Infertility
In young, healthy and sexually regular couples, the chance of the female partner conceiving each menstrual cycle is 20%. This value begins to decline after the age of 30 for women, and the decline becomes more pronounced after the age of 37. Male fertility also declines with age, but not nearly as early as female fertility decline. Many women and couples are now choosing to delay childbearing, but the older they are, the more likely they are to have difficulty trying to conceive.
If you have not conceived after 12 months of regular sex without contraception, it is important to see a doctor who will fully evaluate your couple’s situation. If you are older than 35 years old or have a reproductive-related condition, you should start the tests even earlier.
Etiology
Infertility can be multifactorial and may be related to factors such as the female partner, the male partner, both partners, or lifestyle. Sexually transmitted diseases may also contribute to decreased fertility. Some of the most common etiologies include
Ovulation disorders tubal obstruction sperm count and quality
In some cases of infertility, the cause cannot be specified.
Treatment
Treatment for infertility can include medication, surgery or assisted reproductive technology (ART), and a combination of these methods can lead to better outcomes. At the time of your visit, you will need to ask your doctor about the success rate of the treatment you are receiving and carefully understand how he or she defines “success rate”: sometimes “success rate” refers to the rate of live births, sometimes it refers to the rate of pregnancies （Sometimes “success rate” refers to the rate of live births, and sometimes it refers to the rate of pregnancies (regardless of whether or not they are delivered).
If the cause of your infertility is lifestyle-related, your doctor may recommend changes such as changing the timing and frequency of your sex life, adjusting your weight, and quitting smoking.
Some treatment options require more financial outlay and concerted efforts from both partners. During infertility treatment, it is important for couples to understand the problem of multiple pregnancies and the increased risks to both mother and fetus.
Ovulation Induction (OI)
Ovulation is the process by which an egg is released from the ovary. Women with ovulation disorders need medication to induce ovulation. Even those who are able to ovulate normally may need ovulation induction to obtain a pregnancy.
The most commonly used medication to induce ovulation is clomiphene (Fadilan). Patients can use clomiphene repeatedly, and if they fail to ovulate in the previous cycle, the dose of clomiphene can be increased appropriately in the next cycle.
It is possible that patients on clomiphene may still fail to ovulate or conceive. In this case, injections of gonadotropins may be used to directly stimulate the development of follicles in the ovaries. Your doctor can test the development of the follicles by ultrasound and hormones. If you have too many follicles developing at the same time, your doctor may recommend that you cancel the cycle to avoid multiple pregnancies and ovarian hyperstimulation syndrome.
Most women are able to ovulate regularly after receiving ovulation treatment. If the cause of infertility is only an ovulation disorder, more than half of the patients will be able to conceive within 6 cycles. If you are unable to ovulate after several ovulation treatments, further investigations are needed.
The risk of multiple pregnancies is higher with gonadotropin than with clomiphene. One of the safest and most effective options is elective reduction, which increases the chances that the remaining embryos in the uterus will develop into healthy babies, reducing complications during pregnancy and improving the safety of pregnancy.
In a small number of patients, ovarian hyperstimulation syndrome (OHSS) may occur as a result of ovulation. If you are at high risk for this syndrome, your doctor will adjust your treatment plan accordingly and monitor your condition closely.
Surgical treatment
If a patient’s fallopian tubes are blocked, the doctor may surgically create an incision in the fallopian tubes. Surgery may.
Remove unwanted growths such as polyps and fibroids Loosen scars and adhesions from previous surgery, infection or endometriosis Treat endometriosis lesions that are visible to the naked eye
In some cases, male surgery can help improve sperm quality. The success rate of the procedure depends on the type and severity of male infertility.
Artificial Insemination (IUI)
Artificial insemination involves the doctor placing the husband’s semen into the wife’s uterus through an artificial insemination tube during ovulation. The difference between this treatment and natural attempts to conceive is that IUI replaces the process of sexual intercourse. The extracted semen is first optimized in the laboratory to reduce the risk of infection and improve the chances of fertilizing the egg.
Depending on the treatment protocol, the sperm used for IUI is either from the husband (AIH) or from a donor (AID). Donor insemination is mainly used in cases where the female partner has a normal pelvis and fallopian tubes and the male partner has severe oligospermia or azoospermia. The donor will undergo a series of tests to ensure his health (hereditary diseases, sexually transmitted diseases such as AIDS need to be excluded) and the donor’s sperm will be frozen and preserved.
