is a doctor that has studied medicine, in the case of Mexico, for 7 years, followed by a 4 year major in Gynecology and Obstetrics, after which he specializes in Reproduction Biology. It is here where infertility related problems are studied in depth.
It is defines as the inability to procreate or to have a pregnancy that will come to its complete cycle. This happens after having sexual intercourse for the course of a year without any preventive methods. It applies to women under the age of 35, in women over 35 or on those who have a previous history of some condition this time is reduced to 6 months, when infertility can be defined.
They can be of a social or medical nature. Among the most prominent are lateness in searching for procreation and stress under which not only women, but also men are subject in everyday life. Among medical causes there is extreme obesity, anorexia, severe diseases, thyroid alterations, drug, alcohols, tobacco or prescription abuse or Chemotherapy. Specifically among medical reasons are fallopian tube abnormalities, ovulation and uterine cavity problems and endometriosis. Some 20% of diagnosis come out unexplainable.
Even though many people associate infertility to women, in reality, it presents itself in men just as much as it does in women.
Every couple is advised to search for medical attention if they can’t complete a pregnancy after a year of having sexual intercourse without preventive methods. The doctor does a physical exam to both spouses to determine their general state of healed and to evaluate physical disorders they might have that may be causing infertility.
On their first visit to the Fertility Center, the doctor will investigate their Clinical History and perform hormonal studies, x-rays of the fallopian tubes, ultrasounds on the womb and ovaries and a semen analysis. Some of these basic studies can detect the cause of the problem and establish a plan for treatment and the reproductive forecast of a couple.
The quality and quantity of the semen can be a part of the ability of sperm to fertilize the ovule successfully. The motility of sperm is an important factor, even with a low sperm count, men with high motility can fertilize effectively.
It is important if you have been under consult or fertility treatment, to bring with you the tests that have been done previously; hormonal tests, ultrasound, X-Ray studies like hyterosalpinograph, sperm and semen analysis among others.
Before the start of the cycle treatment of Assisted Reproduction you will be asked for an HIV, Hepatitis B, Hepatitis C and a VDRL Syphilis, tests to be done.
It is important that if you have any of these tests to bring them with you or to have them scheduled at the clinic to have them done on a day of your convenience.
Here are some suggestions: Have any questions you may have written down, so you don’t forget when seeing the doctor.
A history of your fertility (a summary of any previous treatment). If you have undergone fertility treatments elsewhere, you have the right to ask the clinic for a full report on the tests and results of each treatment.
Reports of previous examinations such as X-Rays or any surgery that you may have had.
Initial consult of approximately 1hr and you must be accompanied by your spouse. You should arrive 15 minutes before the scheduled time to fill out a form and to have your vitals checked before going in to see the doctor. A full medical history will be taken from both partners, if applicable. A nurse must be present at the time of the gynecological examination. It is necessary for a semen sample from the male spouse to be taken for analysis (if you feel uncomfortable you may let your doctor know)
A Hysterosalpinography (HSG) is an X-Ray study of the Fallopian Tubes and the uterus that proves is the uteral cavity is normal and if the fallopian tubes are open. It is done between the 7th and 10th day of the cycle and takes about 30minutes to complete.
Some hospitals suggest that you take a sedative before the procedure is done.
You will be asked to remove your clothes and wear a robe. Take a sanitary pad with you for after the examination.
Laparoscopy is a surgery that involves inserting a lens through a small incision at the navel and 1 to 3 small incisions in the lower quadrants of the abdomen, through which instruments are inserted.
The day of laparoscopy, the patient is signed in a hospital and must have at least an 8-12 hour fast, at the clinic, a nurse measures their height and weight and take measurements of temperature and blood pressure.
Medical history is required, including the date of the last menstrual period, any allergies, including allergies to latex.
Eating or drinking anything should be avoided for at least 12hrs prior to admission. Also, prior to admission, a physician will prescribe a medication used to clean bowels. No makeup, nail polish or jewelry should be worn.
A form of consent must be signed.
It is advisable not to use tampons after surgery, pads can be used. An anesthesiologist will ask some questions, and he will be available to answer any questions regarding the surgical anesthetic.
During surgery, abdominal and pelvic organs are checked for sought cysts, endometriosis, fibroids or adhesions, scarring and everything that may affect your fertility. A substance is injected through the cervix to see the permeability of the Fallopian Tubes.
After the procedure the gas that was blown at the start is removed the gas and the incisions are closed with fine sutures. Once recovered from anesthesia and transferred to a room, the gradual recovery is started. The same day in the afternoon a liquid diet and the same day or the next morning the patient is signed off if conditions are suitable.
Polycystic Ovary Syndrome is a common disease that can cause symptoms like irregular periods, excessive facial or body hair, acne, infertility and obesity.
Though you might have been diagnosed with PCOS it does not mean you are sterile. Many women can become pregnant having a polycystic ovary by natural means, while others require a certain amount of medical help.
