Facing and treating infertility

Infertility has been considered by the World Health Organisation (WHO) as a public health problem. It is expected that accessibility to infertility treatment and assisted reproduction will be considered one of the greatest challenges of the millennium.

It is, therefore, important to organise services, techniques and methods in order to improve reproductive health, therefore satisfying the needs of couples throughout their life cycle. The Hospital Particular in Gambelas can now provide the support and guidance necessary by offering a specialist consultation in fertility.

The dynamics of the reproductive process has changed substantially in recent years mainly due to two main factors: behaviour and environment. Infertility has been placed among one of the major dysfunctions of the 21st century.

The WHO defines infertility as the “absence of pregnancy after two years of regular sexual intercourse without the use of contraception”. There is, however, consensus that after one year, couples should seek professional help. Although there are no specific statistics for Portugal, studies reveal that in western countries infertility affects one in seven couples of reproductive age. This figure corresponds to approximately 14% of the population. This figure tends to increase depending on the age of those involved.

The number of cases of infertility is increasing and there are multiple causes for this; they may or may not be associated to anomalies of the male or female reproductive system. Screening should take place in various stages and both male and female should be screened simultaneously. In approximately 30% of cases both partners contribute to the problem.

Causes of infertility
▪ Later pregnancies (more women decide to start a family after the age of 35).
▪ Increase in the prevalence of sexually transmitted infections
▪ Medication
▪ Physical inactivity
▪ Obesity
▪ Consumption of tobacco/alcohol/drugs
▪ Pollution

The male is responsible for over 50% of cases of marital infertility; of these at least a third are exclusively the responsibility of the male and in the same proportion the responsibility is both male and female. Bearing these results in mind, in addition to a marital anamnesis, it is imperative that the first approach to a couple’s reproductive difficulties should be a sperm analysis.

Male infertility is basically due to two factors: sperm alterations (low sperm count) and impossibility in engaging in the sexual act (erectile impotence or absence of ejaculation).

As far as female infertility is concerned, the main factor responsible seems to be the delay in deciding to fall pregnant, which may cause ovarian dysfunction, compromising the quality and quantity of ovules produced. However, there are other physiological changes and alterations that may be equally and significantly responsible for this dysfunction in women; alterations of the fallopian tubes, uterus and uterine cavity.

Infertility treatment known as medically assisted procreation varies according to the primary cause of the problem. However, the first approach is intrauterine insemination, where sperm is deposited in the uterine cavity. The success rate is approximately 20%.

The following step is in vitro insemination. This procedure has a success rate of approximately 50%. This process passes through several sequential steps: ovarian stimulation; collection of ovules and sperm; fertilisation of the ovules; fertility assessment; culture of the embryos and, lastly, transfer or freezing of the embryos.

Presently, technology in this area is highly differentiated, permitting sequential observation of embryos almost on a permanent basis, while at the same time providing monitoring of various parameters, ensuring safety in the results obtained.

Additionally, it is also possible to diagnose genetic and chromosomal alteration of the embryo, before it is implanted in the female womb. Genetic screening is normally carried out when: abortion is recurrent; when the woman is over 38 years; repeated implant failure; severe problem in the male; karyotype alterations; monogenic diseases (e.g. sickle cell disease, spinal muscular atrophy).

The HPA Health Group, now in partnership with the IVI – European leader in assisted reproduction – is proud to provide all the necessary support and guidance to couples in order to assist them in becoming proud parents.

By Dr João Calheiros Alves
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Dr João Calheiros Alves is gynaecologist/obstetrician and specialist in infertility and assisted reproduction at the Hospital Particular do Algarve