Infertility is the inability to conceive within one year of targeted attempts (or within 6 months if the woman is over 36). By targeted attempts we mean concomitant intercourse with ascertained and monitored ovulation (with observation of symptoms, with the use of ovulation tests, monitoring of basal temperature, etc.).
Infertility also includes those situations in which conception occurs but the pregnancy is not completed.
A woman who has never been able to get pregnant will be diagnosed with primary infertility. If a woman has had at least one pregnancy and a baby in her arms, it is referred to as secondary infertility.
Infertility is not just a female problem. Nowadays, although the numbers and statistics clearly state that infertility involves men and women equally, it is always the woman who generally begins first to check and blame herself for the non-arrival of pregnancy.
About 40% of infertility cases can be attributed to female infertility while men’s problems account for another 40% of infertility.
The remaining percentage may be due to a combination of male and female infertility, or there may not be a known cause, and in this case it is referred to as idiopathic / unexplained infertility.
Causes of male infertility
In general, infertility in men is mainly linked to problems in terms of:
- sperm concentration in seminal fluid
- motility of spermatozoa
- sperm morphology
There are a variety of risk factors, medical conditions, and medications that can affect male fertility
The main risk factors associated with male infertility are represented
- old age
- cigarette smoke
- alcohol abuse
- overweight and obesity
- exposure to toxins, such as pesticides, herbicides, and heavy metals
- sexually transmitted diseases
The main medical conditions that cause male infertility are: retrograde ejaculation, varicocele, cryptorchidism, anti-sperm antibodies, hormonal imbalances, hypogonadotropic hypogonadism …)
Medicines and drugs
Taking certain medications or drugs can cause infertility
These include: drugs for chemotherapy or radiotherapy, drugs for rheumatoid atritis or ulcerative colitis, drugs for hypertension, tricyclic antidepressants, anabolic steroids, marijuana and cocaine.
Any of these factors or a combination of them can cause infertility.
Causes of female infertility
The causes of female infertility are many, and they interfere with the following processes:
Risk factors for female infertility include:
The main medical conditions that affect the female reproductive system and can cause infertility are:
Medicines and drugs
Among the drugs and narcotics that can affect female infertility we find:
- chemotherapy or radiotherapy drugs
- prolonged use of high-dose non-steroidal anti-inflammatory drugs (NSAIDs)
- antipsychotic drugs
- drugs like marijuana and cocaine
Very irregular menstrual cycles and the absence of menstruation are two symptoms of non-ovulatory cycles.
What to do if pregnancy does not come?
If you have been trying to conceive for several months but without success, there are some diagnostic investigations that become necessary.
If you are looking for a pregnancy for 12 months (or 6 months if you are over 36 years old) it is good to consult a gynecologist who specializes in couple infertility.
It also becomes necessary to consult an andrologist if one of the following conditions occurs in the male:
- erectile dysfunction (ED)
- problems with ejaculation, such as delayed ejaculation or retrograde ejaculation
- decreased sexual desire
- pain or swelling in the genital area
- previous surgery in the genital area
- non-optimal spermiogram outcome
Depending on the history and the outcome of the spermiogram, your doctor may want to perform additional tests which may include: hormone tests, testicular ultrasound, genetic tests
A woman’s fertility begins to decline noticeably after the age of 35-36. Women under the age of 36 should see an infertility-trained gynecologist after 12 months of targeted attempts, or as little as 6 months if she is over 36 years of age. This because the time factor after the age of 36 becomes very important.
Probably the gynecologist will want to check if ovulation occurs regularly, by ultrasound monitoring or specific hormone dosages and by asking the woman to monitor cycles with ovulation tests and / or basal temperature.
What are the treatments for infertility?
Treatment depends a lot on the problem encountered (if it is known), on what you are looking for during pregnancy, on the age of the woman, on the health of the couple, and on the treatment preferences of the couple.
Male infertility treatments
The treatment is related to the type of problem encountered. Options for men can include surgery, medications, and assisted fertilization.
Surgery can correct any obstructions that prevent ejaculation or correct conditions such as varicocele. In some cases, the spermatozoa can be retrieved directly from the testes to be used in a treatment for MAP (ICSI in this case).
Medicines can be used to manage hormonal imbalances. They can also be used to treat other conditions that can affect male fertility, such as erectile dysfunction infections that decrease the quality of semen.
Finally, assisted fertilization allows fertilization to take place either through IVF, or through ICSI, with the spermatozoa collected in the ejaculate or surgically extracted from the testicles or donated by a donor in heterologous fertilization.
Female infertility treatments
As in males, treatments may include surgery, medications, and assisted fertilization
Although surgery can sometimes be used to treat female infertility, it has become rarer due to advances with other fertility treatments. Surgery can improve fertility in the following cases:
- to correct an abnormally shaped uterus
- to make the fallopian tubes patent
- to remove fibroids
Surgical treatment of endometrioma is indicated in the event that the symptoms are or become resistant to medical therapy, or in cases where the size increases or exceeds 3 cm in diameter in infertile patients (ASRM 2014; ESHRE 2014).
There are an infinity of medications which can help the woman regulate the activities of hormones related to reproduction. There are treatments for the thyroid, to stimulate the growth of follicles and induce ovulation, and to support the luteal phase.
obviously if the problem of infertility is related to weight problems (in excess or in serious deficiency) the therapy in this case will concern a path to reach, together with a nutritionist and in some cases a psychotherapist, the healthiest weight.
The assisted fertilization treatments are the classic treatments represented by IVF, IUI, and ICSI.
Are there alternative treatments?
There are three main natural pathways that could help improve fertility. They are yoga, acupuncture and nutrition.
Obviously none of these can do anything when for example the problem is represented by obstruction of the tubes, or obstructive azoospermia.
According to a 2018 review, at least 29% of couples try some form of natural or alternative infertility treatment, either alone or to complement traditional treatments.
Acupuncture involves inserting small, fine needles into various points on the body. These points are believed to help stimulate the body’s energy flows.
There is no definitive evidence to support acupuncture as a treatment for infertility.
A recent review of clinical trials found limited evidence that acupuncture could improve both ovulation and menstruation in women with PCOS.
Yoga includes postures and breathing techniques to promote relaxation and decrease stress levels.
Studies on yoga as an infertility treatment are limited. However, it is believed that the practice of yoga can be helpful in relieving the stress that can be associated with fertility treatments.
The market offers an infinity of fertility supplements. Most of these supplements contain folate, zinc, vitamin C, vitamin E, and iron.
The question mark is a must on their effectiveness.
To rebalance the bacterial flora i probiotics, which can promote healthy digestion and improve overall well-being.
The importance of the vaginal bacterial flora and the understanding of the complex balance that allows protection from infections has been the subject of studies and research for some time. Recently, however, researchers have begun to turn their attention to the role that the vaginal microbiota plays in a woman’s fertility.
What we eat can affect …