There are many therapeutic solutions available for the treatment of infertility. In certain cases, several of them may be considered for a couple.

Initially, we usually propose the simplest technique. In case of failure, other possibilities will then be used. In other situations, the fertility assessment will highlight a major cause of infertility and these couples will be referred to in vitro fertilization.

For each problem there is a solution?

In women, ovulation problems come to the forefront (more than 30% of cases) of the causes of infertility. Tubal obstruction, following an ectopic pregnancy or infection, is also common. However, this last reason for sterility has decreased in recent years: the increased use of condoms has reduced the number of STDs which previously favored tubal infections. In women, infertility can also have many other origins such as endometriosis, a disease linked to the presence of uterine tissue outside the uterus, an anomaly of the cervix, changes in cervical mucus preventing the passage of sperm or the formation of antibodies directed against them.

Causes of infertility and associated treatments in women

Cause of infertilityPMA techniques
Obstruction in the uterine tubesSurgery 
In Vitro Fertilization (IVF)
IVF with ICSI
Tubal ligationSurgery
In vitro fertilization
IVF with ICSI
Ovulation problemsHormonal treatment 
In vitro fertilization
IVF with ICSI
Sexual intercourse problemsArtificial insemination
Obstacle at the level of the cervixArtificial insemination 
In vitro fertilization
IVF with ICSI
Unexplained infertilityIn vitro fertilization
IVF with ICSI
Obstruction in the uterine tubes associated with an absence of spermatozoa or a hereditary disease in menIVF with sperm donation
Insufficient sperm count in ejaculateIVF with ICSI
Shape of the sperm that does not allow natural insemination 
Absence of oocytes, even after stimulation Hereditary disease in womenIVF with  egg donation
Absence of oocytes associated with absence of spermatozoaEmbryo donation
Hereditary diseases in men and womenEmbryo donation
Impossibility for the woman to bear a childSurrogate mother (banned)

Ovulation induction

Trying to achieve quality ovulation is often the first proposition made to a couple. This simple ovarian stimulation is reserved for women suffering from anovulation (absence of ovulation) or dysovulation (when ovulation does not occur correctly each cycle). This is called ovulation induction. To do this, it is necessary to ensure the normality of the uterine cavity, tubes and sperm.

To stimulate ovulation, it is possible to use clomiphene. It is prescribed at the start of the menstrual cycle. The major side effect of this treatment is the possible alteration of cervical mucus. This then requires the additional supply of estrogens or the addition of gonadotropins.

These gonadotropins are recombinant FSH (obtained by genetic engineering) or a mixture of FSH and LH, the hormones usually secreted by the pituitary gland to stimulate the ovaries. These gonadotropins are used alone or in combination with clomiphene as an injection every day or every other day for 6 to 12 days, in the first part of the cycle. Their use requires monitoring the growth of ovarian follicles by ultrasound and hormonal measurements in order to avoid ovarian hyperstimulation and multiple pregnancy syndrome.

When the anomaly responsible for ovulation disorders is located in the hypothalamus, it is possible to use a GnRH pump (hypothalamic hormone stimulating the pituitary gland) and thus reproduce quasi-physiological cycles.

>> Pornography Addiction: What You Need to Know

Artificial insemination (intrauterine)

This technique may be necessary when:

  • Spermatozoa present abnormalities in number and/or mobility;
  • The obstacle to fertility is located at the level of the cervix (in the event of an absence of mucus, for example).

It may also be indicated in the event of repeated failures to stimulate ovulation in the event of difficulty ovulating or in the event of an abnormality of the cervix.

The principle of intrauterine insemination is:

  • Stimulate follicular growth;
  • Trigger ovulation with an injection of chorionic gonadotropins (hCG), a hormone having the effects of LH.

Insemination will generally be undertaken 32 to 38 hours after the LH surge or HCG injection. It then consists of introducing a fine catheter, connected to the syringe containing the sperm of the spouse (or a donor), either inside the uterine cavity (intrauterine insemination) or in the cervix (intracervical insemination).

