disorders or impaired sperm quality) and will suggest further examination stages and a treatment method on the basis of your answers.
An important step in diagnosis is the blood test for hormone determination. Not only ovarian hormones, which control the female cycle, but also thyroid hormones or the hormones of the pituitary gland can have a negative influence on fertility.
In women with cycle disorders, ultrasound monitoring (in connection with blood tests, starting from the 10th to the 12th day of the cycle) can show whether follicular growth, and thereby, ovulation, take place. In the case of normal ovum maturation the ovulation and thereby the optimal time for fertilisation can also be predicted.
Fallopian tube patency
The fertilisation takes place in the fallopian tube. The fallopian tubes must be patent (open), so that sperm cells (coming from the vagina through the womb) and ovum cells (released from the ovary during ovulation) can meet there. An outpatient operation (laparoscopy) in a hospital can be used to check whether this is the case.
The inside of the womb is normally smooth and lined with a mucous membrane. In rare cases, uterine anomalies, polyps (mucosal overgrowth) or larger myomas (benign muscular knots) can interfere with the implantation of the embryo. Uterine endoscopy – a short outpatient procedure that can also be completed without anaesthetic – can recognise these findings so they can be surgically removed later on.
A rare cause of sterility are chromosomal disorders in men and women. A blood test checks whether a normal set of chromosomes - female: 46XX or male: 46XY - is present. Deviations from this are hereditary but do not necessarily lead to illnesses. The implications of an unusual set of chromosomes must be discussed with those persons affected in extensive genetic counselling.
The risk of a miscarriage is 11 to 15 percent and this continually increases with the woman’s age. The most frequent cause of this is a random incorrect distribution of the chromosomes during fertilisation. There is no treatment for this. In order to rule out other rare causes, after three or more miscarriages or full-term pregnancy we recommend uterine endoscopy, chromosome analysis, and specific blood tests (related to coagulation and the immune system).
A semen test should be one of the first steps in diagnosis, because a limitation of the sperm quality can significantly reduce the chances of becoming pregnant naturally.
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