What is infertility.
Studies have shown that couples with normal fertility have an 85% chance of conceiving at 1 year and 93% at 2 years without contraception. The latest figures and statistics show that about 15 out of 100 married couples suffer from infertility and infertility. In our country, a person exposed to the risk of pregnancy (i.e. without contraception and with a normal sexual life) for 1 year without pregnancy is generally called infertile. If there are diseases that cause infertility, such as endometriosis, polycystic ovary syndrome, male factor infertility such as oligozoospermia and azoospermia, or irregular menstrual cycles such as anovulation or scanty ovulation, the above time limit is not required and the person should receive direct fertility treatment.
What are the etiologies of infertility.
The etiology of infertility usually has the following four aspects.
1. female causes ;
2. male causes;
3. Causes common to both men and women;
4. Unknown causes
1, female causes.
(1) Fallopian tube factor: damage or obstruction of the fallopian tube, which hinders the meeting of the egg and sperm.
(2) Ovarian factors: abnormal ovulation or various ovarian tumor lesions.
(3) Cervical factors: poor development and glandular secretion of the cervix or various inflammatory diseases and tumors of the cervix.
(4) Uterine factors: congenital dysplasia, malformation, uterine tumors and endometriosis.
(5) Endometrial proliferation, endometrial inflammation and submucosal tumors.
2, the main causes of male infertility are
(1) insufficient sperm count: normal men can produce at least 20 million sperm per milliliter of semen, if less than 20 million sperm is the number of insufficient.
(2) Insufficient sperm vitality: less than 25% of fast forward sperm.
(3) Poor sperm morphology: more than 70% malformed sperm.
(4) Absence of sperm or complete lack of sperm: testicular failure, blockage of vas deferens and bilateral vas deferens.
(5) Sexual dysfunction: ejaculation disorder or impotence.
(6) Necrospermia, retrograde ejaculation and hematospermia.
(7) Endocrine function abnormalities.
3. Infertility factors for both men and women
(4) Infertility of unknown origin: Infertility of unknown origin is about 10-17% when both husband and wife have been examined for infertility and the results are normal.
What are the common points of infertility?
10-15% of couples of childbearing age have infertility problems, of which 35% are female factors, 35% are male factors, and 20% are common factors between men and women. This is why it is essential for both men and women to be tested together. Another 10-17% have unexplained infertility, meaning that all tests are normal.
What is primary infertility and secondary infertility?
Primary infertility and secondary infertility can be classified according to whether or not you have had a pregnancy after marriage. Primary infertility refers to never having had a pregnancy; secondary infertility refers to having had a pregnancy and not having another pregnancy for ≥1 year afterwards.
When should I have a fertility test?
If you have been planning to get pregnant for more than 1 year with no result, you should go for a fertility test or counseling. However, if the male partner has definite or suspected oligospermia, or if the female partner is over 30 years old and has a history of pelvic inflammatory disease, dysmenorrhea, recurrent miscarriages, or irregular menstruation, you should be treated as soon as possible.
What are the common causes of male infertility?
About 35% of infertility in infertile couples is due to sperm abnormalities, including reduced sperm count (sperm reduction), reduced sperm motility (weak spermatozoa) or excessive deformed sperm, which can cause infertility, including
1. History of pre-existing cancer treatment: chemotherapy or radiotherapy can cause sperm abnormalities or infertility.
2. Pre-birth exposure to hexestrol: In the 1950s and 1960s, synthetic estrogens were used to treat miscarriages. It can cause reduced sperm count, reduced viability, abnormal sperm formation, small penis, cryptorchidism, and testicular abnormalities.
3. Hormonal imbalance: Thyroid problems, low testosterone, high FSH and excessive prolactin can all affect sperm count.
4. Immune problems: Men with vasectomies can develop an immune response to sperm (autoimmunity), but there may be other causes as well. Anti-sperm antibodies can fight against sperm and prevent fertilization of the sperm with the egg.
5. Impotence/sexual dysfunction: Many drugs can cause this symptom, such as hypoglycemic drugs, antidepressants, etc. Over 20% have low libido, erectile dysfunction and impotence as a result of lower testosterone and anxiety.
6, Infections: Mumps in childhood, STDs such as gonorrhea and chlamydia can impair male fertility, and recent prostatitis can reduce sperm count and viability.