In vitro fertilization (IVF)

Initially developed to allow women with a tubal anomaly () to become pregnant, this medically assisted procreation technique has gradually seen its indications broaden:

  • Endometriosis ;
  • Spermogram abnormalities ;
  • Unexplained infertility.

The principle of in vitro fertilization (IVF) is to stimulate the ovaries by repeated injections of gonadotropins (recombinant FSH obtained by genetics or a mixture of FSH and LH of human origin). These hormones secreted by the pituitary gland and which usually stimulate the development of follicles are used here in high doses in order to obtain a multifollicular response. This stimulation must be monitored by ultrasound and hormonal measurements.

When follicular maturation seems to have been achieved, the triggering of ovulation is decided and an injection of hCG is prescribed.

The puncture of the follicles must be done 36 hours later, vaginally and under ultrasound control. In the follicular fluid thus collected, we find the oocytes which will be cultured with spermatozoa prepared in order to obtain fertilization.

Two to five days later, two embryos (usually) are transferred to the patient’s uterus.

>> 12 Signs of Green Flags in a Relationship: The Keys to a Healthy Bond

Microinjection (ICSI)

Microinjection or ICSI (intra Cytoplasmic Sperm Injection) begins like classic IVF but, instead of culturing the oocytes and sperm and waiting for fertilization, the biologist himself introduces, under a microscope, a mobile sperm in each punctured oocyte.

The indications for ICSI are essentially reserved for major sperm abnormalities (very low number of sperm and/or very low motility). The spermatozoa obtained by testicular biopsies are thus “micro-injected”.

Gamete donation

Gamete donation includes :

  • Donation of male gametes (sperm)
  • Donation of female gametes (oocytes)

These gametes from donors can be used during artificial insemination, conventional IVF or with ICSI.

Please note: if medically assisted procreation involves the use of sperm or egg donation, the law imposes specific procedures (written consent filed with a notary) and health and safety conditions.

Genital tract surgery

In men, this surgery of the genital tract can be decided, for example, in cases of limited narrowing of the vas deferens or in certain significant varicoceles.

In women, tubal surgery retains its place and can be done during laparoscopy. The release of pelvic adhesions or the treatment of endometriotic lesions is also done laparoscopically in order to promote the occurrence of pregnancy. In the uterus, endoscopic surgery allows the treatment of uterine septa, polyps, etc.

Also read: 15 Great tips for being a happy couple

Risk Factors

There are several common risk factors for infertility in both men and women:

Age:

Fertility gradually declines with age, particularly for women, with a significant drop occurring in the mid-30s and accelerating after age 37. Older women may experience infertility due to fewer and lower-quality eggs or underlying health issues. Men over 40 may also have reduced fertility, with increased risks of birth defects and genetic abnormalities in offspring.

Tobacco Use:

Both partners smoking tobacco can diminish the chances of conception and decrease the effectiveness of fertility treatments. Women who smoke are at higher risk of miscarriages, and even if the pregnant individual doesn’t smoke but their partner does, the risk of miscarriage increases. Smoking can also lead to erectile dysfunction and low sperm count in men.

Marijuana Use:

The impact of marijuana on fertility requires further research, although its use during pregnancy has been associated with adverse effects on unborn babies, potentially increasing the risk of miscarriage and stillbirth.

Alcohol Use:

Women should avoid alcohol entirely when trying to conceive or during pregnancy, as even moderate consumption can contribute to infertility. Heavy drinking can reduce sperm count and impair sperm motility in men.

Obesity:

Being overweight or obese, coupled with a sedentary lifestyle, can elevate the risk of infertility. Obesity is linked to lower semen quality in men.

Underweight:

Individuals with eating disorders like anorexia or bulimia, as well as those on very low-calorie or restrictive diets, may face fertility challenges due to inadequate nutrition.

Exercise Patterns:

Lack of physical activity contributes to obesity, thereby increasing the risk of infertility. Additionally, intense and frequent exercise, particularly in women of normal weight, may disrupt ovulation.

Rate this article
Share:

Leave a Reply

Your email address will not be published. Required fields are marked *