“In three quarters of cases, infertility is of male or female origin, or it associates both sexes. In 10 to 25% it is not attributable to a specific defect of one of the two partners”, notes the National Institute for Health and Medical Research (Inserm) (Source 1). Medical assistance can solve a number of infertility cases, and assisted reproduction (ART) can get around most of the difficulties.
What are the causes of infertility?
In women, infertility can be caused by:
- Polycystic ovary syndrome (PCOS);
- Ovarian failure, which results in“deterioration of oocyte quality, with an increase in the rate of spontaneous miscarriages and fetal chromosomal abnormalities” , according to Inserm (Source 1) ;
- Premature ovarian failure, “abnormally large follicular loss associated with the absence of a menstrual cycle, with early menopause occurring before the age of 40” ;
- The stenosis bilateral tubal, that is, reducing the permeability of the fallopian tubes, blocking the passage of sperm to the egg;
- Uterine abnormalities (Rokitanski syndrome (absence of uterus), malformations, endometrial polyps, certain uterine fibroids);
In men, infertility can be caused by:
- Testicular insufficiency: sperm abnormalities are the most common causes of infertility in men. The quality and quantity of sperm is altered;
- Sexual dysfunctions: “regardless of erection and ejaculation disorders of psychogenic origin, vascular, hormonal, metabolic or neurological factors can lead to sexual dysfunction “, notes Inserm (Source 1).
Some causes common to both sexes:the hypothalamic-pituitary pathologies, “responsible for a impaired hormone production which may cause the absence of ovulation (…) or a deficit in sperm production “, observes Inserm (Source 1). Certain cancer treatments like chemotherapy can also lead to infertility. Finally, other factors such as tobacco, overweight, obesity, stress, or even exposure to certain pesticides, solvents, heavy metals are incriminated.
What are the symptoms of infertility?
What can be called a symptom of infertility is the inability to conceive a child after a year of unprotected sex. Other signs may appear or accompany this inability to conceive, such as erectile dysfunction, from pain in the testicles for men, and abnormal menstrual cycles for women.
After 12 months of unsuccessful trials, it is advisable to carry out a infertility assessment, during which a fertility specialist will try to find out with you why the pregnancy does not come, in order to maximize your chances for a natural pregnancy, or to offer you alternative solutions. He will ask you in particular about your history, your lifestyle and will prescribe medical examinations if necessary. If you are trying to have a child and you or your partner suffers from certain pathologies (chronic diseases, genetic diseases), do not wait the recommended 12 months before consulting a fertility specialist!
Better safe than sorry: think about the preconception consultation, which makes it possible to detect early on if there are problems that may be hindering conception.
What treatments for female infertility?
When an infertile couple is taken care of, there are three types of treatment:
- The treatment medical ;
- The treatment surgical ;
- Medically assisted procreation (AMP) : intrauterine insemination, in vitro fertilization (IVF) and fertilization assisted by intracytoplasmic injection (ICSI).
Medical treatment for infertility in women: ovarian stimulation
The woman’s ovaries are stimulated to better control your ovulation which is absent (anovulation) or irregular (dysovulation). This ovarian stimulation or ovulation induction is done by the hormone FSH (Follicle Stimulating Hormone), which allows one or two follicles to develop and lead to the maturation of one or two oocytes. It may be sufficient to treat infertility.
This stimulation must be monitored byultrasoundsand hormonal assays. It is carried out by subcutaneous injection and can last two to three weeks. Ovulation induction can also be performed as part of in vitro fertilization (IVF) and intracytoplasmic injection (ICSI), in order to increase the chances of obtaining embryos.
Drug or injection treatment for female infertility
Different treatments can be offered to you depending on the quality of your ovulation:
- Clomiphene citrate completed by a estrogen intake to improve cervical mucus;
- Treatment by injection of gonadotropin hormones, hormones that stimulate the gonads, or sex glands, to perform their reproductive functions. These gonadotropins are used alone or in combination with clomiphene (one injection every day or every other day for 6 to 12 days, in the first part of the cycle).
Infertility in women: artificial insemination
It is preceded by a ovarian stimulation. It consists of inject selected sperm into the woman’s uterus at the time of ovulation. The objective: we override the cervical mucus in the event of an abnormality and we promote the rapprochement between the oocyte and the spermatozoa. The treatment is carried out in the continuity of an ovarian stimulation, which makes it possible to deposit sperm at the optimal time.
