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Age_Causes of InfertilityA 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 this period. 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 women 40 and over will have difficulties.
Ovulation Disorders and Polycystic Ovary Syndrome (PCOS)
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 that do not cyclically mature. Women who suffer from PCOS ovulate less than fertile women or they don´t 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 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.
Obstructed Fallopian Tubes
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. Reproducción FemeninaThe 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 if 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 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 emigration 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 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. It is frequent that the gynecologist finds 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 affect the person´s life, fibroids are removed.
The relationship between fibroids and fertility is unclear. What is uncertain is if 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 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 an 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.
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 and healthy embryos are implanted.
It has been calculated that 60% of all miscarriages are due to genetic causes. If a patient has had 2 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.