7, genetic abnormalities: Klinefelter’s syndrome (XXY syndrome) accounts for a small percentage of male infertility, such patients have two X chromosomes and one Y chromosome, while normal people have only one X chromosome and one Y chromosome. They are usually tall and thin, with small testicles.
8, the impact of lifestyle: such as scrotal temperature increase (such as the use of hot tubs or long showers) can affect the production of sperm.
What are the factors that affect male fertility?
1, smoking and drinking: nicotine and alcohol substances have a direct toxicity to the spermatogenic epithelium of the testes, because of the different individual human drama, tolerance of different, the degree of harm to each person varies, but more can cause sperm development malformations, the number of reduced, even if the birth, the fetal malformation rate is much higher than non-smokers. Visiting male patients during the visit must avoid smoking and alcohol, especially alcohol (including beer), at least to the wife’s pregnancy.
2, long-term wearing tight pants and hot water bath: the testes produce sperm the most suitable environment for 35-36 ℃, 1-2 ℃ lower than the normal body temperature. All of the above will make the local environment of the scrotum temperature rise, so that sperm production is reduced, the activity rate is reduced, and the malformation rate is increased.
3, sex life: too frequent sexual production, each ejaculation of the sperm content is reduced, and the maturity of sperm is not enough, so that the chance of conception is reduced. But too little intercourse (less than 1 time per week) will lower the metabolism of the testicles, which will also cause a decrease in sperm quality, and too little sex is not conducive to the metabolism of the woman’s ovaries.
4, there are also such as age, environmental pollution, drugs, diet, infection, etc. will cause the sperm quality to decline. The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things.
The actual fact is that you can find a lot of people who are not able to get a good deal on this.
Theoretically, the prostate gland is the body’s accessory gland, and its secretion prostatic fluid is part of the semen. The actual fact is that you can find a lot of men who have been suffering from chronic prostatitis for many years and have a lot of pus cells in their prostate fluid, and their fertility is not affected.
Another noteworthy trend is that many patients suffering from infertility along with chronic prostatitis insist that chronic prostatitis causes infertility, which is also somewhat biased. In fact, there are many causes of infertility symptoms, both male and female, and both parties, and one should not be satisfied with the diagnosis of chronic prostatitis and ignore the diagnosis of other causes. The actual fact is that even if the infertility is caused by prostatitis, it is currently possible to achieve fertility through sperm in vitro treatment, intrauterine insemination or ICSI.
The routine examination of male infertility
1, semen routine examination: to understand the number of sperm, viability, vitality, malformation rate, liquefaction time and other indicators. The male doctor will conduct a physical examination to understand the development of testicles, epididymis and vas deferens, the presence of tenderness, and the presence of varicocele.
2.Serum sex hormone measurement: mainly for patients with azoospermia and severe oligozoospermia, FSH, LH, T, etc. will be detected.
3.Testicular tissue biopsy: This test is done in patients with azoospermia to understand the spermatogenic function of the testes.
Genetic examination of male infertility
1, Y chromosome microdeletion : Y chromosome microdeletion is found in about 10-12% of patients with azoospermia or oligospermia (less than 10×106). It is uncertain whether such patients will pass on Y chromosome deletions and infertility problems to their sons, but the possibility exists. Because of this, patients with severe oligospermia should have a chromosome test to determine if the decrease in sperm count is due to the Y chromosome microdeletion.
2. Congenital bilateral absence of vas deferens (CBAVD)
This refers to the absence of a duct (vas deferens) that transmits sperm from the testes to the penis at birth. About 1.4% of male infertility patients have CBAVD.
Is it possible to have children with “azoospermia”? What is the significance of a testicular biopsy?
The testes are the “factory” where men produce sperm and sex hormones. The sperm produced by the testes are first stored in the epididymis and then discharged through the vas deferens, ejaculatory ducts and urethra during ejaculation. A lesion in any of the above links (the blockage caused by such lesions is usually irreversible) can cause oligospermia or even “azoospermia”.
A testicular biopsy is an important test in masculology, as it provides a direct estimate of the spermatogenic capacity of the testes and provides direct information that is important for the patient’s subsequent treatment plan.
Testicular biopsy is necessary for patients with the following conditions.