The collection of semen is scheduled on the day of insemination after a period of sexual abstinence from 2 to 6 days. It is then prepared in the laboratory in order to reproduce the changes it undergoes during sexual intercourse by crossing the cervical mucus.
Infertility in women: in vitro fertilization (IVF)
IVF allows fertilization to take place in “Test tube”and can therefore be better controlled. The embryo (or embryos) formed after two to three days, are then either transferred to the uterus for the normal continuation of a pregnancy, either frozen.
Before getting started, you must be aware that this is a very tiring test for the couple. First there is a ovarian hyperstimulation with even greater monitoring (ultrasound and blood test) of follicle growth. Then we proceed to triggering of ovulation. The liquid contained in each of the follicles present is punctured with a needle, within twelve hours, and under local or general anesthesia. Each oocyte is then brought into contact with the previously collected sperm. Three days later, if fertilization has occurred, embryo transfer to the uterus can take place. It takes an average of fourteen days to know if the transfer was successful and if a pregnancy is progressing.
Infertility in women: micro-injection or ICSI (intra Cytoplasmic Sperm Injection)
In IVF with ICSI (from English: “Intra cytoplasmic sperm injection”), the steps are identical to conventional IVF, but we put the oocyte in direct contact with a single sperm previously selected. It begins as a classic IVF but, instead of culturing the oocytes and spermatozoa and waiting for fertilization, the biologist himself introduces, under a microscope, a mobile spermatozoon in each punctured oocyte.
Infertility and endometriosis
In case of endometriosis, medicines to stimulate ovulation or a in vitro fertilization may be necessary to hope to conceive a child.
What treatments for male infertility?
Apart from anatomical problems (obstruction of the spermatic passages, etc.), which will be corrected in a surgical, the responses to male infertility are most frequently assisted reproduction techniques.
Genital tract surgery
In humans, this genital tract surgery can be decided for example in case of limited narrowing of the vas deferens or in some varicoceles important.
Male infertility: reproductive aids
An abnormality “reasonable” spermatogenesis is not always an obstacle to spontaneous procreation, but statistically, the delays will be longer. the recourse to a PMA (medically assisted procreation) will therefore depend on how long one is prepared to wait.
You must know that “the success rate of IVF (in vitro fertilization) decreases markedly after 37 years in women”, specifies Elise de La Rochebrochard, researcher in epidemiology of human reproduction at INED (National Institute of Demographic Studies). And the miscarriage rate, during artificial insemination, increases with the age of the father, reaching 35% when the latter is over 40. (Source 2).
Depending on the problem, the doctor, a uro-andrologist specializing in fertility problems, offer artificial insemination or IVF, often associated with ICSI (intracytoplasmic sperm injection).
Fertility problem: tips for managing the test as a couple
Most couples who experience infertility feel a sense of injustice. Not being able to give one child to another generates guilt, which must be defused within the couple.
Here are some keys to better manage the two-person event:
Knowing how to communicate with others
Return to the word and the complicity, work on the esteem of oneself and of the other despite the ordeal, an approach which is essential. “It’s in your head, you think about it too much” … These reflections reinforce the doubts: “If I can’t do it, then it’s my fault!” Decomplex yourself. Even if some infertility can result from psychological blockages, these cases mainly concern heavy stories.
Resolve resentment and resentment
Besides the rejection of the one who is infertile and the fantasies associated with it, “if I had stayed with my ex, I would already have children”, it is necessary that overcome feelings of unease with family, friends or colleagues. Knowing that a natural function in others is complex for you causes jealousy. This is even more obvious in a sibling where it awakens old emotional competitions. In addition, a feeling that is difficult to express is then transferred to strangers: “I can’t stand to see children in the street anymore”, “the headlines with the pregnant stars annoy me …” . These couples feel out of step with, at the end of the day, the risk of gradually isolating themselves.
Break the silence and free the floor
Although the cause of infertility is only female in 60% of cases, it is often the woman who takes responsibility for infertility to others and to the family. A lie by omission, because it is difficult to question the manhood of the spouse. But with whom to confide this heavy secret of infertility? Breaking the silence and sharing the sadness are important steps. “It is not painful to speak; what hurts is to experience failure”, assures Léa Karpel, clinical psychologist at Antoine-Béclère hospital in Clamart. If one of the partners has expressly requested silence from the other, then a conflict of loyalty begins: betraying the promise made to the spouse or lying to his family. In pairs or with the help of a psychologist, the couple must learn to free their words.