Advanced Diagnostics for Women

Our advanced fertility diagnostics

„What’s wrong when everything seems to be right"?

In most cases, the basic diagnostics for men and women can determine the root causes of fertility issues. Sometimes, however, the causes can be more complicated. If neither the spermiogram nor the cycle observation prove conclusive, further research must be carried out. Together, we will get to the bottom of your fertility issues and find the right treatment for you. Based on your unique situation, we will discuss further examinations that are most likely to reveal the cause of your fertility issues.

 

Diagnostic options:

 

1. Fallopian Tube Examination

Inflammations and infections in the abdominal cavity can severely restrict the transport function of the fallopian tubes or cause them to close altogether. This means that sperm can no longer pass through to fertilise the egg, or that a fertilised egg can no longer be transported towards the uterus.

 

Types of Examination

• Ultrasound with contrast medium

MA thin catheter is used to inject the contrast medium into the uterine cavity. A vaginal ultrasound probe can then be used to follow the flow of the contrast medium through the fallopian tubes. As the examination is virtually painless, it can be performed without anaesthesia. However, the costs for this examination (approx. €150.00) are not covered by the statutory health insurance funds, and therefore must be paid by the patient. The contrast medium contains gelatine, but no iodine or radioactive substances.
 

• Abdominal endoscopy (laparoscopy)
A camera is inserted into the abdomen through a small incision near the navel. At the same time, a thin catheter is used to inject a blue dye solution into the uterine cavity from the vagina, which is then distributed into the fallopian tubes. If we can observe the colour solution escaping into the abdominal cavity via the camera, we can conclude that the fallopian tubes are open. A laparoscopy requires a general anaesthetic. However, it offers the possibility to detect changes such as cysts, inflammations or adhesions and the option to treat them in the same session.

 

 

2. Is there inflammation in the pelvis or uterus (Endometriosis)?

Endometriosis is thought to be caused by mucous membrane deposits that pass through the fallopian tubes into the abdominal cavity during menstruation. In around 15% of all women, the mucous membrane cells attach themselves to the tissue, where they embed and form inflammatory substances. The result: increased menstrual cramps, organ adhesions or cysts in the ovaries. With a laparoscopy, the areas of inflammation, adhesions or cysts can be identified and removed, thereby improving your fertility.

 

Type of Examination
Abdominal endoscopy (laparoscopy) 

 

 

3. Does the uterus have the shape that your child would need?

In many women, the uterus may have developed fibroids (benign muscular growths) over an extended period of time. Although hardly noticeable in daily life, these fibroids deform the uterine wall and thus the function of the mucous membrane. Moreover, they can interfere with the implantation of the embryo and cause miscarriage or premature birth. Rare congenital changes in the shape of the uterus may also cause fertility problems.
 

Type of Examination
Ultrasound, if necessary, endoscopy or laparoscopy with surgical treatment.

 

 

4. Is the lining of the uterus suitable for your baby?

Benign growths in the mucous membrane, so-called polyps, may hinder fertility. Therefore, if polyps are present, their removal is usually recommended.

Type of Examination
Ultrasound, uterus endoscopy

As the egg matures, and especially once ovulation has taken place, the body releases various hormones and secretions. These change the lining of the uterus, which becomes thicker and enables the embryo to implant. This preparation affects the structure of the mucous membrane, as well as the composition of the protective defence cells. Sometimes, however, this finely tuned structure is disturbed, or defence cells prevent the implantation of the “intruder”. We examine whether your mucous membrane is receptive to the embryo at the right time, i.e., whether the “implantation window” is open. We can also examine the defence cell make-up in the uterus, which can affect embryo implantation or cause early miscarriages.
 

Type of Examination
Mucosal biopsies

1. ERA test (Endometrial Receptivity Array Test)
   A small sample of mucosa is taken at the normal “implantation” time in the cycle and genetically tested. If the implantation window has shifted, the embryo transfer must be adjusted accordingly.
2. UA test for so-called “natural killer cells” and other immune system cells.

As these test procedures are new and not yet established as standard fertility treatments, the costs are not generally covered by health insurance.
 

5. How active are your ovaries?

Even young women are occasionally found to have reduced ovarian function. The cause can be genetic, but antibodies against the ovarian cells are also sometimes detected in these cases. Other triggers are thought to be environmental influences such as smoking. We would be happy to discuss a range of fertility options with you, however, as of yet there is no known treatment for this disorder.

Type of Examination
Laboratory tests, ultrasound

Have you had not one, but several miscarriages?

Miscarriages are unfortunately not an uncommon occurrence in pregnancy. Approximately 10- 15% are considered to be clinical, i.e., proven pregnancies that end before the 20th week, usually in the first 10 weeks of pregnancy. The risk of miscarriage is primarily dependent on the age of the woman; for women under 30 it is about 10%, for those over 40 it rises to about 50% and for those over 45 it is even higher. The cause of individual miscarriages is usually a genetic maldistribution of the chromosomes. We refer to frequent miscarriages or miscarriage tendency when a woman has experienced 3 or more miscarriages. An increased miscarriage rate can be due to fertility issues affecting either or both partners.

 

We investigate whether there is a genetic predisposition in the father or the mother that leads to a genetic change in the child. Women’s health concerns may also prove to be the cause of miscarriages. Common examples include thyroid and sugar metabolism disorders, increased tendency to thrombosis, changes in the shape of the uterus, mucous membrane problems or immunological causes. Furthermore, smokers and those who consume heavy amounts of alcohol, have an increased risk of miscarriage, as well as women who are overweight (with a BMI over 30).

 

There are several possible examinations that may reveal the cause of miscarriage tendency. Together, we will discuss which option is best for you.
 

Type of Examination
Laboratory tests, uterus endoscopy, mucosal biopsies

Perhaps the cause lies in the egg’s genetics?

Sometimes the genetic make-up of the egg prevents pregnancy or leads to frequent miscarriages. These genetic changes in the egg cell are mainly age dependent. A genetic examination called “Polar Body Diagnosis” can be carried out within the framework of artificial insemination.

You can read more about this topic in the chapter "Polar Body Diagnosis" in Additional Measures.

Type of Examination
Blood sampling, genetic test; IVF/ICSI treatment with Polar Body Examination

 

 

Getting to the bottom of the causes

Some women and couples have already come a long way on the path to having a child. Our medical fertility experts are prepared to work with you to clarify the causes of your fertility 40 issues, employing top-notch resources and expertise to analyse your unique situation. Let’s discuss the diagnostic options possible for you.

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