Infertility treatment

Infertility treatment

What is infertility and when we recognize it?

We talk about infertility when, after a year of regular unprotected sex, a woman does not become pregnant. This definition, of course, applies to the so-called. "Statistical couple" trying to get pregnant. That 100 couples trying to get pregnant approx. 90% will complete these efforts successfully within 2 years (80% in the first year). 10% par to group, in whom we diagnose infertility. People after 35 and especially 40 From the age of 18, they usually seek advice earlier than one year of efforts. Age itself is one of the main determinants of fertility.

What are the causes of infertility?

We break down the causes of infertility into factors: male, female and common infertility. The male factor is usually a decline in sperm's ability to fertilize. I embrace the female factor: mechanical causes (obstructed or malfunctioning fallopian tubes), hormonal (which result in the lack of or incorrect ovulation),immunological.

What is immunological infertility?

This is a relatively rare condition, wherein immune particles are produced in the female and / or male organism (antibodies) resulting in decreased sperm activity and loss of fertilization. In such cases, the process of implantation of the developing embryo within the uterus or the development of early pregnancy may also be disturbed. Diagnostics involves the examination of various groups of antibodies in the blood serum. The treatment involves vaccines prepared from the partner's serum, pharmacotherapy. In many cases, in vitro fertilization is considered.

What is the diagnosis of infertility?

It is a series of studies involving both partners. The diagnostic period should be limited to a relatively short period of time, which in practice means 2 monthly cycles. During this period, the following tests are performed:

  • semen analysis
  • hormonal tests, immunological including post-intercourse test
  • evaluation of ovulation
  • assessment of the patency of the fallopian tubes
  • endoscopic diagnostics

Can only a specialist examination determine anovulation??

For a woman, a harbinger of ovulation is the presence of the characteristic mucus before the middle of the cycle. The popular temperature measurement only informs about the occurrence of ovulation on a given day, however, it does not make it possible to assess the quality of this ovulation.

How is the patency of the fallopian tubes examined??

The test is performed in the first phase of the cycle between the end of menstruation and ovulation. It consists in injecting contrast with a device placed in the cervix. Contrast fills the neck, the uterine cavity and fallopian tubes. During this time, a series of radiographs is taken. The patency of the fallopian tubes can also be assessed visually during diagnostic laparoscopy.

What is semen analysis?

The basic test to check male fertility is semen analysis. The test is performed after 4 day-long sexual abstinence. In order to perform it, the man must provide semen obtained during masturbation at home or in a doctor's office. The semen should be stored at a temperature close to body temperature and submitted for testing as soon as possible. If the semen is not tested within 30 min, nor will it be kept at 37 degrees, this is a significant proportion of the percentage of sperm cells that may either die or reduce their viability. Semen analysis should reveal abnormal numbers, motility and other abnormalities of sperm and seminal fluid. A reduced sperm count should not be taken as a definitive diagnosis of infertility, or rather, as a signaling factor of a fertility problem. Currently it is believed, that quantity below 20 million sperm per milliliter is considered abnormal, nevertheless, pregnancy is sometimes possible even with such small amounts of sperm.

Post-sexual intercourse test.

Test after sexual intercourse, it is used to assess the activity of sperm in the cervical mucus at a certain time interval after intercourse. The test should be preceded by a semen analysis. To do this test, the woman is asked to come to the doctor's office approx. 10-14 hours after intercourse on the day just before expected ovulation. The collected mucus from the cervix is ​​examined under a microscope. The number and motility of sperm are assessed. The test is invalid, if there is no sperm in the mucus or it does not move. The correct result is based on a statement, at least 6 active sperm in the field of view of microscope x 400. The presence of a normal number of sperm but stationary sperm may indicate an immunological cause. The inflammatory factor should also be excluded. (perform culture from the cervical canal).

Testicular biopsy.

Sometimes, in cases where there is no sperm in the semen and the blood levels of FSH are normal, a testicular biopsy is performed, which consists in taking a tissue section during general anesthesia and further histopathological examination to show the presence or absence of sperm-forming cells in the testes.

How we treat infertility?

Treatment of infertility is a series of methods aimed at restoring the fertility of both partners. In cases of couples where the cause of infertility is known or suspected, it is aimed at changing the existing abnormality. The methods used should be mentioned:

  • improvement of the general gynecological condition of a woman
  • improving a man's overall health and improving sperm quality
  • getting ovulatory cycles
  • the use of assisted reproduction methods

What is insemination?

It is a relatively simple procedure which consists in administering, preferably on the day of the expected ovulation, laboratory prepared and activated sperm. It is a painless procedure. Sperm are fed directly into the uterus through a thin catheter. After a short rest, the patient goes home.

What are the methods of assisted reproduction?