1. High degree of sperm deficiency or “azoospermia” with normal testicular size and blood FSH values within the normal range.
2.Azoospermia with moderately reduced testicular volume, asymmetric testes, and no vas deferens or epididymis can be found.
3.Obstructive “azoospermia”.
4. Patients with oligospermia or azoospermia due to varicocele.
The following patients are not suitable for biopsy.
1, testicular volume 10
2.Azoospermia with shrunken or soft testes and high FSH;
3. Klinefelter’s syndrome (also known as microspermia), which is caused by chromosomal abnormalities.
If there is active sperm on testicular biopsy, IVF can be done with the husband’s sperm (ICSI).
The sperm count will drop very significantly within a few weeks after the testicular biopsy, and may even cause a temporary absence of sperm in the testes, and some people may also cause an immune reaction; these effects generally take 3-4 months to recover to the pre-operative situation, so it usually takes 3-4 months after the biopsy to do ICSI, during which the male partner should also take some drugs to help sperm growth.
What are the common causes of infertility in women?
Abnormal ovulation, tubal disease, endometriosis, unexplained infertility, age and infertility, premature ovarian failure, pelvic adhesion disease, recurrent miscarriage, immune infertility, polycystic ovary syndrome (PCOS)
Causes of female infertility – Ovulation abnormalities
Ovulatory abnormalities are defined as anovulation, sporadic ovulation or irregular ovulation. Ovulation abnormalities can lead to infertility. Anovulation can be due to poor follicular development or impaired release of eggs from the follicular fluid.
Diagnosis.
1. Blood FSH levels: Blood FSH levels can predict whether you are approaching menopause.
2, Blood progesterone level: progesterone level can determine if ovulation is occurring.
3, Ultrasound: you can dynamically observe follicle development and ovulation; you can also estimate ovarian function, such as small ovaries with few small follicles is a sign of near menopause.
4.Endometrial biopsy: A small piece of endometrial tissue is taken for pathological examination to observe whether its growth can support pregnancy.
Causes of female infertility – Fallopian tube disease
It refers to blockage or damage to the fallopian tubes. Tubal disease is one of the causes of infertility. The main reasons for the formation of adhesions and blockages are endometriosis and a history of abdominal or obstetrical and gynecological surgery. Tubal disease can prevent the egg and sperm from uniting and fertilizing in the fallopian tubes, or if a fertilized egg forms, it cannot move to the uterus, which can create a tubal pregnancy and further damage your fallopian tubes.
Diagnosis.
1. History of previous treatment and pelvic examination will be helpful in diagnosis.
2. Hysterosalpingography: A contrast agent is injected into the uterine tubes to observe any tubal abnormalities under X-ray.
3.Laparoscopy: A thin fiber optic mirror is placed into the abdomen through the umbilicus to observe the pelvis, uterus and adnexa, and sometimes to separate the adhesions.
Causes of female infertility – endometriosis
Endometriosis is a condition in which the endometrial tissue grows outside the uterus. Endometriosis is one of the causes of infertility. Endometrial tissue grows outside the uterus and attaches to other tissues in the abdominal cavity such as the ovaries and fallopian tubes. Endometrial tissue, whether inside or outside the uterus, responds equally to the hormonal changes of the menstrual cycle, proliferates and then bleeds the next period, but the endometrium that grows in the pelvic cavity cannot expel blood from the body as it does with menstruation, and the bleeding site is prone to inflammatory reactions and the formation of adhesions. Adhesive tissues can block the fallopian tubes or affect ovulation. In addition, the endometrial tissue growing in the ovaries bleeds during the cycle, forming ovarian cysts called endometriosis cysts, which can interfere with ovulation. Endometriosis is progressive disease, it may tend to get worse and is prone to recurrence after treatment, and endometriosis usually resolves symptoms by menopause.
Diagnosis: History and pelvic examination can suggest endometriosis, but only laparoscopy can provide a definitive diagnosis.
Causes of female infertility – Unexplained infertility
It is a condition in which the cause of infertility cannot be determined after various tests for both the female and male partner. About 15% of infertility patients fall into this category. The diagnosis of unexplained infertility must be made by laparoscopy to exclude endometriosis and pelvic adhesions. Unexplained infertility may have functional abnormalities of the egg and sperm that cannot be detected by convenient and practical methods.
