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Why Can’t I Conceive Naturally?

Girofiv

The first step to determine the cause of infertility and apply the optimal treatment is to conduct a couple’s evaluation and review provided medical reports to gather all necessary case-specific information.

However, no single test can conclusively assess a couple’s reproductive potential. Only the woman’s age is a proven prognostic factor, as advanced age reduces the likelihood of natural conception.

Each case is unique, but typically, during a first visit to GIROFIV, the gynecologist will request a basic fertility workup. If more specialized tests are needed, a complementary study is usually recommended.

Basic Fertility Evaluation (Initial Visit)

Medical History

A detailed anamnesis to understand the patient’s medical background, including:

  • Age
  • Duration of infertility
  • Family history
  • Prior illnesses or surgeries
  • Previous pregnancies
  • Frequency and timing of sexual intercourse

Gynecological Exam & Ultrasound

Assesses the anatomy and functionality of the female reproductive system. An early-cycle ultrasound evaluates ovarian reserve by quantifying antral follicles in each ovary.

Basal Hormonal Testing

Measures key hormones (FSH, LH, estradiol, progesterone, AMH) to evaluate ovarian function.

Medical History

Includes evaluation of:

  • Age
  • Duration of infertility
  • Family history
  • Prior medical conditions or surgeries
  • Sexual habits

Semen Analysis (SA)

The primary diagnostic tool for male fertility. Evaluates semen volume, sperm count, motility, and morphology.

VIEW WHO REFERENCE TABLE

Advanced Fertility Testing (Specialized Procedures)

Karyotyping

The study of the number and structure of chromosomes within cell nuclei. Conducted via blood test.

Each body cell should contain 46 chromosomes (22 autosomal pairs + 1 sex chromosome pair). Gametes (eggs/sperm) carry only 23 chromosomes to ensure the embryo’s correct total.

Karyotype abnormalities increase the risk of genetically abnormal gametes, leading to infertility or recurrent miscarriage.

HyFoSy (Hysterosalpingo-Foam Sonography)

A minimally invasive imaging test using vaginal ultrasound and contrast gel (ExEm Foam) to assess uterine cavity and fallopian tube patency. Less painful than traditional hysterosalpingography and performed in-office. Critical for diagnosing tubal obstruction (30% of infertility cases).

Laparoscopy

A surgical procedure under general anesthesia using abdominal optics to inspect pelvic organs (uterus, ovaries, fallopian tubes). Detects adhesions or blockages and may include therapeutic interventions.

Hysteroscopy

Direct visualization of the uterine cavity via cervical insertion of an optic device. Diagnoses polyps, fibroids, adhesions, or other endometrial abnormalities.

Endometrial Receptivity Analysis (ERA)

A molecular test to identify the optimal embryo transfer window by analyzing endometrial gene expression. Requires an endometrial biopsy (no sedation). Indicated for implantation failure with high-quality embryos.

Karyotyping

Chromosomal analysis via blood test to detect abnormalities that may cause infertility or recurrent pregnancy loss.

Sperm DNA Fragmentation

Evaluates DNA integrity in sperm. High fragmentation rates correlate with poor embryo quality and miscarriage risk. Uses CometFertility technology to differentiate single-strand (reduced fertilization) and double-strand (miscarriage risk) breaks.

Causes: Primary (testicular dysfunction) or secondary (varicocele, toxins, chemotherapy, smoking, obesity, age >45).

FISH (Fluorescent In Situ Hybridization)

Analyzes sperm for chromosomal abnormalities (X, Y, 13, 18, 21). Limited to patients with ?1 million sperm/mL.

Other Andrological Assessments

Referral to an andrologist for sexual dysfunction, testicular pain, or suspected varicocele.