Infertility, or the unintended childlessness, is a rising problem, which currently relates to about 15 – 20% of couples in the developed countries of Europe and to 5 – 8% of couples worldwide. We can start speaking of it after one year of a regular unprotected sexual intercourse; as in case of any other disease, the couple should in this case look for a professional medical help and undergo the recommended examination revealing the cause of the problem, thus making it possible to design a treatment. For an easier orientation in this problem we give the causes, which may lead to reduced fertility and further to infertility of a woman or a man, or to repeated abortions.
Causes of female infertility:
- A hormonal imbalance, consequently leading to a defect of maturing and release of the ovum, a low quality of the mucus of the cervix preventing sperm penetration, or a reduction in the quality of the cavum uterum and thus the aggravation of the condition for nesting
- Pathology of the embryo transport (closures due to inflammation or an inborn defect, endometriosis)
- Inflammations and alterations of the surface and glandular cells of the cervix
- Formation of antibodies against own or partner’s embryonic cells or trophoblast
- Endometriosis at all stages
- Idiopathic, i.e. unknown cause of infertility
Causes of male infertility include:
- a defect of sperm formation, reduced mobility, defect of sperm shape
- a defect of sperm transport
- a defect of sexual functions
- a combination of the above
Apart from the mentioned causes of infertility it is necessary to mention those factors, which potentiate the problem. To these belong: age, sexual intercourse frequency, external environment, stress, state of nutrition and a genetically given reproductive potential.
The basis of a correct diagnostic direction is a detailed family and personal anamnesis, palpation, cytologic and colposcopic examination by a gynaecologist and a single or repeated ultrasound examination monitoring the alteration dynamics. Hormonal examination bound to the menstruation cycle gives us information about ovulation or specifies the cause of its absence and the extent to which other endocrine glands contribute (thyroid gland, pancreas...). We can gain information about the sate and transport function of the respective parts of the reproduction system of a woman most ideally by using complex endoscopic examination methods (hysteroscopy, laparoscopy with a color test of patency). Laparoscopy is also the only diagnostic method in verification of the initial stages of endometriosis. By means of blood or cervix mucus examination we obtain information about the presence of antibodies against the embryo.
The examination of a man is, similarly to the case of a woman, supported by the data from the anamnesis, clinical examination, examination of the ejaculate and in case of a finding of a pathology it is supplemented with a genetic, hormonal, cultivation or ultrasound examination, with an orientation to the occurrence of varicocele, or the examination by a sexologist, psychologist or another specialist according to the kind of problem identified. Currently, according to statistical data, the man participates in a reproductive problem of a couple in up to 53% of cases, which is binding when planning the examination, both from the side of the examiner and the subject.
Among the methods extending the information on diagnosis we cannot miss the first IVF cycle, because there is no other method, which would clarify the mutual behaviour of the gonadal cells.
If we are not limited by a time factor in the form of the woman’s and the man’s age when selecting the treatment procedure, and if we are not dealing with bilateral defect of the ovum transport (a closure of the Fallopian tubes) or a severe pathology of spermatogenesis, in which case the treatment of the first choice is by means of the assisted reproduction, then we try to proceed from the simple methods, which burden the couple less, to the more demanding ones. In practice this means that in case of a diagnosed ovulation with an irregular menstruation cycle we start with the cycle adaptation, a considerate induction of the ovulation with antioestrogen, small dosages of gonadotropines in combination with timing of the conception optimum, through the intrauterine insemination to the techniques of assisted reproduction (IVF,...). The procedure selection in case of the male factor domination is based on the severity of the pathology and in case of light forms of the defect we can proceed from the insemination up to IVF, ICSI, TESE, MESA.
Indication to the ART treatment:
- Bilateral (both-sided) closure of the Fallopian tubes
- Unilateral (one-sided) closure of a Fallopian tube, refracting to another treatment method
- Ovulation defects
- Male factor of infertility
- Immunologic cause of infertility
- Idiopatic infertility
- Pathology requiring the donation of gametes
- Chromosomally-linked disease requiring the preimplantation genetic diagnostics
Complications of the treatment:
- Ovarian hyper-stimulation syndrome
- Multiple pregnancy
- Inflammation complications
- Complications connected to bleeding