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The inability to become pregnant after 12 months of regular intercourse is called infertility. About 20-30% of couples struggle with this problem, and this percentage is growing every year. Among couples seeking medical help, the problem of infertility is on the female side in approx. 40%, and on the man’s side in approx. 30%. In other cases, the problem lies on both sides or cannot be clearly defined.
The most common causes of infertility include abnormalities in ovulation, fallopian tube function, endometriosis, and sperm abnormalities. A relatively large number of pairs belongs to the so-called idiopathic infertility, that is, unexplained infertility.
Diagnostics in infertility
In the treatment of infertility, diagnosis is the first step to success. Its purpose is to find out what is wrong with your infertility and to obtain information about your general health so that treatment is effective and safe.
As part of diagnostics, it is necessary to perform basic tests, i.e. hormonal and microbiological tests (to exclude infection of the reproductive organ), ultrasound and semen analysis.
Depending on the previously performed diagnostics and the data obtained from the interview with the patients, the doctor may rely on these data or order additional tests. After the initial diagnosis is obtained, the doctor may recommend non-invasive treatment that is comfortable for patients (e.g. monitoring ovulation and planning sexual intercourse at the most favorable time) or hormonal treatment. It is very important that all elements of treatment are explained to patients in detail and justified, and implemented after obtaining their approval. A professional approach to patients also means respecting their worldview and the certainty that the actions taken cover all available methods of fertility treatment.
For couples struggling with infertility problem the very fact of the necessity to undertake diagnostics and treatment is an uncomfortable and stressful situation. Future potential parents, apart from being professional, also expect understanding of their problem. Doctors investigating infertility should do everything possible to alleviate the stress associated with diagnosis and treatment methods, so they often offer interviews with a clinical psychologist that can have a positive impact on the overall treatment.
In a situation where, despite the implemented pharmacological treatment, we do not achieve the intended goal or in the case of clear indications, we offer patients the use of assisted reproductive methods, i.e. intrauterine insemination (with the sperm of a partner / anonymous donor) or an in vitro fertilization program. These techniques significantly increase the likelihood of pregnancy, and for some couples they are the only chance of having children.
Who is affected by infertility?
Because of that causes of infertility can lie on the side of both a woman and a man, we conduct diagnostics at the same time in both partners. The causes of female infertility are the so-called female factor. These include ovulation disorders (hormonal disorders), fallopian tube factor, endometriosis, uterine factor, and immune factor.
The reduction of fertility in women may result from frequent infections of the birth defects or the treatment of neoplastic diseases with the use of chemotherapy and radiotherapy.
The greatest enemy of a woman who wants to get pregnant and give birth to a child is, after all, the passage of time, as the woman’s fertility systematically decreases with age. It is believed that the peak of fertility is around the age of 25, after which time it begins to slowly decline. Its greatest decrease occurs after the age of 35, when the ovarian function significantly decreases, dramatically reducing the chances of having children. The postponement of the decision to start procreation to later years of life, observed in recent years, also in Poland, is one of the reasons for the increasing percentage of couples having problems with infertility.
The solution in this case may be freezing oocytes. This procedure helps to protect the woman from the disappointment associated with the inability to get pregnant after cancer treatment or when she decides to become pregnant later. Frozen ova, if it is the donor’s will, can also be donated anonymously to another woman. Egg donation is a unique opportunity for women suffering from infertility to have a child of their own. The indications for such a solution are, among others. premature decline of ovarian function, insensitivity to gonadotropins, defect of adenylate cyclase system, carrier of genetic defects or chromosomal disorders as well as older age of the patient.
Diagnostics of the female factor should include a thorough history, microbiological tests (allowing to reveal or exclude ongoing infections in the genital organ), hormonal tests (determining the ovarian reserve and other disorders related mainly to the ovaries and thyroid gland), immunological and anatomical tests (thanks to which it is possible to detect abnormalities in the reproductive organ). genitalia, in particular the uterine cavity and fallopian tubes, as well as the presence of endometriosis). Very helpful tools for anatomical diagnosis, in addition to the gynecological examination itself, are transvaginal ultrasound and hysteroscopy, which allows you to obtain direct, magnified images from the inside of the uterus on the monitor screen.
Male factor (causes of male infertility) may concern abnormalities related to sperm production (impaired spermatogenesis, which may be caused by hormonal abnormalities, past infections), the occurrence of varicocele and anticancer treatment (radiotherapy). Another group of causes of male infertility includes anatomical congenital (genetic, hypospadias) and acquired abnormalities as a result of infections, injuries or surgery. There is also an important psychological factor that leads to the inability to have intercourse (impotence, premature ejaculation).
The problem of male infertility affects approx. 5% of men and is the cause of approx. Half of the failures among couples trying for a child.
Diagnostics of the male factor should include a detailed interview, taking into account diseases and infections and their treatment, drugs used, type of work and related risks, poisoning, lifestyle, diet, etc. The basic test to check male fertility is a semogram, ie semen analysis. During the analysis, the concentration, mobility, viability and morphology (structure) of the sperm are assessed, and the seminal fluid is also examined. Before submitting semen for testing, a 3-5-day period of sexual abstinence is recommended. The semen is obtained by masturbation, preferably on the premises of the clinic in a specially prepared room ensuring complete intimacy. In some cases, it is possible to deliver the ejaculate from home, however, it should be ensured that the semen is delivered to the laboratory as soon as possible (no later than 60 minutes after ejaculation) and at a temperature close to body temperature.
The best and fully reproducible method of semen evaluation is its computer analysis (e.g. SCA system). The accuracy and objectivity of this method is unattainable with traditional methods. An additional test for the evaluation of sperm is the analysis of sperm DNA fragmentation. Research shows that about 20% of men experience damage to sperm DNA, which leads to fertility problems. Moreover, in men with semen abnormalities, hormonal and urological diagnostics are performed.
Assisted reproductive methods
The assisted reproductive methods used are intrauterine insemination (IUI) the sperm of the partner or, if necessary, the donor (sperm bank) and the methods extracorporeal ignition (IVF-ET). They differ significantly, i.e. intrauterine insemination is a method in which the egg is fertilized naturally by the sperm in the fallopian tube. The indications for IUI are the cervical factor (mucus hostility), male factor, endometriosis, ovulation disorders, idiopathic infertility (with unknown causes).
During in vitro fertilization, the ova (previously stimulated and collected from the patient) are fertilized in an embryological laboratory so that after 3 or 5 days after fertilization they can be transferred back directly to the patient’s uterine cavity. The indications for IVF-ET include obstructed fallopian tubes, markedly decreased sperm parameters of the partner, some forms of endometriosis, non-rupturing follicular syndrome (LUF), and idiopathic infertility.
In the case of a disease such as infertility, the period of waiting for offspring is often long and difficult, full of self-denial and stress, however, failure to undergo treatment usually destroys the chances of motherhood.