Infertility

What is infertility?
Infertility is a disease in which a couple can not conceive after many unsuccessful trials. In the past, the couples which could not conceive in 2 years time were considered infertile. Nowadays we recommend the first check-up for infertility after a year of failed efforts. Infertility is a common disease which has a tendency to increase. According to the international statistics, infertility occurs in 10-15% of couples. An exact statistic for the occurence of infertile couples in Slovakia does not exist. Thanks to the number of infertile pairs and new trends, infertility has ceased to be a taboo. How to cure infertility and where to find professional help is becoming more of an open discussion. We are willing to advise and help you achieve a longed-for pregnancy.

Causes of infertility
Nowadays amongst couples women are not immediately considered the cause of infertility as was the norm in the past. Nearly in half of the infertile pairs the cause of infertility is diagnosed during the sperm quality test of a man and often there is a problem with both partners.


Causes of female infertility:

The picture (below) represents a female reproductive system. Reasons for infertility in females may be diagnosed in the following organs.






Ovaries
Ovaries are responsible for the production and maturation of female sex cells – eggs. Their function is controlled by the pituitary gland, the hypothalamus (part of the brain) as well as the thyroid and adrenal glands. Failure in egg production may be caused by anatomic disorsers including absence of ovaries, tumors, endometriosis or by the malfunctioning of the ovaries. More frequently we diagnose disability of ovaries to produce eggs as a result of the ill regeneration of ovarial functions. Syndrome of polycystic ovaries is one of the most frequent disease of this group. When using ultrasound examinations we find many small follicles however none of them fully matures and therefore is unable to release any eggs.

Fallopian tubes (oviduct)
The Fallopian tube enables transport of eggs from ovaries to the uterus. Moreover, it is the site of fertilisation and the fertilised egg passes through one of the Fallopian tubes into the uterus.

In the case of obstructions in the Fallopian tubes becoming pregnant naturally is imposible. Therefore, we recommend our patients to have in vitro fertilisation. There are several possible reasons for the obstruction. Fallopian tubes may be blocked by scar tissue after prior surgeries, often after appendix surgery and in case of tumors in the pelvic region. A blockage in the Fallopian tube can also result from previous chlamydia infection which a woman may not have notice. I tis only possible to diagnose a blockage of the Fallopian tube through surgical procedures (LSK, HSG, HYCOSY – see chapter “how do we cure infertilityy“). A Fallopian tube which has once been damaged can never be totally cured by any surgery.

Uterine cavity
The main function of the uterus is to receive a fertilised egg and allow it to develope and grow until the birth of the child. In case of absent uterus the woman can not get pregnant and therefore give birth to a baby. Early miscarriages are the results of irregular shape and size of the uterus as well as its deformities. The walls of the uterus are lined up with a special tissue called endometrium which breaks down regulary (menstruation) and it provides nutrients for the foetus from the start of pregnancy. infertility could also be caused by the lack of endometrium, scar tissue or polyps in the uterinal cavity.

Cervix sticks out into the vagina. It forms a canal through which sperms gets into the uterus and further into the Fallopian tube. Sperms can not pass through the canal into the uterus and Fallopian tube where fertilization takes place when the mucus present in the canal is too thick or the immune system produces antibodies against the sperms.

Further causes of infertility
Genetic disorders, inherited diseases, pain during sexual intercourse and impossible sexual intercourse.

Causes of male infertility
Male fertility is dependant on the number of sperms. However, the most important factors are the number, motility and morfology of sperms. Generally, methods of assisted reproduction are the only possible treatments of male infertility.

Sperm production disorders
Sperms are constantly being formed in the testes during a cycle of 60-70 days. There are different factors affecting the development of sperms, including: nutrition, smoking, radiation, stress and chemical compounds. Sometimes it is very difficult to influence the effect of these factors. Commonly, the number and quality of sperms in semen decreases. Low number of sperms (oligospermia) can negatively affect the chance to become pregnant because it reduces the possibility of a sperm to successfully reach an egg and fertilize it. Men whose concentration of sperms is below 5 million per ml (mililitre) of semen have very low almost zero chance for their partners to become pregnant naturally.
If there are not any sperms in semen we talk about azoospermia. Total absence of semen is called aspermia.

Causes of reduced number of sperms

1. partial or total disfunction of testes
2. sperm maturation disorder
3. a barrier between testes and penis –semen doesn`t contain sperms
4. reverse (retrograde) ejaculation - semen turns round in a place where the vas deferens meets the urethra and ends in the bladder instead of normal ejaculation of sperms from the outer part of the urethra

Morfology and motility of sperms
Abnormal morfology – shape of sperms (teratozoospermia) and week motility (astenozoospermia) can stop sperms to reach an egg and fertilize it. Sperms have to be quite mobile to be able to get to an egg quickly and stay alive for several hours in the female`s reproductive system. instances of high number and good motility but abnormal shape of sperms their fertilization ability is significantly limited.

Antibodies against sperms
Antibodies represent natural protection of a human body against foreign particles. They are the part of an immune system. However, sometimes the female immune system considers sperms as foreign particles (antigens) and it produces antibodies against them. Actually a male`s body can under certain conditions also produce antibodies against his own sperms. This happens in men who have undergone vasectomy in the past. Antibodies cause sperms to become paralysed, clump or covered with a protective coat which makes them unable to fertilize an egg. Antibodies could be identified in semen, cervical mucus or in the blood of one of the partners.

Transport of sperm disorders
The second biggest reason for the infertility in men is the problem with sperm transfer from the semen, including cancer of the genitals, inherited diseases, impossibility to have sexual intercourse caused by different reasons.