Infertility affects 15% of the world’s population. In Spain, it is estimated that there are around 16,000 cases per year. There are different degrees of infertility and it can be caused by a variety of factors, including genetic and environmental.
What is infertility?
Infertility can be defined as the inability to conceive naturally after a year of unprotected sex. Statistics show that 85% of young, healthy couples conceive after a year of unprotected sex, this percentage that can rise to 93% after 2 years.
Delaying maternity (the Spanish average is 31 years old), exposure to radiation (specifically cancer patients) or a lifestyle that affects one’s gametes are all factors that have an impact on one’s fertility.
Spain is internationally recognized in the field of fertility. Professionals in this field, therefore, are some of the best in the world. This is why thousands of people decide to come to Spain to undergo assisted reproduction treatments, with some of the best professionals.
There are different degrees of infertility, which can be caused by a variety of factors, including genetic, as well as environmental causes. Here are the main causes affecting infertility.
A woman is said to be the most fertile between the ages of 15 and 24. In this day and age, however, very few women choose to have children during these ages. In general, fertility starts to decrease from the age of 25. Approximately one third of women who wait until 35 will have problems to conceive, and approximately half of the women 40 and over will have difficulties.
Ovulation disorders are due to an endocrine imbalance that makes it impossible for the ovary to work properly. Many times ovulation disorders are linked to obesity or being underweight, acne and excessive hair growth. One of the most frequent causes of this disorder is the Polycystic Ovary Syndrome (PCOS). It is estimated that 3-10% of the female population has PCOS. The woman usually suffers from irregular cycles, fertility problems and/or excessive hair growth.
The ovaries look like they contain small cysts that are actually follicles which do not cyclically mature. Women who suffer from PCOS ovulate less than fertile women or they do not ovulate at all. If there is no ovulation, pregnancy cannot be achieved. The goal of treatments for women with PCOS is to make them ovulate at a predictable moment.
If there is a resistance to insulin, sometimes pregnancy is achieved only through oral treatment (Metformina), but most of the times, it is necessary to resort to more sophisticated treatments. Everything depends on the level of difficulty to reach ovulation. The doctor, along with the couple, will decide on the best treatment.
Fertilization (when the sperm penetrates the egg) takes place in the Fallopian tube. If both tubes are obstructed, no sperm can reach the egg to fertilize it. The tubes may become obstructed for many reasons. Sometimes the obstruction is due to a previous infectious process like pelvic inflammatory disease or abdominal surgery. The patient usually has no symptoms. Obstructed Fallopian Tubes are diagnosed by hysterosalpingogram.
Hysterosalpingograms are performed (or not) depending on the age of the woman and depending on whether other causes of infertility have been found.
The treatment recommended after tubal patency has been confirmed or not will depend not only on if one or both tubes are obstructed but on many other factors.
Sometimes on the ultrasound scan, accumulated liquid in one or both Fallopian tubes is observed. This is called hydrosalpinx and can be the cause of infertility. Hydrosalpinx increases the risk of infection. Studies show that there is a higher pregnancy rate when hydrosalpinx is removed before a fertility treatment.
Cervical mucus helps prevent infections and kills bacteria except during ovulation. At ovulation, the cervical mucus becomes more fluid to enable a longer sperm survival. Sometimes there are fertility problems when the cervical mucus is not the correct consistency or there is a problem in the anatomy of the cervix.
It has been postulated that the cause of endometriosis is the migration of endometrial cells from their normal location (inside the uterus) to other locations. Sometimes these cells stick to the ovaries or other pelvic organs. These implants of endometrial cells cause endometriomas, cyst-like formations filled with endometrial cells that cyclically shed. Endometriosis is a known cause of infertility.
Symptoms of endometriosis run from an asymptomatic process to crippling menstrual pain, long periods, or painful sex. There is no correlation between symptoms and the degree of the disease. Sometimes it is wise to operate before a fertility treatment is initiated.
Fibroids are benign smooth muscular tissue tumors that are normally found within the walls of the uterus. A woman can have just one or multiple fibroids. Fibroids can be located on the internal surface, external surface or the inside of the uterine wall. The gynecologist may find fibroids in asymptomatic women. Sometimes fibroids cause heavy and/or painful periods or cause problems due to pressure on the pelvis, bladder or intestine. If symptoms have an impact in the person’s life, these fibroids are removed.
The relationship between fibroids and fertility is unclear. What is uncertain is whether there is a mechanism that prevents embryo implantation. In general, it is thought that if the fibroid does not deform the endometrium, it is not necessary to operate, but if the fibroids are big or cause symptoms, sometimes it is better to operate before starting a fertility treatment.
The low number, abnormalities in the size, movement or morphology of sperm can cause infertility. Sometimes male infertility is related to varicocele (varicose veins of the scrotum) which can affect sperm production. Testicular trauma, undescended testicles and hormone imbalance can all cause infertility. Sometimes the presence of diseases like diabetes, central nervous system diseases and pituitary gland tumors can hinder fertility.
If a male fertility factor is found, sometimes it is necessary to consult a urologist to rule out anatomical anomalies and test hormone levels. This consultation can help us determine the pregnancy prognosis and the best treatment option.
There are other studies that can help us study sperm like FISH and sperm fragmentation tests, although none of these studies are 100% conclusive. It does help us orient the couple as to which treatment will be the most successful. There are many options when there is a problem with the sperm- anything from ICSI to preimplantation genetic diagnosis or donor sperm. At ProcreaTec, thanks to our staff’s vast experience and previous good results, we are prepared to offer the best genetic orientation.
