Infertility

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Infertility

Family infertility is a condition when parents who use no contraception and regularly have sexual intercourse cannot have offspring (or rather, a woman cannot become pregnant) in one year. Infertility problem becomes more severe as more than ten per cent of the families in Europe are infertile.

Causes

30 percent of family infertility cases are caused by women’s infertility, 30 percent - men’s infertility, 30 percent - infertility of both of the partners and the cause of the rest 10 percent of family infertility cases is unknown.

Causes of women’s infertility:

  • Fallopian tube diseases (adhesions and scarring after previous pelvic infections, sexually transmitted diseases, endometriosis, surgery, abdominal diseases);
  • Ovarian diseases and ovulation disorders (polycystic ovaries, endocrine diseases – such as hypothyroidism, adrenal tumors, anorexia and other mental illnesses, severe diseases of other systems);
  • Uterine diseases, anatomical abnormalities (myomas, adhesions, changes after previous abortions);
  • Cervical diseases and changes (condition after surgery, inflammation);
  • Another important cause: a situation when antibodies against sperm of a specific man appear in cervical mucus. This might happen when using non barrier (usually hormonal) contraception, when the husband's sperm continuously gets into the woman's vagina.

Causes of men’s infertility:

  • Testicular diseases and abnormalities (previous inflammations, sexually transmitted diseases, congenital anomalies, previous surgeries);
  • Often men, who had mumps, are infertile;
  • Systemic diseases that prevent formation of the sperm (immune diseases, diseases of endocrine glands, some drugs).
  • Immobility of spermatozoids.

Unfortunately, 10 percent of the causes of infertility are still unknown.

Diagnosis

Examination of the couple is started when a woman cannot get pregnant for more than one year (when the couple does not use contraception and regularly have sexual intercourse). The couple is examined thoroughly by different specialists, because diseases of all organ systems can cause infertility. Usually the man and the woman are tested separately.

It is very important to gather accurate information so it is necessary to provide the doctor with information about previous illnesses, operations, previous pregnancies and abortions, allergies, hereditary diseases, sexual life and its problems, previous families, work, living conditions, addictions and many other facts that may seem unimportant to the patient but crucial to the doctor.

Later the partners are fully examined for systemic diseases, the woman is examined gynecologically, tested with ultrasound and her ovulation is monitored using various methods (see “natural family planning methods”). The concentration of certain hormones in the blood is measured. The man’s semen, the woman’s cervical mucus and excreta after sex are also tested. In order to assess the condition of the fallopian tubes special tests (hysterosalpingography) are performed. In some cases laparoscopy is needed.

Treatment

  • The treatment of family infertility is started with clarification of the cause and its removal: the treatment of systemic disorders and anatomical barriers, consultations of sexologists and urologists. In some cases surgical intervention and treatment of infections are needed.
  • Women’s ovulation problems might be also treated by removing the cause. Also, some drugs are used to induce ovulation (gonadotropins, etc.)
  • Other methods of treatment: assisted reproduction techniques. They are used when infertility cannot be cured by other means and when the cause of infertility is a disease of the sperm.

Assisted reproduction techniques include methods making a woman pregnant other than by natural intercourse. The main methods are:

  • Fertilization in vitro. Unfertilized egg is removed from the woman and is fertilized with semen. After that the embryo is implanted into the woman’s womb.
  • Intrauterine insemination. This method is used when there are antibodies against the man’s sperm in the woman’s vagina. The semen is injected directly into the uterus.
  • There are more complex methods such as sperm injection directly into oocytes, testicular biopsy, etc. It should be noted that the treatment of infertility is individual. What works for one couple may not be applied to another one.
   

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