Fertility: When and what to test

Γονιμότητα: Πότε και πως την ελέγχουμε

Dr. Evi Vogiatzi, Geneticist – Embryologist

Lifestyle and daily habits can have a significant impact on both male and female fertility and are among the factors that are adjustable, meaning that we can improve them. We know that smoking and drinking alcohol negatively affects ovarian function and oocyte quality, and has an equally negative effect on sperm parameters and sperm DNA quality, increasing oxidative stress. Reducing smoking or even better quitting smoking altogether and reducing alcohol consumption on a daily basis and occasionally in larger quantities can significantly help couples to have a better chance of a successful pregnancy.

Obesity in women (BMI >30kg/m2) causes disturbances in endocrine function and menstruation, reducing the chances of conception. It has been shown that with an appropriate diet and a loss of 10% of body weight, the ovarian response improves significantly as well as the overall reproductive function. Overweight men are more likely to have impaired sperm parameters or even azoospermia, while obese men have about twice the rate of impaired sperm production than men of a healthy weight. The combination of weight reduction with mild physical exercise leads to more spontaneous conceptions than weight reduction alone.

Underweight women with a very low body mass index (<19 kg/m2), can also experience menstrual cycle abnormalities or even amenorrhea and they should follow a balanced diet with appropriate caloric intake to increase their body weight to improve their chances of  conception. In the process of weight regulation or even when we already have a healthy body mass index, we recommend the maintenance of a balanced diet with the consumption of foods with antioxidant properties such as green leafy vegetables and fruits.

Other factors that can affect our fertility are certain medications for which we should always consult our doctor, the use of unapproved formulas and drugs, active or passive warming of the male genital area (inflammation, fever, hot baths, sauna, long hours of daily driving, cycling, tight underwear), long-term exposure to harmful factors (chemicals, radiation) and a range of health conditions, making it absolutely essential to be examined by the appropriate doctor when we notice significant changes in our daily life or in our body. Stress, although scientific opinions are divided, can act as an inhibitor in the process of conception probably through changes in the physiological hormonal balance and the changes it brings about in the overall functioning of our body.

If pregnancy has not been achieved after significant changes in lifestyle, or after a year of systematic intercourse, or when there are age-related reasons for lower reproductive potential, or even when we just want to check our reproductive health as a precautionary measure, we should consult a qualified reproductive specialist. The couple should be informed about fertility testing and possible interventions and treatments that will help them to grow their family. The couple should provide detailed information on their medical history, possible factors that may affect their fertility and also communicate their simple and complex questions, fears and expectations. Every couple and every person is different, so the medical approach is not always the same. The initial fertility investigation often means a series of simple or specialized tests, depending on the respective indications, but usually includes:

  • Male fertility testing with a complete analysis of semen parameters (semen analysis). It is one of the most important examinations of the couple, because a detailed investigation reflects the reproductive potential of the man and the result significantly determines the medical management of the couple. Equally important are sperm quality tests, examining the integrity of the genetic material carried by the spermatozoa, in particular the DNA fragmentation rate, as it has been found to have a significant impact on the likelihood of conception, the quality of early embryos and the likelihood of miscarriage in the first trimester of pregnancy.
  • Laboratory testing for the female partner includes a battery of tests, mainly hormonal measurements, but often and depending on the indications and the woman’s history, other factors such as hematological, biochemical, immunological and molecular tests are also assessed. In women, the assessment of fertility and reproductive health is multiparametric, since we cannot, because of the number and location in the body, examine the oocytes for diagnostic purposes, but also because the female body is the place where the developing embryo is housed and we must ensure the best possible conditions with the most modern diagnostic tools that scientific development has offered us.
  • Imaging tests are also required for the female parntner to check the anatomy and function of the reproductive system, which often includes gynecological ultrasound, testing the patency of the fallopian tubes either by specialized ultrasound or hysterosalpingography, and checking the endometrial cavity by hysteroscopy.

Based on data from numerous demographic studies, a significant proportion of the world’s population will seek medical advice for childbearing problems, will undergo a range of tests, will receive medical or interventional treatment, or undergo assisted reproduction. But we should not assume that a delay in conception, the diagnosis of a fertility problem in the man or in the woman, or a suggested treatment indicates a one-way street leading to either IVF or the fear of never having a child. Your Reproductive Scientists are and should be by your side, forming a team of mutual respect, mutual trust and cooperation from all sides.

Some will solve their problem more directly, some will need different tests, some will undergo IVF, some will have more or less difficulty, but one thing is common for all and this is that every couple is important, every couple is different, every couple needs a personalized approach, while the individual people’s desire for a family is sacred and should bring joy and hope to all of us.