When couples are confronted with reduced fertility or infertility, they make emotional changes. Astonishment, disbelief, sadness and anger alternate. No wonder: Doctors invade the intimate sphere of life, sex becomes a compulsory occupation and a medical mill of unpleasant examinations and treatments comes into effect. The hope for a child is growing, but in times of stress, pregnancy does not take place. What are the causes and how do you get a baby?
After a year of regular community without contraceptives, fertilization will not occur in fifteen of the hundred couples. This does not mean that there is infertility(infertility). The chance is much greater that it involves reduced fertility (subfertility). There are countless causes behind this. These are disturbed oocyte or sperm production, anatomical abnormalities of the reproductive organs and psychological factors such as too high tension and stress. In 30% of the cases the cause lies with the woman, in 30% with the man, with 10% it is with both and with the remaining 30% there is no cause. The latter group does not have to despair. Chances are that the desire to become pregnant is ‘too strong’. A button has been turned around in the head: Pregnant must, and that is NOW! And that is not the way the human body works, because a baby can not be ordered. So be careful to postpone a pregnancy to a kind of ‘moment suprème’.
A man continually makes sperm cells, but women only produce an egg once in the cycle. With a regular four-week cycle, you roughly get around 13 pregnancy opportunities per year. Many people think that ovulation is the moment to become pregnant, but in fact you are already far too late. In the week before ovulation, the hormone balance and thus the nature of the mucus in the cervix changes so that it is made suitable for the collection and passage of sperm cells. Sperm cells can survive for up to a week in this environment. It is therefore not the case that they fly directly to the expected egg cell, but they are ‘stored’ in the crypts after ovulation during the week before ovulation (ie from day 8 to day 14).of the cervix, where they then await ovulation. So do not get started with the thermometer to ‘catch’ the 0.2 degrees C increase that occurs after ovulation. The moment you perceive that temperature rise, the chance of becoming pregnant has already gone by. Another thought is that women would have a 25 per cent chance of becoming pregnant per cycle. This is not the case. The chance of becoming pregnant is almost zero in week 1 (the menstrual week), 75% in week 2, to fall back to almost zero percent in week 3 and 4. This is based on a regular, four-week cycle. If the cycle duration is longer and provided with ovulation, then only week 1 is extended and can continue for several weeks. This is called a delayed ovulationor long build up to ovulation. The result is then menstruations with an interval of 5 to 9 weeks. The woman is slightly less fertile in this case. That is to say, there are fewer options on an annual basis to get pregnant.
If the cycle duration is longer but without ovulation (anovulation), fertility is zero. In that case there are no real menstruations but withdrawal bleeding. These also occur very irregularly. PCO syndrome (Poly-Cysteus Ovarium) is common and can be the basis for this. In cycle disorders, attention must first be paid to the body weight of the woman. Too heavy weight or too light weight can be the underlying cause and give a dysfunctional cycle. In that case the body protects the woman against pregnancy!
Infertility in the man
If you are not pregnant after a year, you seek medical attention. You will probably be referred to a specialist for further investigations. The first study you can expect is a microscopic examination of the sperm, needed to determine whether there is a sufficient number of healthy sperm cells. We also look at the quality that partly depends on the mobility but also on the shape of the cells. A low sperm productioncan be caused by fever, excessive use of alcohol, drugs or tobacco, certain use of medication (especially chemotherapy and radiation), unexpanded testicles, work with chemicals and lead, once-made ‘mumps’, vitamin C deficiency, too high frequency of ejaculations and increased temperature by eg tight underwear, electric blankets, saunas and hot baths. In the absence of sperm cells, a biopsy can be taken from the testes tissue to confirm that no sperm is indeed produced. Other possibilities of infertility in men are absent vas deferens, varicose veins, previous prostate surgery, antibodies against own semen after a recovery operation of sterilization, as well as hereditary factors. If it concerns blockages then they can be lifted surgically, and medication is also possible to increase a moderate production. In addition, the sperm can be concentrated to use for artificial insemination.
Infertility of the woman
If sperm analysis is positive, the man can be exempted from further research. The first studies with the woman are to determine whether ovulation occurs normally. Indications that something is wrong here are irregular cyclesor cycles at too long intervals. By means of hormone measurements and the temperature method, it can be checked whether ovulation occurs. You usually have to keep a calendar for yourself and ‘temperatures’ every day. If there is no ovulation, hormones can be given to induce ovulation. Further examinations that can take place include blood tests, ultrasound, laparoscopy (lower abdominal surgery) and hysterosalpingography (X-ray with contrast to view the fallopian tubes). A cause such as clogged fallopian tubes can arise from previous inflammations in the pelvis (eg chlamydia or other venereal diseases), endometriosis that changes the anatomy, and infections after a birth. Abnormal fallopian tubes can be recovered surgically. Incident problems can also be the cause.
