Infertility

WHAT IS INFERTILITY? Infertility is the inability to conceive after one year of regular, unprotected sex.

WHEN TO BEGIN STUDYING? Usually only after one year of regular unprotected sex, should the study begin. There are however some situations where the study has to begin earlier (6 months):

WOMAN

• Age over 35 years

• Absent or irregular menses

• Abnormalities of the uterus

• Nipple discharge

• Obesity

• History of infection in the Fallopian tubes

• Endometriosis

MAN

• Prior testis lesions

• Varicocele

 

COMMON

• Problems in sexual relations

• Previous history of infertility

 

 

The following table briefly discriminates the main causes, tests that may be needed to make the diagnosis and treatment options available. However, each case is different and each couple should have an individualized approach.

CAUSES EXAMS TREATMENTS
Ovulation problems Hormonal study Ovulation induction
Premature menopause Hormonal study Egg donation
Karyotype
Obstruction of the fallopian tubes Hysterosalpingosonography IVF
Hysterosalpingography
Laparoscopy
Endometriosis Ultrasound Expecting
Laparoscopy Medical treatment
Surgical / laser treatment
IVF
Fibroids Ultrasound Expecting
Polyps Hysteroscopy Medical treatment
Synechiae Laparoscopy Surgical treatment
Hostile Cervical Mucus Postcoital test Medical treatment
Confirm ovulation IUI
Anti-EZ antibodies IVF
Absence of spermatozoa Hormonal analysis TESE / ICSI
(azoospermia) Testicular biopsy Sperm donation
Karyotype
Absence/Obstruction of the vas deferens  Scrotal examination TESE / ICSI
Screening for cystic fibrosis gene
Low number of spermatozoa IUI
(oligospermia) IVF
ICSI
Reduced motility of spermatozoa IUI
(asthenospermia) IVF
ICSI
High percentage of abnormal forms of EZ IUI
(teratozoospermia) IVF
ICSI
Antisperm antibodies Search anti-EZ antibodies Preparation of Sperm / IUI
IVF
ICSI

SPERMATOZOA COLLECTION METHODS

In cases of obstructive azoospermia (and not only), sperm collection may be performed in various ways, the most used are:

  • TESE

    TESE: testicular sperm extraction

  • TESA

    TESA: testicular sperm aspiration

  • MESA

    MESA: microsurgical epididymal sperm aspiration

Male causes of infertility

Male Infertility

The study of man should include a complete medical  and reproductive history, physical examination by a andrologist and at least two semen studies.

The objectives of this assessment are the identification of potentially correctable situations, irreversible situations that can be resolved by techniques of Medically Assisted Procreation, irreversible conditions for which the sperm donation or adoption may be an option to detect serious medical situations they have arisen by an infertility problem.

 

LACK OF SPERM IN EJACULATION (AZOOSPERMIA)

This problem affects 1% of all men (and 10 to 15% of infertile men) may be due to two causes:

• The testicle is unable to produce spermatozoa.

• There is a blockage to the passage of spermatozoa (congenital absence or obstruction of the vas deferens).

 

In the case of non-obstructive azoospermia it is necessary to make some hormonal assays (FSH, LH, testosterone). High FSH values are indicated to continue the study with the realization of a karyotype and microdeletions research of Y chromosome. Low values of FSH and testosterone involve assay of prolactin and assessment of pituitary imaging.

 

In the case of obstructive azoospermia due to congenital absence of the vas deferens, 2/3 of men have the cystic fibrosis gene, which also involves research of mutation in woman.

 

Testicular biopsy may be indicated in patients with azoospermia with normal testicular volume, with at least one palpable vas deferens, normal FSH and also to confirm the presence of obstruction in patients with low volume of ejaculated and palpable vas deferens.

 

WEAKNESSES IN QUANTITY AND / OR QUALITY OF SPERM

These weaknesses can have several causes: hormonal problems, varicocele, infection, certain medications and drugs.

 

The varicocele consists of dilated veins similar to varicose veins into the scrotum and are found in 15% of the normal population and 40% of men with infertility. In his presence is assigned a deleterious effect on spermatogenesis. Although controversial, treatment of varicocele (surgical or percutaneous embolization) is advised when it is palpable, when the couple has documented infertility, the woman has a normal or potentially correctable fertility and the spouse has changes in semen. Instead of the surgical treatment of varicocele can use immediately to IVF / ICSI when these techniques are needed to address woman's issues or when the age of this preclude more waiting time.

 

WEAKNESSES IN FERTILIZER CAPACITY OF SPERMATOZOA

The genesis of the weaknesses may be problems in the acrosome, inability of sperm to join the zona pellucida, etc ...

 

INABILITY TO EJACULATE IN THE VAGINA

This inability may be due to premature ejaculation, retrograde ejaculation or to the impossibility to achieve orgasm.

 

Female causes of infertility

Female Infertility

The study of woman implies first of all a medical history and physical examination, with special emphasis on history and gynecological examination. In addition to the infertility problem we have to see further and detect situations that may compromise the future pregnancy.

Ovulation problems are the most common cause of female infertility.

Simultaneously it is also the cause that the probability of successful treatment is increased. In most cases the woman has irregular cycles or is not menstruating. May also have hirsutism, acne or milk discharge from the nipples (galactorrhea).

The ovulation problems may reside in the ovary:

• The woman has polycystic ovaries • The ovaries contain few oocytes (situations of premature menopause) • There are no ovaries because they were surgically removed or woman born without ovaries

  • PROBLEMS IN THE FALLOPIAN TUBES

    The problems in the tubes are also a common cause of infertility.

    These problems may be due to injury of the fimbriae, the cells lining the inside of the tubes, obstruction or adhesions that distort the tubes. The effects of these injuries range from capturing inability of the oocyte and the inability of spermatozoa and the oocyte meet.

    These injuries can have several causes:

    • Infections are the most common cause and between these Sexually Transmitted Diseases (Chlamydia and Gonorrhoea) are the most frequently implicated.

    • Endometriosis can also cause scar tissue, adhesions and in more severe cases obstruction of the fallopian tubes.

  • ENDOMETRIOSIS

    Endometriosis is an extremely common benign disease in which cells similar to those lining the uterus and peel off at the time of menses, developed in other locations. The most common areas are the pelvis, the ovaries (giving rise to so-called chocolate cysts) and the tubes. Like the endometrial cells also slough off at the time of menstruation, but these have no way out, eventually cause adhesions and formation of cysts.

    Endometriosis is responsible for 4-8% of infertility cases. The majority of women with endometriosis have, however, problems in getting pregnant.

    While one might suspect of its existence, the diagnosis requires the realization of a laparoscopy.

  • HOSTILE CERVICAL MUCUS

    Cervical mucus is a gelatinous substance produced by glands in the cervical canal, whose characteristics change over the cycle. In the ovulation time exhibits special characteristics, which allow an easier spermatozoa migration through the uterus. At the same time also functions as a reservoir of spermatozoa.

    It is said that the cervical mucus is hostile when it is too thick (for poor estrogenization, infection, etc.), or when it contains antibodies, anti-sperm.

  • UTERINE PROBLEMS

    The majority of women with uterine problems do not usually have problems conceiving, but in maintaining pregnancy.

    However, in some situations (submucosal fibroids, endometrial polyps, intrauterine adhesions and malformations) may be interference with the implantation of the embryo.