Evaluation and Treatment of Infertility
Since ancient times infertility has been a serious and complex problem, with implications not only for the family but also for countries and governments. Today, thanks to scientific advances we have demystified many aspects related to infertility. Also based on scientific research we’ve been able to manage these issues in a more rational and efficient manner. In the following we will review some aspects related to this problem. If you need more information then please click here.
When we talk about infertility we mean the reduced ability of a couple to achieve a pregnancy. We know that in a young couple of reproductive age the probability of achieving a pregnancy in one menstrual cycle is approximately 20% to 25%. After 3 months, the probability increases to 50%, then after 1 year having sex without any contraceptive the probability of pregnancy is about 85%. Therefore, 15% of couples will fail to achieve a pregnancy after one year and it is this group of people who benefit from evaluation and treatment for infertility.
Age
On the other hand, we must take into account the factor of age especially in women. After age 35 there is a marked decrease in the reproductive capacity of the woman which continues to decline over the years. This is largely due to a decrease in the quantity and quality of eggs remaining, which not only affects the probability of pregnancy, but also increases the probability of spontaneous abortions and babies with genetic defects.
Evaluation and treatment of infertility
With age also increases the likelihood of developing medical conditions or diseases that affect fertility such as endometriosis, uterine fibroids, sexually transmitted diseases, pelvic infections, diabetes, and obesity, among others. Therefore, in patients older than 35 years it is recommended to start treatment for infertility evaluation after 6 months of unsuccessful attempts to achieve a pregnancy.
Important factors
It goes without saying that it takes a functional reproductive system in both the man and the woman to achieve pregnancy. In many cases infertility is the result of multiple causes both in women as in men, and sometimes there is not a specific etiology.
Infertility evaluation must be conducted in a systematic manner to include studies of a ovulatory factor, menstrual cycle, uterine and tubal factor, cervical factor, pelvic factor, and male infertility factor.
Ovulatory Factor: The vast majority of patients who do not have regular menstrual bleeding have ovulatory problems. The causes of this condition are hormone problems such as hypo-or hyperthyroidism, hiperprolactinemia, and hyperandrogenism. Stress, anorexia nervosa, marked loss or weight gain and premature menopause also cause ovulation problems. Ovulatory function can be evaluated using temperature measurements, ovulatory basal levels of progesterone and endometrial biopsy.
Menstrual cycle and its stages: In cases of hormonal problems such as thyroid problems or prolactin. It is possible to correct the problem by correcting the hormonal imbalance of the ovulatory diagnosed. In cases of anovulation associated with hyperandrogenism (polycystic ovarian syndrome) are drugs like clomiphene citrate, which help induce ovulation. For patients not adequately stimulated, oral medications can be used as the FSH hormone injections to stimulate egg development.
Uterine and tubal factor: The partial or total blockage of the fallopian tubes can be caused by inflammatory reactions due to previous pelvic infection or endometriosis. This not only causes infertility but also increases the likelihood of ectopic pregnancies. The blockage can also be caused by the presence of fibroids near the junction of the fallopian tubes and uterus. Uterine cavity defects such as septa, polyps, adhesions and fibroids have the potential to affect embryo implantation and cause spontaneous abortions. To assess both the uterine cavity as the fallopian tubes preference study is hysterosalpingogram.
Depending on the type of problem that is causing the blockage tubal or uterine defect, surgical treatments exist that can be used to correct the problem. If surgery is not an acceptable alternative for the type of tubal damage, then in-vitro-fertilization is the best choice. This treatment involves stimulation of the ovaries with fertility drugs (FSH) to increase the quantity of eggs produced. Before ovulation occurs, the eggs are aspirated and then fertilized in the laboratory. Produced embryos are transferred into the uterine cavity, where implantation occurs. The in-vitro-fertilization is also indicated in couples with infertility caused by ovulatory factor, male factor, endometriosis or unexplained infertility.
Cervical Factor: Cervix not only serves as a reservoir for sperm but also produces mucus that facilitates transportation and sperm function. There are conditions under which this mucus can make an environment hostile to sperm and impair fertility. In the post-coital study, a sample of cervical mucus is examined after the couple has had sex to assess the quality of cervical mucus and its interaction with sperm. If there is any problem in this regard, including antibodies against sperm can treat partner’s intrauterine inseminations using sperm. This treatment consists of placing the sperm directly into the uterine cavity using a catheter after having processed and cleaned the semen sample in the laboratory.
Pelvic Factor: Endometriosis occurs when the tissue lining the uterine cavity is in other areas than the uterine cavity, for example, fallopian tubes, ovaries, and the abdominal cavity. Endometriosis not only can cause inflammatory reactions affecting pelvic anatomy but can also produce toxins that affect the quality and function of the eggs, sperm and embryos. Using laparoscopy can remove visible areas of endometriosis in the pelvic cavity and also restore the anatomy in areas where you are adhesions caused by endometriosis or previous pelvic infections.
Male Infertility Factor: Approximately 40% of couples who suffer from infertility are the cause of a male infertility factor, either because of the quality or concentration of sperm or their transportation problems to the vagina and uterus. Semen analysis gives us information on the concentration, motility and morphology of sperm among other things, and serves as an initial tool to assess male problems. Male fertility can be affected by hormonal problems, neurological and genetic, exposure to radiation or industrial toxins and environmental, for some drugs, alcohol, and snuff, and recreational drugs and genital infections or trauma.
Intrauterine insemination technique supplemented sperm controlled hyperstimulation of the ovaries may be used in pairs, where there is some degree of impairment in concentration, motility and sperm morphology, thereby increasing the number of sperm reaching the fallopian tubes and the number of eggs produced. In cases where the total number of motile sperm is very low, it is recommended in vitro fertilization (IVF) technique supplemented with intracytoplasmic sperm injection (ICSI) where micromanipulation techniques using a sperm is injected into each mature egg in order to increase the likelihood of fertilization.
Unexplained infertility: In 15-20% of couples undergoing infertility evaluation will be the etiology of the condition. This does not mean that there is a problem but at present we have not discovered the cause of this problem. However, there are successful treatments for these conditions as are controlled ovarian hyperstimulation where we use fertility drugs to increase the quantity and quality of eggs produced per cycle and increase the likelihood of pregnancy. This treatment can be supplemented with sperm intrauterine inseminations. In vitro fertilization is another alternative treatment available for this type of condition. At present, in vitro fertilization is the most successful among different assisted reproductive techniques to achieve a pregnancy.
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