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Fertility assessment diagnostic tests

At the CMR, couples have access to the following diagnostic examinations to assess fertility.


It initially consists of bimanual exploration to assess any disorders of the external genitalia (vulva and vagina) and internal genitalia (uterus, ovaries), followed by a mirror examination for visual assessment of the cervix.

The examination may be supplemented by a transvaginal ultrasound to assess the presence or suspicion of pathologies such as fibroids, endometrial polyps or ovarian cysts.
The examination and ultrasound are not painful.

If requested, the centre can also perform the PAP TEST, an examination that allows screening for the prevention of neoplastic lesions of the cervix.


This method uses ultrasound emitted by a probe placed on the abdomen (transabdominal ultrasound) or inserted into the vagina (transvaginal ultrasound) through which the internal genital organs, uterus, ovaries and tubes are visualised on a monitor, the latter being visible only if pathologically dilated (hydro/sactosalpinx).

The aim is to visualise the morphology of these organs and identify any atypical masses or malformations.

This examination is not painful and involves no risks because it uses harmless ultrasound waves rather than ionising radiation.


It is an ultrasound method, which makes it possible to assess tubal patency and to identify and/or exclude changes in the uterine cavity.
It consists of the introduction, through a small catheter inserted vaginally, of 10-20 cc of saline solution and air into the uterine cavity, with subsequent passage (or non-passage) of the same through the tubes into the peritoneal cavity.

The examination must be performed before the 12th day of the menstrual cycle.


This type of diagnostic examination makes it possible to assess, by means of a 3D ultrasound scan, the interior of the uterine cavity and the possible presence of related pathologies.
It is performed when a malformation or the presence of polyps, fibroids or adhesions (synechiae) is suspected.
It is performed painlessly on an outpatient basis.


The ovarian cycle, whether natural or pharmacologically stimulated, is monitored with a series of ultrasound scans of follicular and endometrial growth up until the moment ovulation.
This ultrasound monitoring is often combined with hormonal monitoring of oestradiol production and possibly other hormones involved in the ovulation mechanism.


This type of diagnostic examination makes it possible to assess, by means of a 3D ultrasound scan, the interior of the uterine cavity and the possible presence of related pathologies.
It is carried out when a malformation or the presence of polyps, fibroids or adhesions (synechiae) is suspected.
It is performed painlessly on an outpatient basis.


It is an endoscopic method for diagnosing and possibly treating various pathological conditions affecting the uterus (cervix and body).

It is performed by introducing a thin fibre-optic instrument through the cervical canal. In more than 95-97% of cases, the examination can be performed on an outpatient basis.

Hysteroscopy makes it possible to diagnose uterine malformations and the possible presence of adhesions, polyps, fibroids and uterine tumours. During the examination, tissue samples can be taken for histological examination.

The main indications are:
• abnormal uterine bleeding
• study of the infertile patient
• definition of abnormal endometrial thickening (detected on ultrasound)
• ultrasound suspicion of endometrial polyps or submucosal fibroids
• repeated miscarriage
• suspicion of uterine malformations


It is an examination carried out in order to assess male fertility, allowing the non-invasive and painless, detection of anatomical abnormalities, alterations caused by infectious or traumatic processes, or to monitor the progress of previously diagnosed pathologies for which the patient is being treated.


A couple undergoing infertility diagnosis must necessarily consider a spermiogram, a test carried out on a semen sample obtained by masturbation and appropriately collected in a special sterile urine container.
A period of abstinence from sexual intercourse (ejaculation) of between two and six days is required for the examination.
Our centre is equipped with special rooms for the collection of seminal fluid.

In exceptional cases, semen collection at home is possible, but it is strictly necessary to deliver the sample to the laboratory no later than 40 minutes after collection and drastic temperature changes must be avoided (20-37 C°).

The spermiogram initially analyses macroscopic parameters such as the overall volume, appearance and smell of the sample, its pH, degree of liquefaction and viscosity, and the possible presence of round cells.
Next, the microscopic parameters are examined, which are:
- nemaspermic concentration;
- nemaspermic motility;
- nemaspermic morphology.

Alterations in these parameters define:
- Azoospermia (absence of spermatozoa in the ejaculate);
- Oligozoospermia (reduction in sperm count);
- Teratozoospermia (morphological changes in spermatozoa);
- Astenozoospermia (reduction in the percentage of motile spermatozoa).

It is possible to complete the analysis by performing a spermioculture.


This fertility assessment test is carried out on a semen sample and aims to detect the possible presence of microbiological populations responsible for inflammatory processes in the genital tract.

In some cases, they may be the cause of failed fertilisation.


It is a test that involves, through the removal of seminal plasma by washing, an assessment of the number of 'best' spermatozoa from a morphological and motility point of view, separating them from dead spermatozoa and debris.

There are several procedures to achieve this selection, including:
- Swim-up (upward migration);
- Separation on a density gradient.


This type of test, as its name suggests, aims to search for breaks or lesions in the sperm's genetic material.
Fragmentation of sperm DNA can be caused by alterations in the spermatogenesis process, excessive production of reactive oxygen species in the ejaculate, exposure to environmental or industrial toxins, oxidative stress, smoking... All these are well-known causes of DNA fragmentation and infertility.
The percentage of spermatozoa possessing fragmented DNA is detected by the TUNEL method (acronym for Terminal deoxynucleotidyl transferase dUTP Nick End Labeling), which uses enzymes capable of identifying the presence of breakpoints in the DNA double helix.
A semen sample with a percentage of spermatozoa with fragmented DNA greater than 30% is considered pathological.


It involves the detection of anti-spermatozoa autoantibodies, which can sometimes bind to the surface of spermatozoa, inhibiting their functionality and interfering with the fertilisation process.
This screening test allows the identification of any significant presence of two main classes of immunoglobulins (IgA and IgG) bound to the surface of the spermatozoon.

The MAR Test is appropriate when:
- asthenozoospermia, i.e. poor sperm motility, is not associated with a reduction in their number;
- there is a presence of autoimmune diseases or unexplained infertility;
- there is a clear presence of agglutination in the seminal fluid.


This examination consists of the collection by aspiration of spermatozoa by means of a needle penetrating the skin.This method is used when sperm are not detectable in the seminal fluid.

Sampling is necessary if the male partner has azoospermia (i.e. a lack of spermatozoa in the ejaculate) due to an obstruction of the seminal tract.

Sometimes they can be found in the testis or epididymis, although in very small quantities.