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Dr. Orfanoudaki Irene MD  PhD  -  Infertility & Assisted  Reproduction 

THE  infertility  currently plagues about 1 in 5 couples of reproductive age and is found in 1/3 of cases in men, in 1/3 in women and in 1/3 is found in both partners.

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Infertility of a couple is called the failure to conceive after 12 months of sexual intercourse without precaution or use of contraceptives.

In this case, the couple should consult their gynecologist in order to investigate the reasons and causes. In particular, you consider it necessary to investigate the problem when:

  • If the woman is over 35 years old.

  • If the woman's period is unstable.

  • If the woman or her partner already knows they have an infertility problem.

 

There are several causes of infertility.

The fact is that the normal fertility of a couple is affected by the frequency of sexual intercourse, the age of the woman, smoking, physical activity, psycho-emotional factors, various systemic diseases, as well as the use of various drugs.

But in particular, the main reasons are the following:

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For the woman

  • Problems with the fallopian tubes, ovaries, and problems related to ovulation (tubalitis, polycystic ovary syndrome)

  • Cervical mucus disorders (hostile behavior of cervical mucus and cervical diseases in general)

  • Uterine fibroids - Endometrial adhesions - Endometrial polyps

  • Uterine problems such as thin endometrium, septa, polyps, fibroids

  • Sexually transmitted diseases associated with infertility (mainly chlamydia)

  • Pathological conditions, such as thyroid disease, diseases that cause amenorrhea)

  • The old age of the woman <35 years

  • Infertility of unexplained etiology which accounts for a significant percentage of infertility cases (approximately 25-30%)

 

For the man

  • Spermatogenesis disorders oligospermia,  the  asthenospermia, azoospermia

  • Varicocele

  • Excretory disorders - Obstructive oligoasthenospermia

  • Sexual dysfunction

  • Endocrine disorders

  • Urinary tract infections

  • Immunological agents - Antisperm antibodies

Investigation by the gynecologist.

When  an infertile couple visits their gynecologist, then the doctor will record an extensive history of both.

also  the doctor will perform an initial assessment of the problem with an intravaginal ultrasound to investigate the anatomy of the woman's pelvis.

In addition, the gynecologist will request a series of laboratory and imaging tests, such as a complete hormonal test and hysterosalpingography.  for the woman, while for the man she will ask to do a sperm diagram, in order to highlight possible problems  related to male infertility.

If the sperm count is abnormal,  then the man should consult a urologist-andrologist for more specific tests, such as cultures, scrotum ultrasound and hormonal testing.

 

Therapeutic approach.

Generally the  assisted reproduction techniques  include ovulation monitoring (in the natural cycle, without medication), ovarian stimulation (for the purpose of multiple follicular development), intrauterine insemination and in vitro fertilization.

 

In particular, the four main treatments that doctors can help the infertile couple are:

Hormone therapy, which may involve the husband or wife, with the aim of improving sperm or inducing ovulation respectively. THE  induction of ovulation  indicated in women with ovulatory disorders. This treatment includes the administration of drugs and the ultrasound control of the development of the follicles. When the follicles reach the desired size, contact with the partner is planned.


2. The surgical approach and the microsurgical approach to problems of the female fallopian tubes. Respectively, surgical correction of varicose veins and testicular biopsy with sperm collection in men.

3. Insemination, where the man gives a sample of sperm, which is processed in a laboratory to increase sperm motility. The specialist doctor then uses a very simple technique, without the use of local or general anesthesia, to place the treated sperm inside the uterine cavity, in order to increase the chances of achieving pregnancy.

4. In some cases there are even more specialized techniques, which concern the techniques of assisted reproduction, such as the one with the classical method or in cases of male infertility factor with the method of micro-fertilization.

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The 1st  and 3rd methods have the advantage that they are minimally invasive and have lower costs, however they have lower success rates compared to in vitro fertilization, while they can not be applied to women with blocked fallopian tubes or to serious male factor problems (very low number or mobility sperm).

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As far as the 4th method of in vitro fertilization is concerned,  the chances of success  for a woman it is around 24% at the age of 38-39 years, 15.6% at the age of 40-41 years and 6.6% at the age of 42-43 years.

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Nowadays more and more couples turn to their gynecologist for assisted reproduction in order to obtain a  child.

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But we should not forget that in Greece there is a law on Medically Assisted Reproduction that sets the age limit for women at fifty years.

I always advise young couples to visit their gynecologist immediately, so that their infertility can be treated at a young age and with the highest success rate.  

Irene Orfanoudaki

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