infertility

Synonyms

Sterility, infertility

English: infertility, aridity

definition

The infertility can be with the terms sterility or. Infertility be described in more detail.

Infertility describes the impossibility of conception despite an existing sexual intercourse with the intention of conceiving a child.

You should try to get pregnant for more than 2 years. Depending on whether the person concerned has already become pregnant, one speaks of primary or secondary infertility. The inferility must be viewed in a gender-specific manner. With the woman she says something about the ability to carry the child. Although she can become pregnant, she is unable to maintain the pregnancy without complications (e.g. Risk of abortion). With the man it must infertility can be seen in connection with the quality of the sperm. You can do this with a Semen analysis determine. In addition, infertility can also occur if the sexual act is crossed by certain barriers (e.g. Anatomical) cannot come about.

Epidemiology

10-15% of couples of childbearing age have one infertility on. The unreported number of infertility is probably still significantly higher.

Diagnostic options

a) Basal temperature curve for measuring the Infertility:
The woman measures her temperature early in the morning before getting up, which is then plotted graphically against time. The curve should normally be divided into two cycle halves, which can be distinguished by a temperature rise in the second phase. The increase in body temperature gives a sure indication of whether or not there is one ovulation has come and whether that progesterone is effective, which is responsible for the temperature changed by 0.5 degrees Celsius.
If the second phase of the female cycle does not show such an increase in temperature, there may be a disturbance in follicular maturation (without FSH no ovulation of the dominant follicle). Another reason for the lack of temperature rise is a dysfunction of the corpus luteum, which produces progesterone.

b) hysterosalpingography to determine the infertility:
The patient is given a contrast agent into the uterine cavity, which spreads through the fallopian tubes to the free abdominal cavity. Taking up X-rays one can see closures and extensions of the Fallopian tube detect. In addition, the uterus Make fibroids visible.

c) Hystersalpingo contrast sonography to determine the infertility:
The difference to the hystersalpingography shown above is the gentler contrast medium. This can be done using Ultrasonic can be detected and does not require X-rays.

d) laparoscopy to determine the infertility:
It is a minimally invasive procedure in the form of a Laparoscopy. This gives you a direct view of the tubes. In contrast to hysterosalpingography, you can check the mobility of the tubes and detect adhesions with the surrounding pelvis. With the blue instillation, the tube patency can also be examined here. The great advantage of laparoscopy is that interventions can be carried out on the tube itself, such as loosening adhesions.

e) Fern test to determine the infertility:
This can be used to determine the spinnability of the cervical mucus. If the fern test is positive, which is expressed by the formation of crystals in the mucus of the cervix, then the sperm find optimal conditions for a passage from the cervix to the uterus.

f) Gynecological smear to determine the infertility:
A swab of cells in the cervical area is obtained on a cotton swab. This smear can be checked for changes in the cervical mucosa and possible bacterial changes.

Start of therapy

With the woman

• ovarian = ovarian infertility therapy
  Ovulation triggers such as Clomiphene or cyclofenil stimulate the body's own production of gonadotropins such as FSH and LH (luteinizing hormone). They are taken in a low dose at the beginning of the cycle. They should be taken in combination with estrogens, because ovulation inhibitors have an anti-estrogenic effect and thus reduce the patency of the cervical mucus. One of the side effects of taking ovulation triggers is excessive stimulation of the ovaries, which can lead to cysts. There is also a risk of multiple pregnancies when there are potentially more eggs to be fertilized.
  If the female organism is not able to secrete enough gonadotropins independently, these must be administered in the form of human menopausal gonadotropins (HMG) and human chorionic gonadotropins (beta HCG). The HMG is obtained from the urine of menopausal women and contains FSH and LH in equal proportions. This is used for follicle maturation. The HCG then causes ovulation. When giving gonadotropins, it should be noted that they must be given together with GnRH (gonadotropin-releasing hormone) analogues. The GnRH comes from the hypothalamus and ensures the release of FSH and LH from the pituitary gland. Even with insufficient gonadotropin production, this small amount still has an effect on the maturation of follicles. This must be prevented during the therapy, as otherwise the follicles cannot mature uniformly and the corpuscles of luteum form prematurely. Gonadotropins are administered on the third day of the cycle and administered subcutaneously in low doses.
  If the delivery of GnRH from the hypothalamus is disturbed, it can be replaced by cyclemate, which is released in a pulsatile manner every 90 minutes by a portable mini-pump.

