In­fer­til­ity: Causes and reme­dies

Lesotho Times - - Health -

BABY-MAK­INGNG seems easy. There is a lot of ed­u­ca­tion, even en anx­i­ety, around pre­vent­ing un­wanted preg­nancy eg­nancy once we be­come sex­u­ally ac­tive. But many cou­ples deal­ing with in­fer­til­ity would uld dis­pute the no­tion that get­ting preg­nantt is as sim­ple as shelv­ing birth con­trol. Dr. Jamie amie Grifo, pro­gram direc­tor for NYU’S Fer­til­ity ity Cen­ter, sees strug­gling cou­ples in his clin­ic­nic ev­ery day.

“Un­der­stand­ing nd­ing how much in­fer­til­ity can im­pact your lifeife can help you make bet­ter de­ci­sions about when you start and how you go about it,” said Grifo.

To as­sist with that goal, here are an­swer­swers to five fre­quently askedd ques­tions on in­fer­til­ity.

1) How com­mon­mon is in­fer­til

ity?ty? In­fer­til­ity is clas­si­cally de­fined as a year of try­ing un­pro­tected sex with­out con­cep­tion. In­fer­til­ity nfer­til­ity to­day af­fects one out ut of ev­ery six cou­ples.

“The re­al­ity ty is that it’s much harder to get preg­nant than many of us be­lieve,” said Grifo.

It used to be thought that in­fer­til­ity was pri­mar­ily a woman’s prob­lem, but that is not the case. Men and women are af­fected al­most equally, with 30% due to male fac­tors, 30% due to fe­male fac­tors. The other 40% is of­ten due to a mix­ture of prob­lems, or is re­ferred to as “un­ex­plained.”

But the trend to­day is putting more of the fo­cus on women.

“The so­cial trend of de­lay­ing child­bear­ing -- the older age of women when try­ing to con­ceive -- is the sin­gle big­gest fac­tor in in­fer­til­ity to­day,” Grifo said.

2) What causes in­fer­til­ity in women? ing preg­nancy is us­ing an egg donor and not talk­ing about it. Very few women over the age of 44 get preg­nant with their own eggs.”

Age plays a key role be­cause the num­ber of avail­able eggs drops dramatically as a woman ages, as does the chro­mo­so­mal nor­mal­ity of each egg.

“Women have seven mil­lion eggs as a fe­tus, 1 to 2 mil­lion when they are born, 600,000 went they hit pu­berty,” ex­plains Grifo. “And ev­ery month she wastes 500 eggs to ovu­late the one good egg, and many times it’s not a good egg. By age 40, 97% of the eggs she had at pu­berty are gone.”

Men, on the other hand, are con­stantly mak­ing fresh sperm ev­ery 90 days, said Grifo, so those cells re­main young and healthy even though the man is older.

“So while there is a mea­sur­able decline in male fer­til­ity with age, it’s very mod­est,” said Grifo. “Whereas with women it’s very clearly de­fined. Pretty much over the age of 44 fe­male fer­til­ity ap­proaches zero.”

3) What causes in­fer­til­ity in men? rea­sons. Phys­i­cal is­sues, such as in­juries to the tes­ti­cles, ra­di­a­tion and chemo­ther­apy, the fail­ure of tes­ti­cles to drop, or an en­large­ment of veins in the scro­tum called varic­o­cele, can all con­trib­ute as well.di­a­betes can cause erec­tile dys­func­tion and ejac­u­la­tory is­sues due to a re­duced blood flow from vas­cu­lar dam­age; thy­roid is­sues such as hy­per­thy­roidism can af­fect sperm count and mo­bil­ity. Hor­mones af­fect sperm pro­duc­tion, too.

“En­docrine ab­nor­mal­i­ties can cause it, low testos­terone can be a fac­tor, there are ge­netic causes of in­fer­til­ity in men and some of it is chro­mo­so­mal, in that they are miss­ing a piece or have ex­tra chro­mo­somes,” said Grifo. “In­fec­tious dis­ease like mumps or sex­u­ally trans­mit­ted dis­eases and in­fec­tions can have an im­pact on sperm pro­duc­tion as well.”

Even if the tes­ti­cles pro­duce vi­able sperm, there can be is­sues in how well a man’s sperm moves to ac­com­plish its goal of fer­til­iza­tion. Sperm can swim too slowly, or not at all, ba­si­cally dy­ing be­fore they reach the fe­male egg.

4) What type of fe­male in­fer­til­ity is easi

est to ad­dress?

Sur­gi­cal in­ter­ven­tions are less suc­cess­ful in achiev­ing preg­nancy. Sur­gi­cally re­mov­ing patches of en­dometrio­sis -- a painful con­di­tion where the cells that line the uter­ine cav­ity grow into the tis­sues out­side of the uterus -- can dou­ble the chances for preg­nancy, but suc­cess rates for sur­gi­cal re­pair of the fal­lop­ian tubes are low.

5) What are the op­tions if med­i­ca­tion or

surgery fails to help? When a cou­ple doesn’t re­spond to med­i­ca­tion or sur­gi­cal in­ter­ven­tions, they of­ten turn to as­sisted re­pro­duc­tive tech­nol­ogy (ART).

In­trauter­ine in­sem­i­na­tion (IUI) in­volves plac­ing the man’s sperm into the woman’s uterus with a long, nar­row tube. IUI is most ef­fec­tive for treat­ing women with cer­vi­cal de­fects or scar­ring, or men with low sperm counts, is­sues with sperm mo­bil­ity, erec­tion or ret­ro­grade ejac­u­la­tion.

In-vitro fer­til­iza­tion (IVF) is prob­a­bly the most well-known ART tech­nique. That’s when sperm and eggs are re­moved from each par­ent and mixed to­gether in a lab­o­ra­tory to cre­ate an em­bryo. Ma­ter­nal age, body mass in­dex, life­style fac­tors and re­pro­duc­tive his­tory can all af­fect the suc­cess of IVF, as can the viability of the em­bryo.

“The most ef­fec­tive form of IVF in­volves screen­ing em­bryos and putting back only chro­mo­so­ma­lly nor­mal ones, although there is con­tro­versy about that topic,” said Grifo. “But the data is be­com­ing clear: the sin­gle big­gest cause of IVF fail­ure is im­plant­ing em­bryos that look good but aren’t, and are ac­tu­ally chro­mo­so­ma­lly ab­nor­mal.”

If th­ese tech­niques don’t work, cou­ples some­times turn to a third-party donor for help. Sperm or egg dona­tions can as­sist cou­ples with is­sues who can­not con­ceive. Sperm banks have been around for years. To­day there are now egg banks, which have grown in pop­u­lar­ity as egg-freez­ing tech­nol­ogy has im­proved.

“Donor eggs have made the process eas­ier and less com­pli­cated,” said Grifo. “In­stead of syn­chro­niz­ing a donor and re­cip­i­ent, now you can just pick the frozen eggs and syn­chro­nize them to the re­cip­i­ent’s cy­cle. And you’ll be choos­ing from a younger woman, so you get a higher chance of get­ting an em­bryo that will make a baby.”

There’s also an even newer trend: Younger women are freez­ing their own eggs to use later in life.

“Most women don’t want some­body else’s eggs, they want their own,” said Grifo. “So a woman on a ca­reer path or who is con­sciously go­ing to de­lay child­bear­ing has the op­tion of putting a batch of eggs in the freezer so she can be her own egg donor if she turns out to need it.” — CNN

Cop­ing with in­fer­til­ity can be painful for cou­ples.

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