Hormone stimulation in the woman
If there is a clear problem with the menstrual cycle, a hormone preparation such as Clomid (clomiphene citrate) can offer a solution. This medication, which you take for five days, causes ovulation to follow. The disadvantage of this is that several egg cells can mature at the same time with a greater chance of a multiple birth. Hormone stimulation can lead to overimulation of the ovaries. Sometimes Clomid is combined with other medications. In a single case, there is a rarer cause for the hormone disorders. Examples of this are too high a prolactin level, early transition, too low progesterone production (luteal phase insufficiency) and PCO (Stein-Leventhal syndrome).
A post-coital test or community researchcan take place before the expected ovulation and provides insight into the quality of the (clear and stretchable) mucus that is released around ovulation and whether motile sperm cells can penetrate. An approaching ovulation is demonstrated by a vaginal ultrasound with the mature follicle being visualized. The intention is to have a community the night before the examination, after which the doctor takes an amount of mucus during the test. Microscopic examination shows whether sufficient sperm cells are present. Unfavorable mucus can be caused by a slightly abnormal hormone balance and can be treated with estrogen. “Allergy” for sperm is a relatively rare phenomenon that can be eliminated by temporarily dropping the desire to become pregnant and using condoms during that time.
Artificial insemination can be done with sperm from your own partner or from a donor. IUI means Intrauterine Insemination , where the sperm is brought into the womb. FSP means Fallopian Sperm Perfusion where the sperm cells are placed in the fallopian tube. This treatment can occur with reduced fertility of the man or with hostile cervical mucus. It is also done with misunderstood infertility. Often the sperm is ‘reprocessed’ in a laboratory. FSP seems to have better results than IUI, but is not yet being used everywhere. All these treatments can be accompanied by a hormone stimulation in the woman, in order to make the circumstances of becoming pregnant as favorable as possible. KID is a variant of artificial insemination, in the sense that donor seed is used. This method offers a solution if there is a case of greatly reduced or complete infertility in men. Another possibility is if the man is hereditary with a disease. KID is also applied to lesbian couples and single women. This also applies to IUI and IVF.
IVF means In Vitro Fertilization, also called test tube fertilization. This way can be the answer to blocked fallopian tubes, severe endometriosis and adhesions, reduced fertility of the man and in the case of misunderstood infertility. The woman receives a hormone treatment that allows multiple egg cells to ripen. This can be followed by ultrasound. A follicle puncture then takes place with a hollow needle. This means that several follicles (egg vesicles) are sucked up. These cells are brought into contact with the sperm in the laboratory, and fertilization is awaited. If this happens, a few days later, two pre-embryos will be replaced with a thin tube in the uterus. This is called an embryo transfer. Finally, it remains to be seen whether an implantation will take place. The chance of this is a small twenty percent. The chance of multiple births is also increased here, but there is also an increased risk of premature birth. Furthermore, no negative consequences for the child are known.
A step further is ICSI. This means Intra Cytoplasmic Sperm Injection . The procedure is the same as with IVF, but no fertilization is awaited. Instead, a single sperm cell is selected in the laboratory and injected directly into the egg cell. This method is eligible if there is bad seed, or where the regular IVF has not helped.
If there are no oocytes (anymore), or in case of hereditary burden on the woman, egg donation can be chosen. A donor undergoes IVF treatment and the woman who wants to become pregnant also receives hormone treatment to have the fertilized egg to be received implanted. The oocytes donated by the donor are brought together in the laboratory with the sperm of the partner of the woman. Erected embryos are placed in the womb of the wishing mother.
Factors that negatively affect fertility
Before a couple proceeds to a series of unpleasant treatments, it is important to know a number of points. First of all, it sounds disrespectful, but unfortunately some couples can not have a child together, but each separately with a different partner. Why this is has not yet been precisely demonstrated. Fertility does not have to lie to a person, the combination of two people can also be the cause. Another even more important point is that if people abandon the hope of a child, sometimes, unexpectedly, a pregnancy follows. The many treatments that have been undergone for years, were of no avail, but just do not think about it anymore. And so it turns out again that the human body is a strong piece of nature. It is not allowed to impose a pregnancy, but it determines when the moment is most appropriate.