A gynaecological examination is the initial means of ascertaining any serious organic malformations which could be hindering your chances of becoming pregnant. Normally your gynaecologist will have already performed such an examination. An ultrasound scan is often indicative of myomas, malformations or endometriosis. In addition, this method provides information on the condition of the endometrium.  
If the ultrasound is carried out in the middle of a cycle, follicles (fluid-filled sac containing the egg) in the ovary can also be detected or the quality of the ovaries can be assessed. In such a way, possible conclusions regarding the woman's hormonal condition can be drawn.

Hormone screening involves a simple blood test. The test is done in our own hormone laboratory, always using the latest analysis methods such as radioimmunoassay (RIA) and chemiluminescence.

A hormone analysis in the man may also be important and highly informative! This is the case in particular if the sperm quality is impaired or there are symptoms such as reduced physical fitness, loss of vitality, weight loss, fatigue and exhaustion. A hormone test is also helpful if there is a drop in libido or impotence.
The spermiogram is the most important means of establishing male infertility. It entails the collection of ejaculate from masturbation after a waiting period (period with no intercourse or masturbation) of three days. The waiting period is used on the one hand for reasons of standardisation (comparability of findings) and on the other hand because leaving too short a period since last having intercourse may negatively influence the total sperm count, whereas leaving too long a period in turn deteriorates the motility of the spermatazoa. 
Diagnosis is then achieved with an exact computer-assisted sperm analysis under the microscope (CASA).

Two methods of examination are combined to monitor the cycle: the ultrasound and determination of oestradiol – this is a hormone which is formed solely by the growing ovarian follicle and therefore provides precise information on its maturity. 
Monitoring of the cycle mostly begins on the 7th to 10th day after menstruation. One to two ultrasounds are carried out a few days apart. Blood is also taken on the same days to obtain information on the current hormone status. In the middle of the second half of the cycle, one further blood test is performed to rule out corpus luteum deficiency.

Laparoscopy is used to examine the fallopian tubes and is much more conclusive, but also more invasive than other methods, in investigating the function of the fallopian tubes. This is because not only the fallopian tubes, but also the uterus, ovaries and the rest of the abdomen can also be examined. Consequently, adhesions, myomas, endometriosis and other changes can be identified. Laparoscopy is performed under general anaesthetic.

Prior to the procedure, a syringe is inserted in the cervix via the vaginal opening in order to inject a harmless blue dye into the uterus. An optical device is inserted through a small cut in the abdomen. If the fallopian tubes are permeable, the dye will visibly pass into the abdominal cavity. The optical device can be used to visualise all the other important organs on a monitor. A rod is inserted through another small cut in the pubic region in order to check the organs for their mobility. Laparoscopy is carried out as an outpatient procedure at our clinic.

This outpatient examination investigates the permeability of the fallopian tubes. A special, harmless glucose solution (Echovist solution) is first injected through the vaginal opening. An ultrasound probe inserted into the vagina then monitors the flow of the liquid into the fallopian tubes. This reveals how permeable they are. On account of the positive rinsing effect (pertubation), this treatment more often leads to pregnancy as a result.

In rare cases, the secretion in the cervix becomes very thick: this is described as cervical sterility. To test for this, a specimen is taken from the cervix following sexual intercourse. This procedure causes no discomfort. A microscope is used to count the number of motile sperm following sexual intercourse. Such a test is only useful, however, if the spermiogram taken from the partner is normal, since the test is effective only to a minimal degree, or not at all, if the sperm function is impaired. Use of the commonly prescribed medication Clomifen will also negatively affect the test result. 
The appropriate treatment in the case of thickened secretion is insemination, since the sperm are then inserted directly into the uterus, bypassing the cervix. Hence there will be no interaction between the secretion and the sperm. Successful insemination is reliant, of course, on free passage through the fallopian tubes.

This procedure is often performed at the same time as laparoscopy. Hysteroscopy is the examination of the uterine cavity to detect any changes which may be causing bleeding disorders or preventing implantation of an embryo. A small camera (2-5 mm in thickness) is pushed through the vagina into the uterine cavity. The procedure is used to look for myomas in the mucosal lining as well as for polyps, malformations of the uterus and adhesions.