Assisted Reproductive Technology (ART)
Assisted Reproductive Technology is a series of techniques to help infertile couples obtain a pregnancy through the processing of eggs or sperm, which is done in vitro in a laboratory. Assisted reproductive technologies may also involve egg or sperm donation. Sperm can be obtained either through masturbation, or collected during sexual intercourse using a special condom, or even through sperm aspiration or testicular biopsy. The following assisted reproductive techniques are available to infertile couples.
In vitro fertilization-embryo transfer (IVF-ET) is a procedure in which the fertilization process of sperm and egg is completed in an ex vivo laboratory setting, after which the resulting embryo is transferred back into the woman’s uterus.
In IVF, the patient first receives medication to develop and mature multiple follicles. When the eggs are about to be expelled, the doctor will insert a puncture needle through the vaginal wall into the mature follicles and aspirate the eggs inside, guided by ultrasound. Analgesics or general anesthesia can help reduce or even eliminate pain during the egg retrieval procedure.
In vitro fertilization can be performed in two ways: IVF and ICSI. usually, the embryologist will place the eggs with the preferentially selected sperm and monitor the eggs for fertilization. However, if the male partner’s sperm is of poor quality, or if fertilization in previous IVF cycles has been too poor, the embryologist will select one of the most viable and morphologically optimal sperm and inject it into the egg manually to help fertilize the egg, a technique called intracytoplasmic sperm injection (ICSI).
The in vitro culture process for conventional IVF
After a few days, one or more fertilized eggs or embryos are placed vaginally back into the woman’s uterus in a process called “embryo transfer (ET)”. Transferring the right number of embryos is effective in reducing the incidence of multiple pregnancies. Good quality embryos that are not transferred can be frozen for future use.
The success rate of IVF depends on the age of the woman and the cause of infertility. As with ovulation induction and other infertility treatments, complications of IVF include multiple pregnancies and ovarian hyperstimulation syndrome. Fetal reduction is also an effective method for managing multiple IVF pregnancies.
Intrafallopian tube transfer and, in rare cases, two other methods can be used in patients with cervical lesions.
One is “gamete intrafallopian transfer (GIFT)”. In GIFT, the egg is fertilized in the woman’s body. During GIFT, the egg and sperm are placed in the woman’s fallopian tube through a laparoscope for fertilization. Another option is ZIFT, where the egg is fertilized in the laboratory and an embryo is formed, which is then placed laparoscopically in the patient’s fallopian tube to help her get pregnant.
Both of the above mentioned treatments are more expensive than IVF because they involve laparoscopic surgery. The possible complications are the same as with IVF and ovulation induction, and because they involve surgery, they also increase the risk of infection, anesthesia accidents, and other surgery-related risks, so they are rarely used nowadays.
Other options
Before starting infertility treatment, couples should carefully consider possible options, including adoption or “dink”, i.e., choosing not to have children. Couples should discuss their feelings about each other and, if necessary, seek counseling to untie the knots. Talking among friends can also help relieve stress.
Conclusion
Most infertility is treatable. Lifestyle improvements, medications, surgery or assisted reproductive technology can help infertile couples regain their pregnancy. The tests and treatment require a lot of effort and commitment from both partners. After completing the relevant tests, discuss specific treatment options with your doctor.
Terminology
Assisted Reproductive Technology (ART): A series of techniques to help infertile couples achieve a pregnancy through the processing of eggs or sperm
Endometriosis: A condition in which tissue similar to the endometrium appears outside the uterine cavity. Ectopic endometrial tissue is usually found on the ovaries, fallopian tubes and other pelvic structures.
Human immunodeficiency virus (HIV): A virus that attacks some of the body’s immune cells and causes acquired immunodeficiency syndrome (AIDS).
Laparoscopy: A minimally invasive procedure that uses a long, thin instrument to transmit light, images, or perform surgical procedures with minimal postoperative scarring.
Masturbation: Self-stimulation of the patient’s external genitalia, often inducing an erection, is an important method of semen collection.
Multiple pregnancy: A pregnancy with two or more embryos implanted and developing.
Ovarian hyperstimulation syndrome: A syndrome that includes a range of conditions including painful swelling of the ovaries, ascites, pleural fluid and thrombosis due to ovarian hyperstimulation during hyper/ovulatory therapy.
Sexually transmitted diseases (STDs): Sexually transmitted diseases including chlamydia, syphilis, genital warts, genital herpes, gonorrhea, HIV (human immunodeficiency virus) infection, and AIDS (acquired immunodeficiency syndrome).
Sperm aspiration: Aspiration of sperm from the male genital tract, such as the epididymis, vas deferens or testes.
Testicular biopsy: A procedure to obtain a biopsy specimen or tissue from the testis.