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Infertility is defined by the WHO (World Health Organization) as a pathology characterized byabsence of conception for a well-defined period that varies according to the age of the couple. It can affect the man, the woman or even both partners for different reasons.
Only in Italy, approx 15% of couples unable to have children due to infertility. And although receiving this diagnosis can cause stress and tension, pregnancy should not be considered a distant dream. There are indeed different solutions which can be screened and through which there are good chance of conception.
However, it is important to take the situation in hand and contact a doctor who takes care of just this, or one infertility specialist. In fact, through the results of the various tests performed at your request, it will be possible to first identify the causes and then proceed with the appropriate therapy.
We have addressed this delicate subject with the Doctor Elisabetta Colonese, surgeon, specialized in gynecology and obstetrics, couple infertility therapy.
What is that
The term “infertility” means “thereproductive inability of a couple after a limit period. We generally talk about infertility under the age of 35 when you have free, targeted intercourse for a whole year they do not result in conception. Instead, over the age of 35, infertility is considered already after 6 months of continuous intercourse ”, explains the doctor.
Causes
“The causes belong to the couple and can be divided into male or female causes in broad terms. The male causes I am of the despermic type, so a ‘anomaly in the seminal which can be of different degrees of severity. Instead, as regards the woman, the causes can be:
- age first;
- hormonal (e.g. hormonal abnormalities);
- polycystic ovary syndrome;
- anatomical abnormalities affecting the uterus such as fibroids, polyps, or ovaries (cysts);
- tubal-type problems, i.e. mono or bilateral tubal occlusion.
There are also pathologies that can be attributed to the underlying cause of sterility, such as haematological problems»Continues Dr. Colonese.
When you realize that the pregnancy test continues to be negative well beyond the timing outlined, it is good to contact the specialist and perform the necessary tests to understand the causes. In this way, it will be possible to act in a targeted manner.
Exams to be carried out
“First of all it is good to pay a visit to one infertility specialist who will go to frame the couple and ask them suitable exams to understand which of these anomalies we have mentioned may be present and if a cause is identifiable. The exams he will ask are:
- ultrasound, to evaluate the morphology and ultrasound appearance of the woman;
- the count of antral follicles, that is an ultrasound that goes to see the ultrasound ovarian reserve;
- the hormone tests, i.e. AMH, FSH, LH, prolactin, androgen, progesterone, thyroid function;
- examination of the tubes to see if they are open or not;
- a series of haematological tests.
During the gynecological examination it is right to ask, if the woman has not done so, the pap smear and which I recommend to perform annually. Eventually, if necessary, the specialist can also evaluate a vagino-cervical swab complete to exclude that there are pathogens at the vaginal level and a breast control in the form of bilateral breast ultrasound at a young age. While, in adulthood, following the more fibrous modification due to age, a breast control in the form of bilateral mammography, possibly also associated with bilateral ultrasound if the breast is particularly dense or in the case of fibrocystic mammoplasty. There are also tests that can possibly go to see the endo-uterine microbiota, therefore at the level of the endometrium. The man, on the other hand, is asked to perform the seminal test», Specifies the expert.
Possible solutions
«The possible solutions can be divided into first and second level. First level it means that the couple is suitable on the basis of the exams carried out, to stay at least initially, towards targeted relationships at home or towards theartificial insemination, or the introduction of a catheter with the sperm of the husband enabled at the right time. And these two things can be done on spontaneous or stimulated cycle with a small amount of hormones, usually in tablets with a short therapy (on average 5 days).
The second level instead, it involves a technique of in vitro assisted procreation, therefore a technique with hormonal stimulation a little more sustained and longer in time of about 2/3 weeks, and then go for an intervention called egg retrieval which goes to take the follicles that have been stimulated by hormonal stimulation and inside which it is hoped to find the eggs to put in contact with the seminal in the laboratory. After 2-5 days, embryos will be created, hopefully, to be able transfer to the uterus with a catheter absolutely quickly and painlessly, without anesthesia. At that point she waits for about two weeks to have the pregnancy test positive or not ”, concludes the expert.
In general, therefore, in the case of infertility, it is possible to intervene through different techniques which aim to promote conception.
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