It is believed that in a healthy young couple, pregnancy occurs within an average of 1 year of regular intercourse without the use of contraceptives. If pregnancy has not occurred within a year, then the spouses are diagnosed with infertility. Naturally, in this case, it is necessary to find out the cause of this problem.
Fertility is a truly worldwide problem, because found in all countries of the world without exception. Millions of married couples have difficulties with the onset of pregnancy; and this level is critical for maintaining the population.
Fertility specialists have long proven that the likelihood of pregnancy directly depends on the age of the spouses: the older a person becomes, the less chance of success. That is why doctors recommend the earliest possible start of examination and treatment, because the sooner a married couple turns to a specialized clinic, the sooner a long-awaited baby appears in the family.
A combination of several factors is necessary for pregnancy to occur. A man’s ejaculate should have a sufficient number of motile spermatozoa of good morphology, i.e. correct structure. In a woman, the reproductive system is more complex: ovulation must necessarily occur (the maturation of an egg in the ovaries), there must be passable, properly functioning fallopian tubes (they must capture the egg, create conditions for fertilization and transport the embryo into the uterine cavity) and a good endometrial structure for implantation (attachment) of the embryo.
The process of pregnancy is quite complex, multi-stage; Breakdown can occur at any stage.
The task of a specialist is to find out the reason for the absence of pregnancy in the shortest possible time and offer the most gentle method of treatment.
According to the recommendations of the World Health Organization (WHO), the duration of the examination to determine the cause of infertility should not exceed 3-4 months. In life, doctors often face the fact that patients go for years and cannot get an answer to the most important question for them …
In advanced clinics dealing with the problem of reproductive health, all efforts are aimed at reducing the time of examination. In some infertility treatment and IVF departments there are “one-day” diagnostic centers that allow a married couple to be examined to determine the causes of infertility in 1 day. At the end of the day, the couple receives the results of the examination and recommendations for treatment.
What modern methods of infertility treatment exist?
In the arsenal of a reproductologist there are quite a few options for treating infertility, and in each case, you need to choose the most appropriate and effective one.
If the reason for the lack of pregnancy is a violation of the ovulation process in a woman, then a treatment protocol called “classic ovulation induction” comes to the rescue, when, with the help of a slight hormonal effect, the ovaries normalize and the egg matures. Further conception occurs naturally.
If, according to the results of the examination, a decrease in spermogram parameters is revealed, then the couple may be offered treatment by insemination, when specially processed sperm (husband or donor) is injected directly into the uterine cavity.
Unfortunately, such “conservative” methods do not always help: pregnancy occurs only in 15-17% of married couples.
Today, the most effective method of overcoming infertility is the IVF (in vitro fertilization) procedure. The name of the procedure comes from the Latin words extra – outside, outside and corpus – body, i.e. fertilization of germ cells (eggs) of a woman outside her body, followed by transfer of embryos into the uterine cavity.
The chance of pregnancy in one IVF cycle varies and ranges from 40 to 58% on average, depending on the causes of infertility and the age of the spouses.
The IVF program is most appropriate for severe male infertility, with a combined factor and immunological infertility, and with infertility of unknown origin, when traditional examination methods failed to establish the cause of the absence of pregnancy.
With reduced spermogram values, fertilization is carried out using the ICSI method, i.e. A specially selected spermatozoon is injected directly into the egg using micromanipulation techniques. This allows you to increase the chances of fertilization even with severe male infertility.
In the absence of spermatozoa in the ejaculate (azoospermia), it is possible to obtain spermatozoa from the epididymis and from the testicle by puncture (TESA, MESA), after which ICSI is also performed.
In recent years, various donor programs have been used to treat infertility. In the absence of sperm from a partner or the absence of a sexual partner, fertilization with donor sperm is possible (by artificial insemination or IVF).
In premature ovarian failure (for example, after repeated ovarian surgery) and in postmenopausal women (when the production of eggs stops due to age), donor eggs can be used to achieve pregnancy. This allows a woman to become a mother even in the most difficult cases.
If it is impossible to bear a pregnancy (with malformations or in the complete absence of the uterus, in the presence of severe concomitant diseases), you can resort to the services of a surrogate mother in the countries where the surrogacy is legal and has annualy proved and saved protocols. When carrying out such a program, the embryos obtained by the fusion of eggs and sperm of genetic parents are transferred to the uterine cavity of a surrogate mother for gestation.
The technology of cryopreservation has already been well developed; freezing of genetic material (embryos, sperm and eggs), for the purpose of long-term storage for later use.
The IVF program is used not only by patients suffering from infertility.
Often, couples who need a pregnancy with a child of a certain gender turn to the IVF clinic (this need arises in case of genetic diseases – for example, hemophilia, which is more often diagnosed in boys). In this case, a genetic study (pre-implantation genetic diagnosis) is carried out on the embryos before they are transferred into the uterine cavity and the gender is determined.
When conducting an IVF program, selection (i.e. selection) of embryos according to the Rh factor is possible. This procedure is necessary for Rh-negative patients who have had cases of severe Rh conflict during previous pregnancies. Thanks to pre-implantation diagnostics, only Rh-negative embryos are transferred into the uterine cavity. In this case, the pregnancy proceeds without conflict with the mother’s body.
Similarly, genetic diagnosis is carried out for some genetic diseases (for example, cystic fibrosis). Now families that are carriers of cystic fibrosis mutations have a real opportunity to have healthy children.