Infertility 08

--PaulineL 13 janvier 2009 à 15:42 (MET) and Debora; Marjorie & Nour --DeboraA 20 janvier 2009 à 16:11 (MET) and Pauline, --DeboraA 25 janvier 2009 à 16:59 (MET)

What is infertility ?

Infertility is the inability for a couple to have a child after one year of unprotected sexual intercurse.
For women, this means that they cannot conceive, while for men this consists in an inability to impregnate. One of every seven couples have difficulties conceiving. But a great majority, 85% of couples, will conceive naturally in one year if they have regular unprotected intercurse. Over 100 couples trying to conceive naturally:

• 20 will conceive within a month,
• 70 will conceive within six months,
• 85 will conceive within one year,
• 90 will conceive within 18 months, and
• 95 will conceive within two years.

Then people will be diagnosed as infertile if they have not managed to have a baby after two years of trying. If they have never conceived a child, it is known as primary infertility.

Secondary infertility is when people have had one or more babies in the past, but they are having difficulties conceiving again.

What is the difference between infertility and sterility?

Infertility is biologically the inability for a man or a female to produce gametes, while sterility is the total incapacity to produce naturally. In medical usage, sterility usually refers to inability to produce a live child, while infertility is measured by failure to conceive after 1 year without contraception.

What are the causes of infertility and the different symptoms?

There are many causes of infertility. Below are listed some main ones :

• Women

• age
• sexually transmitted diseases
• genital damages/abnormalities
• anovulatory cycle (no ovulation)
• anorexia or bulimia
• smoking, drugs, alcohol

• Men:

• smoking, drugs, alcohol
• overheating of the testicles caused by exercise, hot water, tight clothing, excessive sitting (truck drivers) and other conditions and situations
• sexually transmitted diseases
• use of some medications (antihypertensives, antidepressants, male hormones, cancer treatment)
• genital damages/abnormalities

There is different explanation of infertility :

• The woman can have problems of ovulation:
• Fallopian tubes obstruction: Some people have Fallopian tubes that are blocked. It may be due to a blockage or damages in one or both fallopian tubes
• Age-related factors:
• The man can also be infertile, what reduces twice the chance to manage to have a baby naturally:
• Men and women can have uterine problems:
• There are infertility's case that are unexplained:

What are the different solutions for these infertile people and the issues ?

There are two solutions for infertile people:

• Assisted conception techniques
• Adoption

Assisted conception techniques

1. IVF classical method

This technique was developed in the 1970's. First the women are given fertility drugs to stimulate the production of eggs, to increase the chances of success and, they (the eggs) would be surgically removed from the ovaries. After the removal, the women are given hormones to prepare them to pregnancy. The eggs are fertilized with the sperm in a laboratory and then the embryos are implanted in the mother's uterus.

2. Intra-cytoplasmic Sperm Injection' This technique is almost the same as IVF but it includes ICSI (Intra-cytoplasmic Sperm Injection). This consists in injecting the sperm directly in the egg and is particularly useful for men for whom the classical method would fail.

3. Intra-Cytoplasmic Morphologically-selected Sperm Injection (IMSI) This technique is the same as ICSI but the sperm cells are selected morphologically to have only the better ones. This consists in examining the sperm cells under a high-magnification microscope in order to choose those with a shape and size that indicates good genetic quality. Then they are injected in the egg.

4. Intrauterine insemination Intrauterine insemination (IUI) is another method, which involves the introduction of selected sperm cells directly into the uterus. This increases the number of healthy sperm cells that may reach the fallopian tubes and fertilize an egg. (Sperm washing, selection of healthy and strong sperm cells, can be used in IVF techniques also.) IUI is generally accompanied by ovarian stimulation in order to increase the egg production and improve the rate of success. Sometimes egg selection may be needed too, to have only the healthiest ones.

What are the risks ?

They are many risks with assisted conception techniques. For women undergoing IVF there can be some side effects from fertility drugs or eggs retrieval. There are two main side effects for women:

1.Ovarian hyper-stimulation syndrome (OHSS)

OHSS is a non-common but a known side effect of IVF. This happens when the fertility drugs are too successful and the ovaries cannot deal with a so high number of eggs. If the overstimulation is severe it can produce blood clots and sometimes ovaries damage.

2.Multiple births

This occurs because more than one embryo is put back in the womb with IVF, in order to increase the chances of success. Multiple births increase problems during pregnancy or labour and the risks of cesarean Morever, this can be dangerous for the woman's physical and mental health. Because of that the NICE (National Institute for Clinical Excellence) recommends a maximum of two embryos are put back into the womb during the treatment.

What are the chances of success?

The success rate of IVF is determined to the age of the woman undergoing the treatment. Younger women tend to have healthier eggs which increase the chances of success.

Here are some statistics from the UK :

28% for women who are under 35 years of age, 24% for women who are between 35-37 years of age, 18% for women who are between 38-39 years of age, and 11% for women who are between 40-42 years of age.

Adoption

Lastly, the adoption method is proposed when all the solutions above didn't work.

Some ethical questions

Since they are not natural, these technics are controverted, and some ethical questions are asked.

IVF is criticised because of the personhood question ; during the process, several pre-embryos are destroyed, but some say that having an individual genetic code, they have the right to live, and destroying them is murdering. Morever, this technology being not perfect, there are risks for the future baby to have birth defects (low birthweight, preterm birth), and the parents who choose IVF are sometimes criticised because their choice could be the cause of the eventual infirmity or problems for their offspring .

References

http://www.nhs.uk/Conditions/Infertility/Pages/Introduction.aspx?url=Pages/What-is-it.aspx
http://www.nhs.uk/Conditions/IVF/Pages/Introduction.aspx?url=Pages/Overview.aspx
http://pedsinreview.aappublications.org/cgi/content/full/20/8/e28
http://www.101lifestyle.com/health/infertility/infertility.html
http://www.chu-toulouse.fr/-l-infertilite-
http://www.ncbi.nlm.nih.gov/pubmed/12268268
http://www.emedicinehealth.com/infertility/article_em.htm
wordnet.princeton.edu/perl/webwn
http://www.andrologia.org/eng/maschile_engl.htm

back to Pregnancy_and_Contraception_3BIbDF02-03-04
back to Accueil