Infertility is the inability of a couple to conceive a child. We talk about infertility or sterility when a couple who have frequent sex and do not use contraception fail to have children for at least a year (or six months when the woman is over 35).

For a woman to get pregnant, a chain of events is necessary. His body, and more specifically his ovaries, must first produce a cell, theoocyte, which travels to the uterus. There, in the presence of a sperm, fertilization can occur. Sperm can survive 72 hours in the female reproductive system and the egg must be fertilized within 24 hours of ovulation. Following the fusion of these two cells, an egg is formed and then implanted in the uterus, where it will be able to develop.

Infertility can be very difficult for couples who want to become parents but are unable to do so. This inability can have psychological repercussions important.

There are many treatments for infertility that can dramatically increase a couple’s chances of becoming parents.

Prevalence

Infertility is very common since it would concern between 10% to 15% of couples. Thus the CDC (Centers for Disease Control and Prevention) Americans confirm that nearly 1 in 10 women would have difficulty getting pregnant. 80 to 90% of women get pregnant within 1 year and 95% within 2 years.

In Canada, according to the Canadian Infertility Awareness Association (ACSI), nearly 1 in 6 couples would not be successful in conceiving a child in the 1^ages year of stopping all contraception.

In France, according to the 2003 national perinatal survey and the 2007-2008 epidemiological observatory of fertility, nearly 1 in 5 couples would be affected by infertility after 12 months without contraception. According to the survey, 26% of women got pregnant as early as 1^ermonths without contraception and 32%, more than 6 months later (including 18% after 12 months and 8% after 24 months)³.

Although data is lacking, it seems that more and more women are having difficulty becoming pregnant and that they are also taking longer. Environmental or infectious factors could be responsible for this evolution. Overweight is also singled out. You should also know that fertility decreases withage. Now, women are waiting for their 1^er child later and later, which could also explain why infertility problems are more and more frequent.

The causes

The causes of infertility are very varied and can affect men, women or both partners. In a third of cases, infertility concerns the man only, in another third it concerns only the woman and finally, in the remaining third, it concerns both.

In humans

Male infertility is mainly due to too little production (oligospermia) or a complete absence (azoospermia) of sperm in semen. Azospermia may be due to a lack of production in the testes or a blockage of the ducts that allow sperm to migrate. The sperm may also be malformed (teratospermia) or immobile (asthenospermia). The sperm can then no longer reach the oocyte and penetrate it. Man can also suffer fromcumshots early. He can then ejaculate at the slightest excitement, often even before having penetrated his partner. Dyspareunia (painful intercourse for women) can also prevent penetration. In case of’ejaculation retrograde, the semen is sent to the bladder and not to the outside. Certain environmental factors, such as exposure to pesticides or too frequent excessive heat in saunas and Jacuzzis, can decrease fertility by affecting sperm production. More general disorders such as obesity, excessive consumption of alcohol or tobacco also limit male fertility. Finally, certain anticancer treatments such as chemotherapy and radiotherapy sometimes limit the production of sperm.

In women

The causes of infertility are again multiple. Some women may suffer fromovulation abnormalities. Ovulation may be nonexistent (anovulation) or of poor quality. With these abnormalities, no oocyte is produced and therefore fertilization cannot take place. The fallopian tubes, which lie between the ovaries and the uterus and allow the embryo to migrate into the uterine cavity, may become blocked (for example, in the event of salpingite, an inflammation of the tubes or a problem with adhesion following surgery). A woman may have endometriosis, uterine fibroma or polycystic ovary syndrome, which is a hormonal imbalance that causes cysts to appear on the ovaries and is manifested by irregular periods and sterility. Medicines, such as cancer treatments, can cause infertility. Thyroid problems and hyperprolactinemia can also be responsible. This increase in the level of prolactin, a hormone present during breastfeeding, can affect ovulation.

The diagnosis

In case of infertility, it is necessary to try to find its cause. The various tests offered can be long. The specialists start by checking the general state of health of the couple; they also talk about their sex life. In about a third of cases, the couple’s infertility remains unexplained.

Le Huhner test is a test to be performed a few hours after intercourse. It checks the quality of cervical mucus, a substance produced by the uterus that allows sperm to move better and reach the uterus.

In humans, one of the first tests is to analyze the content of the sperm: the number of spermatozoa, their mobility, its appearance, its abnormalities, etc. We are talking about spermogramme. If abnormalities are detected, an ultrasound of the genitals or a karyotype may be requested. Doctors also check if ejaculation is normal. Hormonal tests, such as testing for testosterone, from a blood sample are frequently performed.

In women, the proper functioning of the reproductive organs is checked. The doctor also makes sure that the menstrual cycle is normal. Blood tests to check the amount of hormones present can make sure the woman is ovulating well. A hysterosalpingography allows a good visualization of the uterine cavity and the fallopian tubes. This examination allows, thanks to the injection of a contrast product, to detect any blockage in the tubes. A laparoscopy, an operation that visualizes the inside of the abdomen and therefore the ovaries, fallopian tubes and uterus, may be prescribed if infertility is suspected. It can help detect endometriosis. A pelvic ultrasound can also detect abnormalities of the uterus, tubes or ovaries. Genetic testing may be necessary in order to detect a genetic origin of infertility.