Sterility in women

Sterility is the difficulty for a couple to get pregnant after a year of frequent and unprotected sexual intercourse in the days close to ovulation. The human species has a low reproductive power since in couples under 35 years of age and with unprotected relationships on the days of ovulation, the pregnancy rate is approximately 25%.

After age 35, this pregnancy rate decreases and at age 40 it is approximately 10%. For this reason, a study is recommended in couples under 35 years of age after one year of unsuccessfully seeking pregnancy and after 6 months in couples over 35 years of age. It is considered a primary sterility when the couple has never achieved a pregnancy and secondary when the couple has a history of spontaneous pregnancies.

Approximately 30% of cases are infertility due to female causes, another 30% due to male causes, 20% due to mixed causes and 20% due to unknown origin.

The basic sterility study includes a first visit where it is very important to take a complete medical history along with an examination. A transvaginal ultrasound is usually done to assess the uterus and ovaries. It is a harmless test that allows continuous monitoring over several days to assess the response of the ovary to treatments. A semen analysis is also performed, a study of the semen to basically assess the concentration, mobility and morphology of the sperm. A hormonal analysis is also requested to evaluate the woman's ovarian reserve and to be able to assess the functioning of the ovary.

After these basic tests, the study can be extended by performing a hysterosalpingography, that is, an X-ray performed with contrast to assess the morphology of the uterus and the patency of the tubes. It should be taken into account that it is a somewhat annoying test and that it requires prior preparation. Another test to perform is an endometrial biopsy.

This sample is obtained by hysteroscopy, with which a tiny camera is introduced through the neck of the womb, the interior of this is observed to verify that it is intact and the endometrial sample is obtained. If necessary, tests can be carried out to determine the existence of coagulation pathologies, genetic or chromosomal problems that may be the cause of sterility.

The causes of infertility due to female factor are basically anovulation, Tuboperitoneal factor, endometriosis and maternal age. Anovulation is the inability of the ovary to produce an egg that can be fertilized by sperm. It is one of the causes of the best prognosis. The Tuboperitoneal factor is responsible for 25% of female causes of infertility. The fallopian tubes can be damaged by previous pathology such as infections, surgery, endometriosis in a way that does not allow the passage of sperm or the fertilized egg. Endometriosis occurs in 35% of infertile couples.

Male causes can be due to an alteration in the production of sperm, due to an obstruction in the duct or due to the impossibility of depositing the semen in the vagina.

There are different treatments for infertility and depending on the causes and special characteristics of each case, one or the other will be performed.

Ovulation induction

It consists of a medical treatment to achieve the maturation of one or more eggs. Treatment can be done with an oral medication (clomiphene) first or with hormone treatment injected subcutaneously. In most cases, an ultrasound control is performed to assess the size and growth of the follicles (small fluid-filled sacs inside which are the eggs). In some cases, an analytical control of estradiol, a type of estrogen, is also carried out. The risks can be multiple pregnancy (between 10-20% of cases) or more rare is the case of ovarian hyperstimulation due to an excessive response of the ovary to treatment and the abdomen fills with fluid from transudate.

Artificial insemination

It can be conjugal (with sperm from the partner) or from a donor (with sperm from a sperm bank). This technique is indicated in women with at least one patent tube, in couples in which the seminogram shows a slight alteration, or in couples with infertility of unknown origin. In cases of artificial insemination, an ovulation induction is first carried out, with the pertinent controls and when the follicle is already mature, the administration of another hormone (HCG) is indicated to produce ovulation a few hours later. Coinciding with ovulation, the semen sample, previously treated in the laboratory, is deposited at the bottom of the womb so that the spermatozoa alone make their way to the ovum and fertilize it. The pregnancy rate is approximately 15% per cycle and a maximum of 3-4 cycles is recommended.

In vitro fertilization (IVF)

It is an assisted reproduction technique in which the oocytes are fertilized in the laboratory with sperm and the embryos obtained are deposited in the woman's uterus. The indications for this technique are multiple, obstruction of the fallopian tubes, male factor, endometriosis, sterility of unknown origin.

Treatment is divided into several phases, the recovery of the oocytes, fertilization in the laboratory and the transfer of the embryos to the womb. The objective of stimulation of the ovaries is to recover several oocytes at the same time since not all oocytes are suitable for fertilization and not all embryos evolve.

Injected hormonal medication is administered and ultrasound and hormonal controls are performed. Just before ovulation, follicular puncture is performed to retrieve the oocytes. The fertilization of the oocytes can be by conventional IVF, which consists of facilitating the encounter between the oocyte and a certain amount of sperm in a culture medium at 37ºC.

Sperm microinjection (ICSI) consists of injecting sperm into the oocyte. The resulting embryos are studied to transfer a variable number into the uterus depending on the age of the woman and the quality of the embryos. The embryo transfer is performed about 2-3 days after the follicular puncture and does not require anesthesia. Leftover embryos can be cryopreserved (frozen) for later use.