According to statistics, about 60% of couples conceive within one year of cohabitation, 80% within two years, and 90% within three years. The World Health Organization has clearly pointed out that infertility can be diagnosed after a history of sexual intercourse without contraception for more than 12 months and still no conception, unlike in the past when infertility was considered only after 2 or 3 years of marriage. The incidence of infertility accounts for about 8% to 17% of women of childbearing age, with an average of about 10%, so infertility is not rare, but a relatively common condition. Recent studies have found that the incidence of infertility is on the rise due to environmental pollution and other reasons. In the United States, one out of every seven couples has difficulty conceiving, while the rate in China is about 6-15%. The female partner is the most common cause of infertility, with about 30-40% being related to the female partner only and about 10-30% being related to the male partner only, while in another 15-30% of cases, both partners can be detected with abnormalities. Infertility is a common clinical disease, although it does not endanger health and life, it brings great mental pain to the patient, affects the relationship between husband and wife, and even leads to family breakdown. From ancient times to the present, infertility has been a nightmare for many families, and it is a common desire of clinicians and patients to find the cause and effective treatment for the pain of infertility.
There are more factors that cause female infertility, mainly in the following areas.
1, tubal obstruction or patency: is one of the most common causes of female infertility, accounting for about 1/3 more. Inflammation is the main cause of lesions, and some ectopic pregnancy surgery and tubal ligation surgery can cause irreversible tubal obstruction.
2, ovulation disorder: is another major cause of female infertility. Normal ovulation requires a well-functioning hypothalamus-pituitary-ovarian axis, and any reason affecting the function of these parts and organic changes can affect ovulation. For example, excessive mental stress, systemic diseases such as hyperthyroidism, polycystic ovary syndrome, hyperprolactinemia, hyperandrogenemia, ovarian failure, etc.
3, endometriosis: the incidence of pelvic endometriosis is increasing year by year, and patients are often combined with infertility.
4, uterine factors: uterine malformation, dysplasia, uterine adhesions, uterine fibroids, endometrial hyperplasia, etc. can affect the embryonic implantation and development and lead to infertility.
5. Cervical factors: abnormal development of the cervix, cervicitis (inflammatory media can engulf or harm sperm), abnormal function of cervical mucus (affecting sperm passage), abnormal function of cervical immunology (anti-sperm antibodies, etc.).
6. Abnormal development or malformation of the vagina: relatively uncommon.
Female infertility patients need a detailed medical history and a systematic examination to clarify the cause. Special tests related to infertility are also needed.
Endocrine function measurement: measurement of serum estrogen and progesterone levels at different times of the menstrual cycle to understand ovarian function; measurement of basal metabolic rate to understand thyroid function; adrenal function test and serum prolactin measurement, etc.
2.Understand the presence or absence of ovulation and predict the ovulation period: basal body temperature measurement and cervical mucus examination or hormone measurement can determine the presence or absence of ovulation, continuous ultrasound monitoring is a more accurate method to determine the presence or absence of ovulation and predict the ovulation period.
3.Tubal patency examination: including tubal ventilation or fluid examination and hysterosalpingography, mainly to understand whether the fallopian tubes are open or not, and whether the uterine tubes are developing normally and whether there are deformities.
4.Hysteroscopy: to understand the situation in the uterine cavity, to find out the uterine adhesions, submucosal fibroids, polyps, uterine malformations, etc., and to understand the functional status of the endometrium through biopsy.
5.Immunological examination: to understand the presence of anti-sperm antibodies, in addition to anti-sperm antibody determination, but also indirectly through the post-coital test, in vitro sperm penetration test, etc.
6.Chromosome examination: to exclude chromosomal diseases and hereditary diseases.
7.Laparoscopy: It can directly observe whether there are lesions or adhesions in the uterus, fallopian tubes and ovaries; it can be combined with tubal lavage to directly see whether the fallopian tubes are patent; in addition, it can be used to destroy the scattered endometriosis lesions by electrocoagulation and separate the adhesions in the pelvis, and if necessary, biopsy can be taken at the lesions. In about 20% of patients, laparoscopy can reveal lesions that were not diagnosed before surgery.
Male infertility can be divided into absolute and relative infertility according to clinical manifestations. The former refers to complete lack of fertility, such as in some patients with azoospermia. However, with the development of assisted reproductive technology, certain absolute infertility can also produce offspring and become relative infertility. Relative infertility refers to having some fertility, but the fertility is below the critical value needed for pregnancy, such as oligospermia, low sperm motility, etc. Strictly speaking, fertility is possible as long as the ejaculated semen contains motile sperm.