You might also be interested in this:

• The ovulation-inducing syringe
• How can you encourage ovulation?

• tubar = fallopian tube-related
  As mentioned above, salpingolysis can be used to restore the mobility of the tubes (fallopian tubes) using laparoscopy. It is also possible to open tube closures.
• uterine = uterine-related
  Adhesion (synchia) can be removed and myomas can be removed by myoma enucleation. Uterine septa can be corrected hysteroscopically. The disadvantage of surgery on the uterus is that it may not be possible to preserve it if, for example, there are excess fibroids.
  You can find more about this under our topic: Myoma
• cervical = caused by the cervix
  The inflammation of the cervix diagnosed by smear can be treated with antibiotics. If the spinnability and thus the patency of the cervical mucus for the sperm is not given, there is a lack of estrogens, which can be substituted.
• vaginal = due to the vagina
  In the case of malformations, the surgical procedure cannot be bypassed. If colpitis is present, these must be treated with medication. The choice of medication depends on the type of infection (bacteria or fungi).

With the man

If there is infertility: due to a disruption of the number, motility and morphology of the sperm cells, testosterone or antiestrogens are used to counter this. If the sperm only show impaired motility, they are treated with kallikrein for several months.

Read more on the topic: Sperm

Reproductive techniques

a) Homologous insemination (artificial insemination of the woman)

This infertility indication is the decreased quality of male sperm. There is too little ejaculate and too low a sperm concentration. Cervical sterility is found in women. By preparing the sperm by means of kallikrein and by transitioning it into a fertile stage, a positive selection of vital and motile sperm can finally be carried out.

b) Heterogeneous insemination
The only difference from the above method of determining infertility is that the sperm comes from a donor. Heterloge insemination is an option if male infertility has been established. The further psychosomatic consequences for the father, who is constantly reminded by the child of his inability to conceive, are worrying. Legal difficulties arise if the child later wants to clarify the identity of its biological father.

c) In vitro fertilization
In this determination of infertility, a transvaginal puncture of a mature follicle is performed to obtain mature eggs. The egg is then later exposed to 100,000 sperm cells to increase the likelihood of fertilization. In vitro fertilization can be described in three phases:

• In the first phase The aim of stimulation is the maturation of a dominant follicle: Here, GnRH is pretreated so that the body's own GnRH production is suppressed and the doctor has control over the uniform and even development of follicles. They grow when HMG is given and release the egg when given beta-HCG.
• In the second phase the follicle is punctured, which is done using ultrasound. The contents of the follicle are aspirated and the mature egg is obtained. This goes into the incubator. (Please also read: Egg donation)
• In the third phase this mature egg must be cultivated. Only after 3 to 6 hours are the egg cells prepared so that they can be brought together with the sperm. After 20 hours, the egg cell is examined for pronuclei, which is evidence of successful fertilization. Only when the sperm has penetrated the egg can it end its second meiosis, which is noticeable in the formation of the pronucleus. After 40 hours, 3 fertilized eggs are transferred into the uterus.

intracytoplasmic sperm injection
If the egg cell is not fertilized in the third phase of in vitro fertilization, the intracytoplasmic sperm injection guarantees the union of the two sex cells. This method only requires a sperm thread from the male patient, which is then injected directly into the egg cell's plasma using a cannula. Even male patients without sperm in the ejaculate can benefit from this method, as the semen threads can be obtained directly from the testicles or epididymis.

Read more on the topic: Infertility in men