Infertility: Types, Factors, and Treatments

Infertility is described as the inability to conceive or carry a child to delivery. The term is usually limited to situations where the couple has had intercourse regularly for one year without using birth control. The term sterility is restricted to lack of sperm production or inability to ovulate. Approximately 40% of reported cases of infertility are due to problems in the male; another 40% to problems in the female; the remaining 20% are of unknown cause or due to problems in both the male and female.
Types

In an article found in a Spanish health related website www.ondasalud.com, infertility is briefly described and divided into different types:

Primary Infertility: This is when the couple achieves gestation, but is unable to fulfill it with a live infant.
Secondary Infertility: When the couple, after pregnancy and normal birth, is not able to give birth to a second alive child.
Primary Sterility: This on the other hand, is when the couple, after a year and a half of sexual relationship without contraceptives has been unable to get pregnant.
Secondary Sterility: When the couple, after the birth of their first alive child, is not able to gestate in the next two to three years of sexual relationships without contraceptives.

Factors

There are also certain factors that influence the male’s fertility. For instance there is the pre-testicular factor; this is when there are alterations in the hormones which stimulate the testicle. This is not an often factor. On the other hand, the testicular factor is when there are certain abnormalities present, which could be genetic, congener (from birth), or acquired (like in infections). Finally, we have the post-testicular factor, which affect the spermatozoids once they left the testicles. These can be obstructions to the spermatic way, seminal infections, and the presence of anti-spermatic antibodies, ejaculatory alterations, and coital alterations.

The absence, lack, or low quality of the sperm, can be a result of a testicular factor like genetic cases, and many other causes that can be acquired in a male’s daily life, like the use of certain drugs, exposure to radiations, or even. On the other hand, if it is due to a post-testicular factor it could be due to malformations in the deferent conducts, or to a vasectomy. When it comes to the quality and quantity of the sperm, the life style of the male can be of influence. For instance, alcohol and drugs can also temporally reduce the quality of the sperm.

On the other hand, factors that influence a women’s ability to fertilize can be the following:

Cervical Factor: There could be functional or anatomic alterations, which can interfere the way the sperm follows, from the vagina until on of the fallopian tubes.

Uterine Factor: Like malformations, or benign tumors.

Other Factors can be alterations to the tubes, or the space of the ovaric tube, like for instance, infections or inflammations of the tubes, also an endocrine factor, like a Polycystic Ovary is possible.

Like for men, factors related to a female’s life style like stress, her diet, and the consumption of certain drugs or alcohol can alter her hormonal balance.

It is very important to know, that in both cases, for men and women, psychological and emotional factors play an important role in their capacity to fertilize.

Treatments

The election of one or another technique depends on the factor that causes infertility.

Induction (IO)
This is stimulation to the ovary, which tries to achieve the correct ovulation.

Artificial Insemination (AI)
AI is a procedure in which the healthcare provider inserts a man’s sperm directly into a woman’s reproductive tract. The most common AI procedure is intrauterine insemination, a procedure in which the healthcare provider inserts sperm directly into the uterus near the time of ovulation.
In Vitro Fertilization (IVF)
Test-tube baby is a common term for in-vitro fertilization and embryo transfer (VIF-ET). The complicated process is used for the following problems: women can’t produce eggs or eggs cannot pass from the salpingo to the uterus; when low or defective sperm can’t fertilize eggs inside the womb.

In an article found in the website of the Reproductive Medicine and Fertility Center of Orlando-Florida, the author divides the VIF process in the following four steps:

1. Retrieval of the mature egg.Fertility drugs (hMG, Follistim, Gonal-F, or Humagon) are used to ripen more than one egg.  This process is called controlled ovarian hyperstimulation.  Eggs are recovered by transvaginal ultrasound directed aspiration of the follicles.  Intravenous sedation is used.  Because timing of the egg collection is critical, ultrasound monitoring and hormone tests are done before egg retrieval.
2. Sperm collection, fertilization, and embryo development.  A semen specimen is obtained and prepared at the appropriate time in relationship to the egg recovery.  Meanwhile, the eggs are placed in culture medium to incubate and mature until timing is optimal for fertilization by the sperm.  The resulting zygote is called a pre-embryo.  In nature as well as in the laboratory, fertilization may not occur, nor does development always continue once the egg is penetrated by sperm.
3. Transfer of the developing embryo(s) into the uterus. On the third or fifth day after egg recovery, the embryo(s) are transferred into a small tube through the cervix into the uterus.  This process is technically much simpler than the egg retrieval in that it does not require anesthesia and is like a regular pelvic exam.
4. Implantation and growth of the embryo(s).  After fertilization and transfer, further development and implantation of the embryo(s) in the uterine lining is governed by hormones, receptors on the uterine lining, and other unknown factors.  Blood tests will be taken to detect pregnancy.  Additional hormones are given to support the early pregnancy.

Sources

• Article in www.ondasalud.com
• Article in www.refundivf.com
• www.resolve.org
• Intergramed America Inc. – The Fertility Company www.intergrammed.com