Causes of female infertility – age and infertility
Age plays an important role in female fertility. As we age, many biological changes occur that can be detrimental to getting and maintaining a pregnancy. The fertility of women decreases gradually from the age of 30-35; it decreases sharply after the age of 40. The incidence of spontaneous abortions and chromosomal abnormalities, such as the chance of Down”s syndrome, also increases with age. The success rate of assisted reproduction techniques such as IVF also decreases with age. Why does age play an important role in fertility? One reason is that when women are older, they rarely ovulate regularly; another is that this is when they have many of the diseases that cause infertility, such as endometriosis. But a more important reason is the decrease in the quality and quantity of a woman’s eggs. More eggs tend to be chromosomally abnormal, which leads to miscarriage.
Diagnosis.
1. History and pelvic examination are necessary, in addition one or more of the following tests are required.
2, FSH: Elevated FSH levels in the blood at the beginning of menstruation may be associated with age-related infertility.
3, E2: Elevated E2 levels in the blood at the beginning of menstruation may be associated with age-related infertility.
4. Clomiphene test: It can be used to check ovarian function. Blood is drawn on the 3rd day of menstruation to check FSH, oral clomiphene is taken on the 5th-9th day, and the blood is repeated on the 10th day of menstruation to check FSH. If there is a significant increase in FSH, it indicates low ovarian function.
Causes of female infertility – premature ovarian failure
Menopause usually occurs in women between the ages of 42-56. Premature ovarian failure (early menopause) means that menopause occurs before the age of 40. Women who experience early menopause usually have depleted eggs in their ovaries. The causes of premature ovarian failure are not known, but there are a number of reasons why the ovaries stop producing eggs: for example, certain chemical and medical treatments can damage the ovaries, including chemotherapy and radiation; autoimmune diseases, such as rheumatoid arthritis, sometimes cause premature ovarian failure because the immune system forms antibodies that can damage the ovaries; and, genetic factors also play an important role.
Diagnosis: Medical history is an important basis for the diagnosis of premature ovarian failure, and some additional laboratory tests are needed to clarify the diagnosis.
1, FSH levels in blood: elevated FSH levels at specific periods of the menstrual cycle can confirm the diagnosis of premature ovarian failure.
2, Immunoassay: Detection of autoimmune such as thyroid, parathyroid and adrenal problems can be associated with developing premature menopause.
3.Karyotype analysis: It can detect whether genetic factors are responsible for premature ovarian failure.
Causes of female infertility – pelvic adhesion disease
Definition: It refers to scarring adhesion bands that stick the pelvic organs together. The surface of the human abdominal organs is covered with a smooth layer of tissue. The lubrication of the organ surface allows the adjacent organs to glide freely, but when the surface is damaged or inflamed, scar tissue tends to form. The scar tissue can cause adhesions between the two organs, and the band of scar tissue between the two organs is called an adhesion zone. Adhesions often cause infertility. If they occur in or around the fallopian tubes, they can prevent the union of sperm and egg; if the tubes are only partially blocked, the sperm and egg can be fertilized, but the embryo is prevented from moving back to the uterus, resulting in an ectopic pregnancy. If there are adhesions in the ovaries, ovulation may be affected; if the adhesions occur in the uterine cavity, embryo implantation will be affected.
Diagnosis: Your medical history and pelvic examination can help with the diagnosis, but to confirm the diagnosis, a laparoscopy or hysteroscopy is needed. A laparoscopy can look directly at your pelvic adhesions and sometimes loosen the adhesions. Hysteroscopy can look at the uterine cavity for adhesions and can loosen them.
Causes of female infertility – Repeat miscarriage
Three or more spontaneous miscarriages are defined as recurrent miscarriages. About 20% of pregnancies are spontaneously aborted before 20 weeks, and most abortions occur before 12 weeks, usually three or more times before they are called recurrent abortions. The main causes of recurrent miscarriage are genetic defects, uterine anomalies, fibroids and uterine adhesions. Miscarriage can also be caused by imbalance of certain hormones such as: lactogen, thyroid hormone or progesterone. Certain diseases such as diabetes or immune system abnormalities can also increase the chances of miscarriage. There are also miscarriages of unknown origin.
Diagnosis.
