As in the rest of the developed countries, approximately 15% of couples have sterility problems; that is to say, one out of every six couples who try to conceive do not succeed after one year of sexual relations without contraceptive methods. On the occasion of World Infertility Month, we have the collaboration of Dr. Mónica Muñoz, medical director of CREA (Medical Center for Assisted Reproduction) and member of Top Doctors, in order to go deeper into this increasingly common problem among couples.
Infertility is becoming more and more frequent, mainly due to the delay in the search for pregnancy for work or social reasons, with the consequent decrease in the woman’s physiological fertility and, in addition, the possible appearance of general or gynecological pathology, which can make it difficult to achieve pregnancy.
On the other hand, a decrease in seminal quality is also observed due to factors such as smoking, alcohol, stress, etc., all of which are closely linked to the current lifestyle.
How should a possible case of sterility be studied?
It should not be forgotten that sterility is a matter of two and, therefore, both members of the couple should be studied from the beginning, and a complete clinical history should be taken, including family and personal history, as well as reproductive history.
In this sense, the woman will undergo a hormonal and ultrasound study and, depending on the results, will be oriented towards more specific tests that allow the functionality of the fallopian tubes or the endometrial cavity to be assessed.
The man will undergo a spermiogram as an initial test, complemented, if required, with analytical, ultrasound or genetic tests.
Any diagnostic or treatment process requires a strictly individualized approach that is studied on a case-by-case basis.
How to approach a case of sterility
Based on the studies carried out on the couple, we must apply the ideal treatment, evaluating its advantages and disadvantages, in terms of efficacy and safety.
The wishes, expectations and preferences of the patients should also be considered, who, making use of their autonomy, should finally choose among the options that are clinically applicable, with a reasonable guarantee of success.
Causal factors of infertility
The most frequent causal factors in sterility are: – Male factor or seminal alterations, in 25-35% of couples. – Endometriosis and tubal disorders, in up to 35% of couples. – Ovulatory factor, which affects 25% of patients. – Unexplained infertility of unknown origin or without apparent cause, which usually represents up to 20% of cases. – Other factors, such as obesity, anorexia, thyroid disorders, alcohol, tobacco or drug abuse and stress can also cause sterility or influence the outcome of treatment.
Assisted reproduction techniques that can be applied
The diagnostic process makes it possible to determine which of the available therapeutic alternatives is the most suitable as the first line of treatment, offering the most appropriate relationship between benefits, complexity, costs and risks. The assisted reproduction techniques available are: – Artificial insemination with the partner’s sperm: this is the simplest technique. After ovarian stimulation, ovulation is triggered and the partner’s sperm, capacitated with a fine cannula, is deposited in the uterus. – Artificial insemination with donor sperm: it is used if the male is affected by severe seminal alterations that require the use of sperm from sperm banks or, in the case of women without a male partner, with gestational desire. – In Vitro Fertilization: after ovarian stimulation and puncture to extract the oocytes, these are put in contact with the spermatozoa to achieve fertilization and initial embryonic development outside the woman’s body, to later transfer the best quality embryo to the uterus. – Sperm microinjection: this is a variant of the previous one that intervenes more actively in the fertilization process, by introducing a spermatozoon inside each oocyte. – Preimplantation Genetic Diagnosis: is a procedure aimed at studying the embryos obtained through In Vitro Fertilization, in order to select those that are free of the genetic trait associated with a genetic disease, for their transfer to the uterus. – Oocyte Donation: this involves transferring embryos from donor oocytes. It is indicated if the woman’s oocytes do not offer sufficient quality to achieve pregnancy, have been exhausted or if she is a carrier of a genetic or chromosomal alteration. – Fertility preservation: freezing of oocytes or sperm for later use in the future for oncological or social reasons.
Why does the failure of a treatment cause couples to give up and then later manage to conceive?
Infertility is a dynamic process over time, so couples who are unable to conceive today may be able to do so in longer periods of time. Even so, it is not advisable to delay the study in cases of advanced age or known reproductive pathology.
Treatments can be ineffective either because of poor ovarian response or because the embryos have failed to implant properly in the uterus.
However, failure is linked to feelings of denial, confusion, guilt or stress reactions that, in some cases, lead couples to abandon treatment. But this does not mean that, in the future, these couples will not be able to conceive.
When, after several attempts, pregnancy is not achieved, it is important for the couple to know when to change reproductive techniques or when to stop. Failure to achieve pregnancy after several attempts can generate the feeling that it is necessary to keep trying at any cost, which is counterproductive for the couple’s bond. The anxiety generated by this situation is not the best ally for a successful assisted reproduction treatment.