Reproductive medicine: sterility and infertility
Unfulfilled desire to have children is a common problem in many societies and leads to enormous psychological stress for involved couples. Reasons for infecundity are equally often spread within women and men and increased especially in industrial nations. Due to several therapy possibilities the couples’ desperate longing can be fulfilled.
Sterility is defined as inability of a couple to beget a child despite of regular (two times per week, within one year) unprotected intercourse.
Infertility means inability of a couple to bear an alive/vital child due to abortion.
Female reasons for infecundity
Endocrine, organic (ovarian, tuba, uterine, cervical, vaginal), mental and idiopathic reasons for female sterility come principally to question. Some are listed in the following table:
|Other||Psychotropic drugs, stress, bulimia, anorexia nervosa|
Male reasons for infecundity
New studies show that in approximately 40 percent of infertility couples the male partner is either the sole cause or a contributing cause of infertility. One important step in clarification of male infecundity is the evaluation of the spermiogram. A spermiogram includes the sperm count in the ejaculate, the motility/agility of the sperm and the percentual number of normally formed sperm (morphology) and defines the quality of the sperm.
- One very simple therapy form of infecundity is “intercourse at optimal time”. The fertile window is made up of the days in menstrual cycle when pregnancy is possible. The length of this fertile phase is determined by the maximum life span of the male sperm and female egg. The theoretical fertile window is therefore six days long, comprised of the five days before ovulation (sperm can survive a maximum of five days in fertile cervical fluid) and the day of ovulation (day 14 in menstrual cycle). When a couple has unprotected intercourse in these days, pregnancy is very likely.
- Endocrinological therapy hormone substitution (e.g. progesterone)
- Operative therapy (e.g. salpingostomy/surgical incision into a fallopian tube, removal of myoma)
- Technically assisted therapy:
- IUS: intrauterine insemination is a procedure that is used to place the sperm directly into the uterus and makes the trip to the fallopian tubes much shorter. A catheter is laid into the woman’s uterus and sperm is injected. The patient should stick to a resting time of a couple of minutes afterwards and then she can pursue her daily activities. Probability of success is at 9 to 18% per try.
- IVF: in-vitro-fertilization is a method of assisted reproduction that involves combining an egg with sperm in a laboratory dish. If the egg fertilizes and begins cell division, the resulting embryo is transferred into the woman’s uterus where it will hopefully implant in the uterine lining and further develop.
- ICSI: intracytoplasmic sperm Injection is a micromanipulation procedure in which a single sperm is injected directly into an egg to attempt fertilization.
Probability of success of IVF and ICSI are at 17 to 30% per try, depending on the female patient’s age.
- Thieme Kurzlehrbuch Gynäkologie und Geburtshilfe, second edition, chapter 13
- American Society for reproductive medicine, www.asrm.org