Evaluation and management of male infertility
A. Detailed medical history, paying special attention to whether the patient has suffered from diseases that affect fertility.
II. Physical examination and laboratory tests.
1. semen analysis as required by the World Health Organization.
2.Endocrine gonadal function determination.
3.B ultrasound examination: to exclude epididymal cysts, vas deficiency, etc., and also to be able to discharge testicular dysplasia.
4. sperm function determination.
5.Chromosome screening: to exclude hereditary factors, especially for patients who use husband’s sperm to perform assisted insemination technique.
Comprehensive medical history and examination results to analyze the cause of infertility. After identifying the causes of infertility, the first symptomatic treatment, control the inflammation of the reproductive tract, remove the organic lesions of the reproductive tract, correct as far as possible the deformities of the reproductive tract, adjust the endocrine level, reasonably and timely use of assisted reproductive technology, commonly known as “in vitro fertilization”, so that patients through in vitro fertilization technology and its derivative technology to regain the right to become a parent. In vitro fertilization (IVF) and its derivatives can help patients regain the right to become parents.
1. Anovulatory Infertility: Ovulation Induction and Monitoring
Ovulation induction is the simplest and most commonly used method in assisted reproductive technology for couples in which the male partner is basically normal but the female partner has ovulation difficulties or irregular ovulation. It is used to induce ovulation in anovulatory women to resume ovulation for the purpose of pregnancy. Commonly used ovulation stimulating drugs include clomiphene citrate, human postmenopausal gonadotropin, follicle stimulating hormone and human chorionic gonadotropin.
2. Fallopian tube failure/severe endometriosis: laparoscopic and hysteroscopic surgery or IVF
In vitro fertilization technique is recommended for patients for whom laparoscopic and/or hysteroscopic surgery is not possible or is not effective. A brief description of the in vitro fertilization technique is the process in which the male partner’s sperm and the female partner’s egg are collected separately, co-cultured in an in vitro environment to unite (fertilize) and develop into an embryo, which is then transferred into the female partner’s uterine cavity where it will implant and continue to develop. Multiple eggs can be obtained in one IVF cycle and fertilized in vitro to form multiple embryos, which can be frozen and stored if there are any remaining good quality embryos after transfer. If this cycle fails, these embryos can be thawed and transferred at a later date.
In addition, if the woman is unable to produce eggs for various reasons (e.g. genetic factors or premature ovarian failure), she can borrow another person’s eggs, fertilize them in vitro with her husband’s sperm, and then implant the embryos in the uterine cavity, i.e. “egg donation IVF”. The donor should be young and have given birth to a child. Currently, the State Ministry of Health requires that egg donation can only come from eggs left over from an IVF cycle.
3. Male infertility: Artificial insemination or single sperm intracytoplasmic injection
Artificial insemination is performed by injecting liquefied semen through a catheter into the female reproductive tract, such as the uterine cavity, during the female partner’s ovulation period. It is suitable for patients with mild semen abnormalities in the male partner and requires that at least one of the female partner’s fallopian tubes is patent and ovulation is occurring.
For patients with severe oligospermia and obstructive azoospermia in the male partner, ICSI technology can be considered after chromosomal defects have been excluded. The ICSI technique can achieve about 70% successful fertilization of sperm from different sources, such as testicular or epididymal sperm extraction for severe oligospermia or obstructive azoospermia. Choosing an excellent reproductive medicine center for treatment is a favorable factor for pregnancy.
At present, the main center can perform a variety of assisted reproduction techniques, such as in vitro fertilization – embryo transfer (commonly known as IVF), for the diagnosis and treatment of infertility caused by various factors. In particular, we are the first in China to perform painless egg retrieval techniques that effectively relieve patients’ pain and tension, individualized protocols and sequential culture, which have obtained extremely impressive pregnancy rates and are popular among patients undergoing assisted conception; we also perform early selective reduction of multiple pregnancies, which eliminates multiple births and complications of more than three pregnancies and makes mothers and children more peaceful. In clinical practice, diagnostic hysteroscopy is widely used in the diagnosis of in vitro fertilization-embryo transfer cycle, embryo transfer under ultrasound monitoring is implemented, and minimally invasive endometrial surgery is actively performed to improve the expression of implantation window activity factor and promote embryo implantation, thus significantly increasing the pregnancy rate.