Problems of sterility in a couple

1994/09/01 Furundarena Salsamendi, Jose Ramon Iturria: Elhuyar aldizkaria

• Osasuna

The 8.4% of U.S. women aged 15 to 44 years with figures from 1988 had problems with having children. In addition, more and more are those who approach the doctor waiting for a solution. Half of couples with sterility problems get some birth. The duration of sterility (and its causes) and the age of the woman influence the possibility of getting pregnant.

There are many couples who achieve pregnancy without having to do with the treatment used, 3% of couples who do not know the cause of sterility on a monthly basis. This is important for people with this type of problem and questions the effectiveness of certain tests and treatments used in exams.

The reasons for being sterile can be many, and some of them, in addition, are not very well known. On the other hand, it has been found that between 10 and 30% of couples have more than one agent causing the problem.

Studies that are performed for the first time should include clinical history, physical examination, the analysis of the seed, the ovulation test, the study of luteinization and ensure the good state of the tubes. Many doctors also perform laparoscopy to diagnose endometriosis and pelvic submarines. With all this, 70% of couples come to know the cause of sterility.

When the cause of the problem is not detected and conventional treatments are not effective, special studies should be carried out. There are microbes that produce asymptomatic genital infections (chlamidya trachomatis, ureaplasma urealyticum and mycoplasma hominis) and their treatment will increase the chances of pregnancy.

As the age of the ovary advances, oocytes decrease and may have insufficient quality. In these cases we are obliged to use more aggressive treatments previously. The possibilities of studying the uterus and the penis inside have increased thanks to histeroscopy and faloscopy, and sometimes can serve to detect undetectable defects.

If after routine treatment the problem persists and no other obstacles have been found for pregnancy in special exams, many specialists recommend insemination induction and intrauterine ovulation. This technique is encouraging and is even cheaper than assisted reproduction, although its effectiveness is to be demonstrated.

The possibilities of combating male sterility are scarce due to the absence of treatments that would affect spermatogenesis, that is, the formation of sperm. As a result, the forces have been destined to increase the mobility capacity of the growth sperm, to eliminate the antibodies, and to increase the effectiveness of the number of growth sperm, by direct insemination to the inside of the uterus. In the worst case, the seed of donors can be used.

The causes of ovarian dysfunction may be present or elsewhere. A possible hyperplasia of the adrenal glands. Other times the brain hypothalamus does not properly expel the hormone GnRH, so we can give it. If, for any of these two reasons, stimulants such as clomifene citrate or gonadotropins are used.

At first most use clomifene because it is cheap, it is taken by mouth and causes fewer multiple pregnancies. However, after 6 cycles of ovulation they resort to other treatments, since from there it is not effective. Then, GnRH or Gonadotropin try to obule it at a pulse or at certain intervals. Its greatest risk is multiple pregnancy.

Assisted reproduction

This is called any technician used to directly obtain oocytes from the ovary. With or without pregnancy, most couples strive once for in vitro fertilisation.

Causes of sterility and prevalence

Ovulation defect 16-30% Tube defect or pipe 12-16% Seed defect 18-31% Endometriosis 5-25% Unknown 13-28% Multiple causes 15-28%

Three general strategies are used: in vitro fertilisation (IVF), intrafalopiana gamete transfer (GTI) and intrafalopiana cytote transfer (ZTI). All three begin by inducing ovulation and eliminating oocytes. In the GTI the oocyte and the seed are placed directly in the fallopian tubes. In the other two, oocytes and seed are unified in the laboratory and after demonstrating fertilization they are placed in the falopian tubes (in the case of ZTI) and in the uterus (in the case of IVF). The probability of achieving pregnancy with these techniques is 15-25%.

Sterility and emotional and social problems

As mentioned above, the problem of sterility causes a crisis in the life of the couple and becomes a generator of emotional problems. Trying to solve it can mean important economic costs, since insurance does not cover these health problems. Social and family pressure can also be high. To combat this, medical services can individually or collectively advise the couple.

There is a great concern in society for the techniques that have the capacity to generate another type of different forms to those that have been created with the formula of the children who have the father, the mother, and the genes of both. Apart from the traditional formula I have said, the Vatican is against families created with the help of technique, for example. At any time, there are advances that demand constant legislative changes. Assisted reproduction is the medical procedure that generates one of the greatest ethical and social problems.

To the couple with this type of problems, it must be seen that there are many others in the same situation, giving all the information available, clarifying the cause of sterility and explaining and analyzing the possibilities of treatment. This allows them to participate in decision-making on possible tests and treatments. It was thought 40 years ago that sterility had no treatment, but today all the couples who so desire have to have the right to try to solve this problem.