These methods, called in-vitro fertilization, consist in combining the collected eggs with the partner's sperm outside the woman's body.. Within 24 hours, the eggs should be fertilized. After a few days (most often after 2) if the embryos develop properly, the procedure for introducing the embryos into the uterus can be performed.

What are the stages of in-vitro fertilization?

This method consists of the following steps:

  • preparation
  • hormonal stimulation
  • egg collection
  • the embryological part
  • embryo administration
  • expectations

What is preparation? In this phase, both partners undergo laboratory tests to assess their health condition and to help them choose the best variant of in-vitro fertilization.. Sometimes supportive medications begin in this phase, helpful during the proper cycle.

What is hormonal stimulation?

Its purpose is to cause the right number of follicles to grow in the ovaries. This is achieved by taking medications daily by injection from the first days of the cycle through the eye period 8-10 days. During this time, patients report for control visits.

What does egg collection look like??

It is a relatively short procedure performed under general anesthesia. The ovaries are punctured with a needle through the vaginal vault under ultrasound guidance. Egg cells are searched for in the bubble fluid. After a short rest, the patient goes home.

What is the embryological part?

It is a series of laboratory activities leading to fertilization and further development of the embryos. In some cases, it is necessary to perform a micromanipulation procedure in which a single sperm is injected into each egg.

What is embryo administration?

It is actually like insemination. With the help of a special thin catheter, the embryos are injected into the uterine cavity. The treatment should be performed as gently as possible.

Why are several embryos given?

Because, that after the embryos are introduced into the uterus, most of them do not implant
and therefore cannot develop. To avoid the risk of multiple pregnancies, no more than 2-3 embryos. Currently, efforts are made to limit the number of embryos administered.

What happens in the waiting phase?

During this time, the patient receives drugs to support implantation and the development of early pregnancy. Po 10-12 days after embryo administration, a pregnancy test is performed

Whether infertility is influenced by lifestyle?

It does, and it usually concerns men. Sedentary lifestyle, shoulder of movement, nicotinism, harmful working conditions ( high temperatures, electromagnetic radiation, heavy metals, etc.), Poor diet can often be the cause of the so-called unexplained infertility. It may also affect changes in sperm structure and motility. In women, the lifestyle does not matter as much, rather all past genital tract infections and immune diseases have an influence on infertility.
Man, who wants to be fertile should avoid alcohol, cigarettes and any medications, which could adversely affect the quality of sperm or reduce sexual performance. Adequate rest, moderate exercise, healthy low-fat diet, and rich in whole grains, fruit, or vegetables – these are the main recommendations. Overweight men should lose weight. There, who exercise extremely intensively, they should slow down a little, (but keep practicing completely). Vitamin C improves the absorption of compounds such as zinc in the digestive tract, copper, potassium, calcium, and at the same time improves the viability and survival of sperm. It can also prevent sperm from sticking together. Vitamin E, anti-oxidant, improves fertility in men with normal sperm counts, but with a simultaneous high concentration of free radicals in the blood and seminal fluid. Vitamin C is also an anti-oxidant. Men with low levels of zinc in the body may take additional zinc tablets. Benefits of using herbal preparations, such as ginseng, have not been proven. Overheating of the testicles should be avoided, therefore men should rather give up hot baths or saunas. Although the results of current observations show no impairment of fertility when wearing tight underwear or pants, however, wearing looser clothes does not hurt. In order to prevent the decrease in the amount of sperm in the ejaculate, you should limit the number of sexual intercourse to one, every two, three days, except for the period, when the woman ovulates.
Recent studies talk about it, that having intercourse every day, or even several times a day, two days before and on the day of ovulation improves the pregnancy rate. Although the sperm count is then reduced in the ejaculate, it is the constantly renewed sperm supply that has a much greater chance of penetrating the mucus and fertilizing the egg. In this approach, fertilization is not a one-time, but a continuous process. Women, who smoke one or more packs of cigarettes a day, and these, who started smoking before the age of 18 are at risk of becoming infertile. Compared to nonsmokers and those, who quit smoking, firing women 20 of cigarettes a day on May Fr. 20% less chance of getting pregnant. The relationship between caffeine consumption and infertility has also been confirmed. Caffeine is found not only in coffee, but also in tea, many cold drinks, chocolate and in a large number of commonly used drugs. Even a little alcohol consumption (e.g.. five drinks a week) may impair fertility and have a harmful effect on a developing unborn child. Frequent vaginal irrigation may impair fertility by disrupting the biocenosis, i.e.. the bacterial composition of the vagina and increasing the risk of inflammatory processes in the reproductive organs. Sexual behavior, such as having sex with multiple partners, not using condoms, having intercourse during menstrual bleeding increases the risk of infection with sexually transmitted microorganisms, which can cause a pelvic infection leading to infertility or the risk of ectopic pregnancy.