How is it diagnosed? PCOS is normally diagnosed through an ultrasound and a blood test. Polycystic Ovaries tend to have a small chain of cysts around its borders and show up in an ultrasound. And it is detected by either of the 2 following blood tests:
- Hematic Biometry (to determine if you have anemia)
- Thyroid function.
Assisted Reproduction of Artificial Insemination is the technique that treats infertility and that achieves that by gamete manipulation.
Insemination, also known as Artificial Insemination is a technique where motile sperm are place inside the womb (uterus) of the woman, substituting copulation.
Generally it is prescribed when sperm count or motility is low, also after failure through intercourse or endometriosis treatments.
The process consists of an evaluation of the couple to verify their health and that the fallopian tubes are permeable. After this, ovulation is induced through special drugs. Ultrasound of the ovulation and on the day of ovulation the male spouse provides a semen sample that will be processed through strict measures in the andrology lab to finally have the motile sperms in the uterine cavity.
The procedure though which a ovaric hyper stimulation is done to start the development of ovaric follicles, when these are mature, the ovules are recovered through aspiration under sedatives and the removed eggs are placed in contact with sperm in the lab.
An evaluation on the couple is done, hormonal and serology tests are performed. In Vitro fertilization is divided into:
- Ovulation Induction
- Ovulation follow-up or follicular follow-up
- Pregnancy Test
The main reasons why In Vitro Fertilization is prescribed are:
- Tubaric Factor
- Severe Endometriosis
- Insemination failure
- Age factor
- Unknown cause infertility
- Male factor moderately altered
Yes, it is possible, generally under the diagnosis of azoospermia, meaning there is no sperm in his semen. In this case sperm can be obtained through testicular biopsy and then treated though ICSI
This procedure started to be performed on male patients that had a low sperm-count and that could not be solved by using conventional FIV, specifically on patients where the progressive mobility and normal morphology did not yield more than 500 thousand sperm; as well as patients with no sperm on their semen (Azoospermia).
- Obstructive Azoospermia
- Non-Obstructive Azoospermia or Testicular causes (Sertoli Syndrome in evolution). In these cases, sperm is recovered from the epididymis or the testicle, respectively, using a surgical intervention done on the same day or the evening before the recovery of the female spouse
- Couples with failure during the fertilization in a cycle previous to the conventional FIV
- Sperm-count under 1 million with progressive motility and normal morphology after spermatic separation
Assisted reproduction has brought us more opportunities of bringing a new life into our lives, but it is not 100% sure. Age factor is a very important one for the treatment to work. The recommended agree is between 20 and 35, after this age, the ovaric reserve begins to decrease and so do the possibilities of pregnancy, on the other hand the possibilities of genetic alterations, such as Down Syndrome increase.
After an ovaric stimulation is started, several programmed ultrasounds are done, as well as hormonal determinations of estriadol, while other clinics only use ultrasound.
The number of days that the treatment for stimulation depends on the protocol used by each doctor.
Through ultrasound, a mature follicle is generally between 18 and 23 mm. There might be immature ovules; this will depend on several factors and gyneco-endoctrinal problems of the patient.
Yes, it must be at the exact time indicated. Once the injection is applied, the aspiration should be performed during the next 34 to 36hrs, when the ovules finish their development. If for any reason you did not apply the injection at the specified time, please let the clinic know as soon as possible.
There is no evidence to suggest that the aspiration of ovules does any harm to ovaries. There is a report that suggest that sterile women that undergo fertility treatment and do not get pregnant might increase their risk of ovaric cancer. Nevertheless, the same study did not consider the information about the drugs used, and the people in the study do not know exactly. Fertility drugs used in Assisted Reproduction have worked for 30 years, and other studies have proved that there is no risk. In most cases, menopause age appears also to be un-altered.
Studies on human reproduction indicate that for a couple with proven fertility, the probability of conception varies from 15 to 20%. In treatments with assisted reproduction, the environment is provided in a way that it would naturally happen in a natural cycle, synchronizing the cycle phases, increasing the possibilities of success.
In these cases it is ideal to evaluate the couple and depending on the results, the possibilities will be determined. Normally good candidates for this routine check are women under 25, and women which had the procedure done less than 5 years, and women who underwent the Pomeroy technique (middle part of the Fallopian Tube). It is also important that the spouse have a good sperm count. When these pre-requisites are not present, the best option will be FIV over the tubaric surgery, since the results are faster.
IIt takes about 2 weeks.
Yes, though we recommend that the male spouse have 3 to 7 days of sexual abstinence. To ensure the semen sample has optimal conditions for AR. When the day is getting closer for the aspiration, ovaries grow and can sometimes produce mild pelvic pain, hence making intercourse uncomfortable. Ideally 5 days of abstinences is recommended before aspiration.