Causes and diagnostics of male and female infertility with available treatments.

Infertility is a condition in which pregnancy does not occur despite regular, unprotected intercourse for one year, or after 6 months if the woman is over 35 years old. Although it is often spoken about quietly, an increasing number of couples today face infertility, regardless of age, lifestyle or previous medical findings.

There are various risk factors that can cause infertility in couples. Most of them can be eliminated by changing lifestyle and habits. However, there are also irreversible processes that may affect fertility. 

Page Overview

When to seek infertility evaluation?

  • if you have been trying to conceive for 12 months (or 6 months if the woman is > 35 years old)
  • if cycles are very irregular or absent
  • if endometriosis, PCOS or other gynecological conditions have been diagnosed
  • if a previous semen analysis was poor or there was a male urological condition
  • after two or more miscarriages
  • if you want a second opinion on an already proposed treatment plan

What most commonly causes infertility?

Causes are often found in both partners, which is why we always approach the evaluation as a process for the couple – not just one person.

Causes of female infertility

Female factor

  • Ovulation disorders
    • PCOS, irregular cycles, anovulation – ovulation is absent or rare.
  • Diminished ovarian reserve
    • Low AMH, reduced antral follicle count, age over 35.
  • Endometriosis
    • Ovarian cysts, adhesions and chronic pelvic inflammation.
  • Fallopian tube problems
    • Blocked or damaged tubes after infections or surgical procedures.
  • Endometrial changes
    • Thin endometrium, polyps, submucosal fibroids or chronic endometritis.
  • Hormonal imbalance
    • Thyroid, elevated prolactin, insulin resistance and other hormones.
Causes of male infertility

Male factor

  • Low sperm count
    • Oligospermia or complete absence of sperm (azoospermia).
  • Reduced motility
    • Asthenozoospermia – sperm move slowly or irregularly.
  • Poor morphology
    • Teratozoospermia – higher percentage of abnormal forms.
  • Elevated DNA fragmentation
    • Can reduce implantation chances and increase miscarriage risk.
  • Varicocele, infections and inflammation
    • Altered anatomy, testicular inflammation, prostate or urinary tract issues.
  • Hormonal and genetic causes
    • Testosterone secretion disorder, FSH/LH or genetic changes.

What does the infertility evaluation process look like?

1. First joint consultation

Brief medical history of both partners, review of previous findings, gynecological examination and basic ultrasound.

2. Diagnostic plan

We discuss which tests are needed for the woman and man and when it makes sense to perform them.

3. Results and analysis

At the follow-up appointment, we review all findings, explain possible causes and answer questions.

4. Treatment plan

Together we choose the best option – from cycle regulation to ART procedures – with a realistic assessment of chances.

We have divided the process into clear steps so you always know where you are and what comes next.

Female infertility evaluation

We introduce the evaluation gradually – from basic hormones and ultrasound, to additional tests as needed.

Hormones and laboratory

  • AMH – ovarian reserve assessment.
  • FSH, LH, estradiol – ovarian function.
  • Prolactin, TSH and thyroid hormones.
  • Progesterone – ovulation confirmation.
  • Additional analyses (insulin resistance, vitamin D, immunological tests as needed).

Ultrasound and structural assessment

  • Transvaginal ultrasound of uterus and ovaries.
  • Folliculometry – monitoring follicle growth and ovulation.
  • Endometrial assessment – thickness, structure, polyps, fibroids.
  • HSG / HyCoSy – fallopian tube patency.
  • Hysteroscopy or laparoscopy as needed.

Male infertility evaluation

The first semen analysis often provides important information, and additional tests are performed selectively when truly needed.

Semen analysis and additional tests

  • Standard semen analysis according to current guidelines.
  • Assessment of count, motility and morphology.
  • Sperm DNA fragmentation test.
  • Microbiological analysis of ejaculate if needed.

Urological examination and hormones

  • Specialist urological or andrological examination.
  • Ultrasound of testicles and prostate.
  • Hormonal panel (FSH, LH, testosterone, prolactin).
  • Assessment of indication for varicocele, TESE/micro-TESE or other procedures.

Infertility treatment methods

After completing the evaluation, we suggest therapy with the best balance between success rate, safety and burden for the couple.

Treatment without or before ART procedures

  • Ovulation regulation and natural cycle monitoring.
  • Treatment of thyroid hormones, prolactin and insulin resistance.
  • Treatment of infections and chronic inflammation.
  • Laparoscopic and hysteroscopic treatment of endometriosis, polyps or fibroids.

ART procedures (depending on findings)

  • Intrauterine insemination (IUI).
  • IVF/ICSI program (stimulation, aspiration, embryology).
  • FET – frozen embryo transfer.
  • Andrological procedures (TESE/micro-TESE) in cooperation with urologist.

Technology we use in infertility evaluation

Modern technology does not replace the doctor, but it can significantly improve the quality of diagnosis and treatment – especially in more complex causes of infertility and repeated failed attempts.

  • advanced ultrasound for assessment of ovarian reserve, endometrium and pelvic structures
  • detailed laboratory analysis of hormones and metabolic parameters
  • embryology laboratory for planning ART procedures when needed
Advanced ultrasound High-resolution transvaginal ultrasound for precise assessment of ovaries, uterus, endometrium and any polyps, fibroids or cysts.
Time-lapse incubator (as part of ART program) For couples who need IVF/ICSI, we use time-lapse technology for continuous monitoring of embryo development in stable conditions.
Specialized andrology laboratory Advanced semen analysis with the option of DNA fragmentation testing and additional sperm quality parameters.
Cooperation with urological and surgical team In cases of varicocele, TESE/micro-TESE or other interventions, we plan the evaluation in cooperation with an experienced urological and surgical team.

Statistics and trust

Instead of "big promises", we offer you realistic information, experience and continuous support throughout the entire process.

Every couple is unique, and we approach each case individually – with the goal of finding the best path to pregnancy together.

20+ years

of experience in infertility treatment and ART procedures

Numerous couples

treated every year, most often with combined causes of infertility

1–2 cycles

average time needed for basic evaluation and treatment plan

Why do couples choose Polyclinic Cito for infertility evaluation?

A combination of experience, modern technology and individual approach – from the first consultation, through diagnosis, to treatment and subsequent pregnancy care.

Experience and subspecialization

Years of work in the field of infertility and ART procedures, with continuous monitoring of contemporary guidelines.

Complete evaluation in one place

Gynecologist, urologist, laboratory and embryology within the same facility – fewer visits, faster diagnosis.

Individual plan and realistic chances

We adapt the treatment plan to your age, findings and goals – with a transparent presentation of expected outcomes.

Continuity of care

We guide you through the entire process – from initial evaluation to possible ART procedure and pregnancy care.

Price of infertility diagnosis and treatment

The prices of infertility work-up services at Cito Polyclinic are defined transparently and in line with the methods used and the medical services included. 

At the first consultation we explain in detail all the costs, what is included in the price and what is charged additionally - with no hidden costs.

You can get the first available consultation appointment by calling +385 21 457 800 or by sending a short message via the contact form

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