Frequently asked questions about sterility and infertility
Generally, a couple has a 25% chance of achieving pregnancy each month they try. After 6 months, 60% of couples has achieved pregnancy and this percentage increases to 80% after a year. Therefore, it is recommended to consult a specialist in assisted reproduction if pregnancy is not achieved after one year of unprotected sexual intercourse.
This is not the same problem, although in both cases you do not have a baby. In fact, the studies and treatments for each case are completely different.
A woman is born with all the egg cells she will have throughout life. An egg cell is one of the organism’s few cells that do not regenerate over time. Therefore, as time passes, the woman’s ovarian reserve decreases. When the amount of egg cells has diminished too much, we speak of a low ovarian reserve.
As time goes by, apart from a decreasing ovarian reserve, a more severe level of cellular ageing takes place than in other organs. This cellular ageing of the eggs causes the increasing difficulty to get pregnant. Because of this ageing, the risks of miscarriage and Down syndrome increase, too, because the chances of genetic abnormalities during fertilisation increase as well.
Endometriosis is a disease that is characterised by the endometrium situating itself in other places within the organism than normal. The endometrium is the ‘skin’ that normally lines the uterus, and where usually the already fertilised embryo should become implanted to generate a pregnancy. In patients suffering from endometriosis, this lining can appear practically anywhere, although most commonly this is in the pelvic region, and above all, in the area of tubes and ovaries.
What is the problem with endometriosis?
Very frequently, patients suffer period pains. However, not all patients suffer these pains and the majority of patients with painful periods do not suffer from endometriosis. Likewise, there may be problems to achieve pregnancy, although many women with endometriosis achieve normal pregnancy without any problems.
How is endometriosis treated?
Endometriosis is a disease that normally evolves through ‘outbreaks’. This means there are moments of high activity when the lesions advance rapidly and moments of low activity, when the lesions do not progress. So far, there is no cure for endometriosis. The aim of the treatments however, is to make sure the disease is inactive most of the time.
Is surgery always needed?
On ovarian level, the endometrium implants usually provoke cysts with a very typical aspect on the ultrasound and a consistency like that of ‘chocolate’. Historically, these cysts were surgically removed almost systematically. Nowadays, the idea is that those cysts should be removed only if they are very large or growing fast, to preserve the rest of the healthy ovarian tissue, or to guarantee a correct diagnosis. In general it is known that where possible, surgery should be avoided because the intervention could damage the healthy ovarian tissue even further.
How does endometriosis affect fertility?
With this disease, the same as when the normal endometrium bleeds when menstruation appears, this also happens with endometriosis implants. These little haemorrhages cause quite some pain in patients during menstruation, as well as some tissues adhering to others. This way, with the tubes getting stuck to other organs like the intestines, the uterus or ovaries, these cannot function properly and capture the egg cell when the patient ovulates. This is one of the factors that complicates gestation in some patients suffering from endometriosis. But apart from that, the endometriosis implants in the area of the tubes may destroy them, which complicates the correct functioning even further. On ovarian level, unfortunately endometriosis does not only affect ‘what can be seen’. Sometimes, ‘what cannot be seen’ is worse. Endometriosis may cause an immunological lesion in the ovaries that affects the amount and above all, the quality of the egg cells more or less depending on the case.
Various causes may affect the functioning of the fallopian tubes. Surgery may at times provoke the tubes sticking to other tissues so they cannot move any more. It is also possible that infections have occurred that were not noticed previously, which left irreversible lesions on the tubes.
Polycystic ovary syndrome is a metabolic disease that affects the ovaries, the adrenal gland (a gland situated above the kidney), pancreas and pituitary gland. It produces a set of symptoms that do not affect all patients. These range from alterations in ovulation, which may produce alterations in menstruating and problems with gestation, insulin resistance or elevated levels of androgens, which causes more facial and body hair or acne.
Indeed, not all women with ovulation problems suffer from polycystic ovary syndrome. Other anomalies in the ovaries, that can cause alterations in ovulation, exist.
This is a blood test, done on a certain day in the cycle in case of a woman, where different levels of hormones that are interesting in each case, are measured.
This is an ultrasound which is done in the first few days of the cycle, to count the density of follicles that exist in the resting ovary. Nowadays, this is considered one of the best predictors of ovarian reserve, i.e. the ovaries’ capacity to produce egg cells of sufficient quality and quantity.
This is an x-ray whereby a bit of contrast liquid is introduced through the cervix to investigate the shape of the uterus and the penetration of the contrast material through the tubes. This is mainly used to see if the tubes work or not.
Although some patients do not notice any pain, frequently this hurts a bit. On the other hand, the intervention is hardly ever described as extremely painful.
There are many causes. In some cases, these causes are genetic, either inherited or not. In other cases, these causes are congenital, which means that you are born with this defect in the sperm cell production, but it is not a genetic problem. Other men have anomalies in their body like varicocele, or the testicles did not descend properly to the scrotum in childhood. Finally, many environmental factors may exist, like tobacco, alcohol, very warm media, cycling, etc. or infections (parotiditis in puberty), which may affect the sperm cell production.
This is a study of the quality of a sperm sample. The sample is obtained through masturbation and we can identify the number, morphology, and other characteristics of the sperm cells.
A basic semen analysis only allows us to descriptively study the sperm cells and their characteristics: mobility, form, number, etc. Capacitation however, consists of letting the sperm cells undergo a series of reactions that simulate what happens to them when to travel through the female reproductive system and identify how many of the cells are still mobile. This gives us a more functional perspective of the real problem and mainly about how to solve this problem.