1. Your medical history, pelvic examination and the following tests can help with the diagnosis.
2. Chromosome karyotype: to help determine if there is a genetic defect.
3.Hysterosalpingogram: It can confirm whether there is a uterine malformation.
4.Hysteroscopy: to rule out the presence of uterine adhesions.
5.Vaginal ultrasound: to observe the condition of the uterus, ovaries and fallopian tubes.
6.Hormone level in blood: Observe any abnormal hormone level.
7.Anti-cardiolipin antibody: elevated this antibody can cause miscarriage.
8.Thyroid function test: abnormal thyroid function can cause miscarriage.
9.Glucose: to detect the presence of diabetes.
What is assisted reproductive technology
Assisted reproductive technology is simply medical pregnancy assistance, which is a technology specifically designed for the fertility of infertile couples, and is a technology that artificially manipulates the combination of sperm and egg to complete pregnancy.
Assisted reproductive technologies include artificial insemination and “in vitro fertilization” techniques. Artificial insemination is the insertion of semen into the female reproductive tract through artificial means using a vessel rather than through sexual intercourse. These include artificial insemination using the husband’s semen (AIH) and artificial insemination using donor semen (AID).
In vitro fertilization (IVF) is commonly known as “in vitro fertilization.” IVF is not a baby that is actually grown in a test tube, but rather a few eggs are removed from the ovaries and combined with the male partner’s sperm in a laboratory to form an embryo, which is then transferred The embryos are then transferred to the uterus, where they are allowed to settle in the mother’s uterus and become pregnant. Normal conception requires the sperm and egg to meet in the fallopian tube, where they combine to form a fertilized egg, which then returns to the uterine cavity to continue the pregnancy. Therefore, “IVF” can be simply understood as a fertilization process done in a laboratory (replacing the function of the fallopian tubes) and is called “in vitro fertilization”.
Couples who need assisted reproductive technology
Artificial insemination is mainly used for male infertility due to oligospermia, weak sperm, abnormal liquefaction, sexual dysfunction, genital abnormalities, female infertility due to cervical factors, infertility due to reproductive tract abnormalities and psychological factors, immune infertility, and infertility of unknown origin. Artificial insemination by sperm donation is suitable for absolute male infertility, hereditary diseases in the male partner, and severe maternal-infant blood group incompatibility between the couple due to special blood type that has failed to be treated. Artificial insemination by donor sperm involves social and ethical issues, and there are strict national regulations on its implementation.
”IVF technology is mainly applicable to infertility caused by tubal factors, infertility of unknown origin including partial immune infertility, infertility caused by anti-sperm antibodies and abnormal cervix in women, male infertility caused by abnormal semen, low sperm, weak sperm or no sperm, endometriosis, which cannot conceive even after medication or surgery, and one of the couple is unable to conceive. The inability to conceive after medication or surgery; one of the couple has germ cell deficiency or some kind of genetic disease; repeated failure of artificial insemination with husband’s semen (AIH) or artificial insemination with donor’s semen (AID); ovarian dysplasia or premature failure; fertilization with donor’s eggs.
There are currently about 100 million families of childbearing age in China, and based on the nearly 10% incidence of infertility reported by available research data, there are about 10 million infertile families in China, a number that is obviously alarmingly large, and under the influence of Confucianism, many families have an urgent desire to have children. Among all infertility patients, 70% can be successfully conceived through simpler treatments, such as ovulation-promoting drugs for female patients with anovulation, Chinese and Western medicine and physical therapy for patients with tubal inflammation, and medication for men with insufficient sperm vitality, while the remaining 30% need to be treated with assisted reproductive technology.
What does the reproductive laboratory do?
The laboratory of the assisted reproduction center mainly includes egg collection room, sperm collection room, culture room, transfer room, embryo freezing room, and preparation room and dressing room. The egg retrieval room, sperm retrieval room, and culture room are the core areas of the fertility center where sperm-egg acquisition, fertilization, and division, so to speak, are where life begins. The transfer room is where the embryos are implanted back into the woman’s uterus, and the remaining embryos are frozen in the embryo freezing room. Due to the improvement in the level of construction of culture rooms and the quality of high-grade culture equipment and culture fluid in the form of disposable consumables, it can be said that the culture system is becoming more and more suitable for embryo culture and is a strong guarantee of higher pregnancy rates.