More and more couples have problems with getting pregnant. Contrary to appearances, this does not only apply to people who decide to have a child at a later age. As prof. dr hab. n. med. Robert Spaczyński, national consultant in the field of gynecological endocrinology and reproduction, infertility affects a significant percentage of the population in the reproductive age, often young and healthy people, who would not suspect it.
- In Poland, every sixth couple has a problem with getting pregnant
- Prof. Spaczyński emphasizes that infertility affects increasingly younger women and men, but women over 40 have the most problems with conception
- The doctor explains the causes of infertility and advises which tests to apply for
- You can find more such stories on the TvoiLokony home page
Every year, about 25 thousand people come. couples suffering from infertility, with more of them each year. Are we dealing with a growing phenomenon? If so, where does it come from?
Indeed, more and more couples struggling with infertility. It is estimated that this problem affects approx. 15 percent in Poland. population of reproductive age, which means that every sixth couple has a problem with getting pregnant. This condition is due to many factors.
First, it results from the socio-demographic situation. Women later decide to have a baby, then they get pregnant. The optimal reproductive age for a woman is 20–25. year of life. After the age of 35, it is more difficult, and after the age of 45, fertility is minimal, as the risk of miscarriage is around 95%.
The average age at which a woman gives birth to her first child is currently over 30 years in the European Union, and over 27 in Poland. Meanwhile, the later, the lower women’s ovarian reserve is.
Infertility also results from environmental factors such as smoking, sedentary lifestyle, improper diet, chronic stress – and this applies to both sexes.
When it comes to female infertility, there are two groups of problems: anatomical – such as obstruction of the fallopian tubes, endometriosis or fibroids – and functional, which include ovulation disorders, polycystic ovary syndrome or premature ovarian failure.
In the case of male infertility, the problem is often reduced sperm quality, resulting from systemic diseases, testicular diseases and the influence of environmental factors. Some medications can also lead to infertility in both genders.
Unfortunately, about 20 percent. couples cannot find the cause and then we define such infertility as idiopathic.
Infertility is a disease that can and should be treated. However, many couples wait a long time to see a doctor on this matter. The situation is not made easier by some gynecologists, if – and this happens – they refer for diagnostics too late. Besides, in our country awareness of infertility is still low …
Yes, that’s true, and this applies to both infertility and reduced fertility (subfertility). As for the diagnosis of infertility, it should be started on average after 12 months of unsuccessful attempts for children. In the case of women over 35, diagnostics should start after six months, and in women over 40 – immediately. Accelerated diagnostics are also required by women after oncological treatment, with anovulatory cycles and those whose partners have low sperm parameters.
What is infertility diagnosis and how is it done?
It begins with an interview with the diagnosed couple and physical examination. A woman should check whether she is ovulating and that the fallopian tubes are not obstructed, and a man’s sperm quality should be checked. Ultrasound and radiological examinations are helpful, and sometimes also genetic tests: karyotype tests are performed when a woman has had two or more miscarriages, and a man has very low sperm parameters.
When should you turn to assisted reproductive techniques such as IVF?
That’s when other infertility treatments fail. In vitro fertilization is the final method that is mainly used in the case of obstructed fallopian tubes in a woman and very poor sperm parameters in a man. In vitro fertilization can also be used in several other cases, e.g. in endometriosis or idiopathic infertility.
More than forty years ago, when the method of in vitro fertilization was first used, only one technique was known, today considered a classic. It consisted in placing the sperm together with the collected eggs in an incubator. Today, in vitro fertilization techniques are much more.
Yes, a lot has changed since then. Today we have micromanipulation techniques (ICSI), in which, using special micropipettes, micromanipulators and appropriate microscopes, the intracytoplasmically selected sperm is injected, which increases the chance of success. The multitude of techniques (including IMSI or PCSI) allows them to be adapted to a specific health situation, both for women and men.
In addition, today we have more and more perfect methods of hormonal stimulation, which also gives the couple a greater chance of offspring.
In the treatment of infertility, pharmacological therapies are used, e.g. drugs to stimulate ovulation, e.g. diuretic and recombinant gonadotropins obtained by modern genetic engineering. How do you rate them?
The role of gonadotrophins, which are the most common preparations in hormonal stimulation, should be emphasized. Gonadotrophins are extremely effective drugs for the induction of multiple ovulation. Gonadotropin preparations are obtained by extracting and purifying active hormones from the urine of postmenopausal women or by using genetic engineering methods in specially programmed cell lines (recombinant human follicle stimulating hormone). Gonadotrophins are usually used in women who have not responded to previous treatment with other drugs.
Considering that the in vitro preparation procedure is quite complicated, and new generation drugs, including recombinant gonadotropins, require specialist knowledge on how to use them, probably not every doctor will be able to prescribe them.
Due to their action, gonadotropins should be used by experienced specialists with constant ultrasound monitoring and, as a rule, in stimulating protocols in assisted reproduction. The use of gonadotrophins in infertile women with regular menstrual cycles as the first-line treatment may lead to multiple pregnancies with a higher obstetric risk.
As for improving awareness of infertility, what should all of us know?
Infertility is a disease that affects a significant percentage of the population of reproductive age, often young and healthy people, who would not suspect it. It has not only health consequences, but also social and demographic consequences. Fortunately, the progress of medical science and the dynamic development of methods of assisted reproduction now enable more and more effective treatment of this disease and give hope to obtain offspring for many infertile couples. However, it is important not to delay diagnosis and possible treatment.
Authorized press interview prepared by the Journalists for Health Association in connection with the 2020th Polish National Conference “Polish Woman in Europe”, November XNUMX.
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