It has been calculated that 60% of all miscarriages are due to genetic causes. If a patient has had two miscarriages in a row the probability of having another miscarriage is higher than in patients who have never miscarried. The patient must be studied to ensure that there is no infectious, immunological or hormonal problem that could be the cause of the repeated miscarriages. Sometimes an underlying problem is never found. Other times a geneticist will recommend a preimplantation genetic diagnosis.
When the man is Hepatitis B, C or HIV positive, a way to reduce the probability of transmission of the disease to offspring is by sperm washing. At the same time PCR is performed to make sure that the virus is not found in the ejaculate. If no virus is detected, artificial insemination or IVF can be performed. This is actually the safest way to reduce the possibility of transmission to offspring.
In 10% of the couples who consult for infertility, no apparent cause can be found. After studying the couple and taking into consideration the age and the time they have been trying to conceive, different treatments will be offered.
Sometimes hereditary diseases impede pregnancy and other times the fear of transmitting a disease to their offspring makes the couple feel ambivalent about having children. Depending on the disease, sometimes a preimplantation genetic diagnosis can be performed to ensure healthy embryos are implanted.
Genetic alterations could cause infertility in two main ways. The first is due to an alteration of gamete (egg and/or sperm) production, like, for example Turner’s syndrome in women or Klinefelter syndrome in men. In these cases, infertility is determined by the absence or anomaly of the gametes and their impossibility to achieve a viable pregnancy.
The second reason deriving from genetic alterations, may not directly affect the parents, but are incompatible with the development of an embryo and usually lead to miscarriages. This is the case of chromosome inversions or translocations.
In the case of mono genetic illnesses, which the parents either have or are carriers, do not usually cause infertility, but they do have an effect on miscarriages and illnesses in the offspring. The Preimplantation Genetic Diagnosis (PGD) can help these couples have a healthy newborn.
At ProcreaTec, we offer the best medical team to help you achieve your dream. We also have a team of psychologists to help you on your journey.
Frequency of Infertility
Achieving a pregnancy seems like an attainable goal – the woman gets pregnant within a few months of trying, the 9 months of pregnancy go by without important incidences and a healthy baby is born. For many couples, however, the path is very different.
Approximately 1 in every 8 couples has problems conceiving. Infertility affects both men and women: the problem can be traced to women 30% of the cases and 30% of the times, the problem is found in the male partner. In another 30% of couples, both members have unfavourable fertility factors and in the remaining 10% of the cases the cause is unknown.
But when should someone consult a professional? Half of the couples who suffer from fertility problems do not go to specialists. It is recommended to consult a specialist if pregnancy is not achieved after a year of unprotected sex. It is normal for couples to feel confused and lost, and professional support can be of great help.
When should one go to a specialist?
Among the multiple factors that affect infertility, age is one of the most predominant of all. If there are no diseases or a medical history that suggests any type of problem, gynecologists usually recommend the couple undergo a fertility examination a year after the couple have begun trying to get pregnant, if the couple is under 35; six months, if they are over 35 and three months after, if they are over 40.
In general, these are the guidelines that are followed, but in some cases it may be recommended to seek professional help before then. For example, if the woman has a pelvic infection (heredetary disease) or if she has already had more than one miscarriage. In the case of the men, if there is a history of undescended testicles or a hereditary disease.
In some specific cases, like, for example, insulin resistence, a pregnancy can be achieved simply after an oral treatment. In most cases, however, more sophisticated treatments are required. It all depends on the degree of difficulty of ovulation. The doctor will decide, together with the couple, the best course of action to follow.
What happens during the first consultation?
During the first consultation, the doctor asks about the medical history and all the necessary information, especially the patient’s personal and family medical background and any other previous treatments.
The doctor will study the already existing tests y she will prescribe any additional test that may be required to complete the fertility picture. Once all the results are in, the doctor will recommend different treatment options based on the patient’s situation and objectives.
At ProcreaTec, we offer different solutions to diagnose and treat a posible infertility. Request a free consultation and tell us about your case.
What is the basic fertility study?
The first step in confronting infertility is trying to reach a correct diagnosis. In many cases the failure to reproduces lies in more than one factor, which is why it is important to undergo a full examination of the couple.
The medical team will review the medical history of the patients and will request any additional tests that may be required to reach a diagnosis. If there is a masculine factor affecting infertility, we will also schedule an appointment with the urologist.
Given that most patients who come to the clinic have already spent time trying to achieve a pregnancy, our goal is to complete this evaluation in the timeliest possible way in order to have a diagnosis within the following menstrual cycle.
There are four main objectives to the basic fertility evaluation:
· Determine whether the woman ovulates.
· Evaluate the ovarian reserve.
· Determine the Fallopian tubes permeability
· Evaluate the sperm quality.
We can have an idea of whether a woman ovulates based on the patient’s menstrual cycle characteristics. Usually, we assume that if a woman has regular cycles, she also ovulates regularly.
All things being normal, in the beginning of the cycle, a follicle containing an egg (or an oocyte) grows. The egg is then released from the ovary to the fallopian tube in a process known as ovulation. After ovulation, progesterone levels rise making the endometrium transform in order to be able to accommodate de fertilized egg. If we measure progesterone levels between days 7 and 9 after ovulation, we will know whether the patient ovulated.
Additionally, it is important to measure other hormones (such as Prolactine or TSH) because they can interfere in the normal egg growth process or in the ovulation.