Infertility
Infertility is a condition when a woman cannot become pregnant after one or more years of unprotected sex. It is known that fertility declines in women as they grow older, therefore some women aged 35 years or older are evaluated and treated by some providers after 12 months of sex without protection. The WHO data estimate that more than 60 million people suffer from infertility.
Types of Infertility:
Primary infertility is a kind of infertility when couples have not become pregnant at least after a year without birth control methods. Infertility can be defined as ‘secondary’ when couples used to be able to conceive but now are unable. In addition to the above-mentioned types, there is a relative infertility (the cases are unclear) and absolute (reproductive system suffered changes that are beyond treatment).
Idiopathic infertility is used in both andrology and gynecology. In gynecology, the term of ‘female idiopathic infertility’ means a condition when clinical examination does not reveal any pathological reasons for infertility of the couple. The more appropriate name for this type of infertility would be ‘unexplained infertility. ‘Male idiopathic infertility’ does not mean an absolute infertility if a male partner was not diagnosed with azoospermia. Couples with this kind of infertility are able to have children, however with a low likelihood of paternity and extended time of achieving pregnancy.
In general, ‘idiopathic infertility’means diagnosis by exclusion. This means that patients would be diagnosed with idiopathic infertility only if all the other possible causes are crossed out. As a rule, seminal parameters are abnormal and may be associated with elevated follicle-stimulating hormone (FSH) indicating spermatogenic failure. Testicular biopsies often display abnormalities in spermatogenesis or spermiogenesis, which range from complete or focal Sertoli cell-only (SCO) syndrome to spermatid arrest (Chapter 9.4.2). Descriptive histological findings play no role in explanation of the pathogenesis or rational treatment.
Males as well females can suffer from infertility. It is commonly believed that the problem of infertility concerns women only. In reality, around 35% of couples with infertility include a male factor too. The solution to this problem can be found only if partners support each other and are ready to undergo treatment together. The statistics shows that about 20-30% of cases of infertility are caused by male infertility. The same percentage of cases is caused by female infertility, whereas 25-40% include both partners. Approximately, in 10-20 cases the causes of infertility cannot be identified.
The main causes for infertility in females:
- Abnormal cervical mucus
- Endometriosis
- Ageing
- Ovulation problems that can be caused by polycystic ovary syndrome or PCOS
- Unhealthy body weight
- Uterine abnormalities.
The most common causes of male infertility:
Anti-sperm antibodies. These particular cells mistakenly take sperm for dangerous invaders and attack them.
Chromosome defects. To chromosome defects belong disorders that are inherited, such as Klinefelter’s syndrome – when a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y). Due to this disorder reproductive organs are excessively developed. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome, and Kartagener’s syndrome.
Defects of tubules that transport sperm. Sperm can be transported by various tubes which can become blocked as a result of different diseases. Other causes may include traumas, inadvertent injury from surgery, infections, abnormal development (such as cystic fibrosis).
Issues with ejaculation. The phenomenon of retrograde ejaculation happens when semen enters the bladder during orgasm instead of coming out of the tip of the penis. This can be the result of suffering from diabetes, spinal injuries, taking medication, undergoing surgery of the bladder, prostate or urethra.
Infection. Sperm production can be hindered by certain infections which might lead to worsening of sperm health. Moreover, the tissues can become scarred and hence block the passage of sperm. Among dangerous infections are inflammation of the epididymis (epididymitis) or testicles (orchitis), and inflammations that are induced by sexually transmitted diseases like HIV or gonorrhea. Despite that some of them might bring about a permanent testicular damage, quite often sperm can still be retrieved.
Hormone misbalances. Inability to conceive can be a result of problems with testicles or some kind of abnormality that impacts hormonal systems (thyroid, hypothalamus, pituitary and adrenal glands). The low level of testosterone and other issues with hormones might have a different origin.
Undescended testicles. Men whose testicles failed to descend form the abdomen into the scrotum during their fetal development are likely to have problems with fertility.
Varicocele. When veins start to swell and thus drain the testicle, this condition is called a varicocele. It results in reduced quality of sperm and contributes to infertility. The reason for varicocele is supposed to be related to abnormal testicular temperature regulation.
The sperm can be evaluated using the following terms:
- Astenozoospermia – decreased mobility of spermatozoids (less than 25%)
- Azoospermia – no spermatozoids in the sperm
- Normospermia – normal tests results
- Oligospermia – a decrease of concentration of spermatozoids in the sperm
- Teratospermia – the amount of spermatozoids with a normal morphology less than 30%
How infertility can be treated?
To treat infertility, either traditional treatment tactics or assisted reproductive technologies are used. In case the traditional tactics do not work, ART is offered .
Assisted reproductive technologies include:
- Planned sexual intercourse
- In vitro fertilization (IVF)
- Intrauterine insemination
- Eggs donors
- Intracytoplasmic sperm injection
- Surrogacy
Your reproductologist will choose a suitable method.
One more point to pay attention to is that these days couples are rather unwilling to see the doctor. They put off the visit to the doctor until it is too late to help with their problem. The earlier you address a specialist, the better!
ADONIS offers a free consultation, so do not wait to make an appointment and get a chance to build a happy family!