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We bring up sterility when a couple cannot achieve conception after more than 6 months of having unprotected intercourse.
Probably yes. There are many reasons for this. Numerous women get married in their late years and many of them have problems conceiving. The ever more common sexually transmitted diseases play their part in this condition as well. Having more than one sexual partner increases the risk of contracting a contagious illness. These infections lead to blockages of the ovarian tubes. Research shows that every sixth couple has some sterility issues.
There are many reasons for both male and female sterility. With male patients, it’s usually the case of insufficient number of immobile spermatozoids, or not producing semen. With the female patient, it could be any of these causes: anovulatory cycles, irregular periods, clogged fallopian tubes, endometriosis, uterine myoma. There could also be anti-semen antibodies in the female patient’s cervical mucus.
The main prerequisite for this testing is providing the semen sample after a 2-3 days abstinence. The sample is given in a sterile glass or plastic container. In our hospital there is a room especially for this purpose. When doing the sperm count exam, we would count the number of spermatozoids, the semen volume, the number of faulty and dead spermatozoids. We would also analyze their morphology and mobility, also the number of leukocytes and agglutinates.
HSG is an x-ray scan and HSSG is an ultrasound scan of the uterus and the fallopian tubes, giving us information about any anomalies of the uterus and the clarity of the tubes. This procedure has 2 benefit – it helps with diagnostics but also opens i.e. ‘unclogs’ the tubes as we inject the liquid contrast in the womb cavity.
With female patients we usually check the levels of FSH, LH, Estradiol, Prolactin, Testosterone and Progesterone. We would check hormonal values if the patient has irregular cycles or amenorrhea or in preparation for IVF. With male patients we check the FSH and testosterone levels. If the FSH levels are high, production of semen is expected to be sparse. If the values are normal but the diagnosis is Azoospermia then the conclusion would be that there could be a disruption on the spermatozoids’ path so the patient would be sent to an andrologist.
Endometriosis is an ailment when the endometrium of the womb implants in an unusual area such as the ovaries, the fallopian tubes, the inner wall of the pelvis etc. This could cause cysts in the ovaries or blockage or twisting of the fallopian tubes. Patients with this condition often have very painful menstrual cycles. Most often it is detected when the patients come for a check-up due to sterility.
Insemination is an assisted reproduction method during which purified semen is injected into the cervix or the uterus. For this procedure we use a special intrauterine or cervical insemination catheter. Insemination is advised for coupled with depleted spermatozoid number or if there are cervical anomalies that unable the semen to pass through it. This is a method that bypasses this obstacle.
In Vitro Fertilization is also known as a “test tube baby” process. It’s an assisted reproduction process that involves overstimulating the ovaries to produce a greater number of egg cells. Then through a process called punction, the follicles with the egg cells are retrieved and the mature egg cells are placed in a dish with previously processed sperm cells. Ideally, around 100.000 spermatozoids gather around each single egg cell and have the possibility to fertilize it. 3-5 days later, the fertilized egg cell is transferred to the uterus, in a process called embryo transfer. The success rate depends of the mother’s age, the causes for infertility and the quality of the IVF program.
This is a revolutionary breakthrough in the assisted reproduction field of medicine. During the ICSI procedure, a single spermatozoid is injected directly into an egg cell, bypassing the zona pellucida, its main obstacle. If fertilization is successful, we would be able to see 2 pronucleus structures the very next day.
TESA- testicular biopsy is performed for patients with obstructive azoospermia or unobstructive azoospermia, caused by hypo-spermatogenesis i.e. an abnormality with the spermatozoid maturation.
MESA – microsurgical epididymal aspiration or PESA – Percutaneous Epididymal Sperm Aspiration are possible ways to obtain epididymal spermatozoids when the patient has obstructive azoospermia.
These two methods are combined with IVF or ICSI method to overcome male infertility, which could be caused by infections, STDs, varicocele disease, endocrinal or genetic abnormalities.
Abortus can be a cause for infertility because it poses a risk on the reproductive health of women, especially if they haven’t finished the reproduction. There are ways to prevent conception such as preservatives, hormonal contraception, diaphragms, spirals etc. Interrupting the intercourse is the riskiest for pregnancy prevention.
При абортусот плодот се отстранува преку киретажа на матката. Понекогаш после таа манипулација остануваат делови од плодот во матката кои представуваат иделна средина за размножување на бактерии кои предизвикуваат инфекции. Овие инфекции можат да доведат до оштетување на јајцеводите и до стерилитет.
Пушењето ја оштетува репродуктивната функција кај жената и пречи на нормалното развивање на плодот. Дури и ако мајката остане бремена има ризик нејзиното дете да се роди со помала тежина од нормалната, познато како интраутерина ретардација на плодот.
Годишниот превентивен гинеколошки преглед е задолжителен за секоја жена, која што води полов живот. Специјалистите препорачуваат на жените кои што се над 35 години да прават по 2 гинеколошки прегледи во годината. Со превентивните прегледи можат да се откријат и лекуваат заболувањата кои водат до брачна неплодност.
Симптомите кај некои заболувања се губат, но последиците остануваат. Симптомите на некои посериозни заболувања често пати се препокриваат со симптомите на полесни заболувања, како што е габичната инфекција. Некои воспаленија можат да поминат дури и без симптоми. Најопасно е заболувањето да го оставиме да помине само од себе.
За жал презервативот може да не заштити од малку заболувања, основно од сида. Добрата лична хигиена не е гаранција за безопасен секс. Ограничувањето на непромислените полови контакти е нај- сигурниот начин да се заштитиме од половите инфекции и болести.
После 30-годишна возраст јајниците произведуваат се помалку јајце клетки со нормална структура. Во повеќето случаи забременувањето после 40 години по нормален начин е речиси невозможно. Освен тоа успешното имплантирање на ембрионот во понапредна возраст е драстично намалено.