Infertility

Causes of infertility

When we are talking about the infertility, one have to mention that we differ the primarily a secondary infertility. The women that have never experienced pregnancy have primary infertility, and the ones that were pregnant before, but are unable to conceive any more are the ones that have secondary infertility. Thus, starting from the first interview with our physicians, all up to the sophisticated methods of assisted reproduction such as micro fertilization (ICSI), patients of "Jevremova" dispensary have in one place all that modern medicine offers as routine methods and treatments for infertility diagnosis and treatment of married couples. Examination of infertile couples starts with anamnesis data on the general health of both partners, duration of infertility and the time that spouses spent trying to conceive, woman’s gynecological health, ultrasonographic, gynecological and cytological examination, hormone level testing, microbiological examination of both partners, indirect confirmation of ovulation ability and the Fallopian tube patency examination, spousal fertility examination and a series of other specific examinations whether these prove necessary.

 

There are many causes of infertility, and can be male factors of infertility (that is in about 25-40% of the couples), female factor of infertility (in 40-45% cases), mutual factor of infertility (in 105 of the cases), and idiopathic factor of infertility.

 

The main factors of male infertility are:

• Testicular factors of infertility; by this we are referring to factors that have detrimental effect on spermatogenesis. The spermatogenesis is the term that we use to describe the process of maturation of the spermatozoon in testicles. Some of the causes that can lead to the disruption of spermatogenesis are: hereditary factors, non-genetic disorders in the development of the testicles, mumps, radiation and chemo therapy…
• Post-testicular factors – these are the factors that can damage the outlet canals and can cause sexual dysfunction
• Pre-testicular factors that represent the hormonal disorder of spermatogenesis
• Infections
• Immunology factors

When one speaks about female factors of infertility, we are dealing with:

• Chronically absence of ovulation (in 30-40% of the cases). The absence of the ovulation can be caused by Turner’s syndrome, premature ovarian failure, unruppted follicle, reduced ovarian reserve due to previous surgeries or inflammation of the ovaries
• Tubal factor, impassable Fallopian tubes
• Unclear factors of infertility
• Other causes

Making the diagnose

Applying the methodical approach, as a rule, examination starts with a simple diagnostic procedure while those more complex are left for the end, with maximal psychological support to the married couple.

 

Sperm analyze - Sperm analyze is the simplest test that we use to exclude the male factor of infertility. The normal sperm count is more than 20 millions/ml. To conceive, more than a half from this number of spermatozoon has to be in good motion and adequate morphology. It is notice that, after the 55 years of age, male fertility declines. With this test the biologist counts the motile sperms, morphology, immature and pathological forms.

 

 

Postcoital test – this test is a type of a smear that is taken after the sexual intercourse. In this test the biologist estimates the motion and immunology factors of spermatozoon in cervical mucus. It is best to perform this test in the middle of the menstrual cycle, because we are expecting the ovulation around the same time.

 

Microbiological and viral tests – laboratory analyses that can detect some of the causes of infertility – Chlamydia, micoplasmae, ureaplasmae, and serological test such as HIV, Hepatitis C, Syphilis…

 

Hormonal status – testing the levels of reproductive hormones

 

Foliculometry - ultrasound assessment of the growth and rupture of the follicles

 

Biopsy and histological analysis of endometrium

 

Cytohormonal analysis of vaginal epithelium

 

FERN test - Estimation of estrogen effect on cervical glands during preovulatory phase of the menstrual cycle.

 

Sonohysterosalpingography screening

 

Hysteroscopy

 

Laparoscopy

 

TESA/TESE

In cases of complete absence of spermatozoon in ejaculate (azoospermia) or when spermatozoons does not have the correct morphology and adequate moving capacity, the puncture or biopsy of the testicles can be done in our hospital in order to obtain a sufficient number of sperm that can be used in the process of fertilization. This intervention is preformed in anesthesia, and a sample of tissue obtained by surgical biopsy can be frozen for future use.