Santiago Brugo Olmedo M.D.
Medical Director
Seremas Medicine for men and women
Seremas Home Seremas Specialties Seremas Reproductive Medicine

Reproductive Medicine

Sterility

ESPECIALIDADES | Medicina Reproductiva

Graphic representing the percentage of incidence of most frequent causes of infertility or sterility.

After a year of sexual intercourse without the use of contraceptives, sterility of one or both members of the couple starts to be perceived as a certain possibility.

This one may be primary, when a pregnancy has never taken place, or secondary, when there have been pregnancies which resulted in live offsprings, assisted interruptions/ abortions or ectopic pregnancies (out of the uterus).

Infertility, on the other hand, is the case of the couple that has suffered one or more spontaneous abortions; in other words, when one or more pregnancies have been interrupted or miscarried spontaneously.

It is really surprising how inefficient human race is to reproduce. In comparison with animals, our species has much more difficulty in achieving it.

Firstly, we must consider that woman’s age is the most important variable regarding pregnancy.

This means that oocyte quality decreases as long as the woman grows older. Even the oocyte genetic content changes with age and that is the reason why there are more possibilities of giving birth to offsprings with genetic diseases or suffering from abortions as long as years pass.

The problem rests in the fact that the genetic code of the oocyte starts to deteriorate and in this way, when sperm penetrates the oocyte and starts to combine its chromosomes with those of the egg, errors take place, especially in the number of chromosomes the embryo will have.

This gives as a result some decrease in the possibilities of achieving pregnancy and in the case this one took place, more miscarriages, usually during the first quarter of pregnancy.

This reproductive deterioration is not so noticeable in men, although it also occurs.

Fertility deterioration in men is gradual and there have been reported cases of proven fatherhood after seventy years old.

Despite this fact, prestigious journals have assured that men at about 50 years old have more probabilities of having children with genetic anomalies than younger men who become fathers at an early age.

A healthy couple, where the woman is about 25 years old, having sexual intercourse during her fertile period, has 15-20% chances of achieving pregnancy in a month; after six months, 60-70% of them get pregnant, and after a year, 85-90% of couples do.

Studies have been reported where women were inseminated with donor’s semen because their partners had azoospermia (lack of spermatozoa in semen), and it becomes clearly noticeable how fertility decreases as long as women’s age increases.

Frequency of sexual relations is also an important factor. It has been demonstrated that if both members of the couple are healthy, a frequency of 3-4 times a week is the ideal one to achieve pregnancy. If they have sexual relations more frequently, there is a risk of not having enough spermatic production and therefore, quality and quantity of spermatozoa in the ejaculate decrease, with the following risk of not achieving pregnancy.

The moment when the sexual relationship takes place is also relevant, since most pregnancies occur when it took place on the ovulation day or one or two days before it; if the intercourse took place after ovulation, the chances of achieving pregnancy are very low, simply because the oocyte is only able to be fertilized until a few hours after ovulation and once this period is over, it looses this possibility.

Everything indicates that there are more couples with difficulty in having children currently; this data is true and it is due in part to the increase in stress, in both men and women.

It is also known that environmental pollution is an important variable when considering decrease in fertility.

In men, stress can also diminish the quality of semen and in women it can make ovulation difficult or even prevent them from ovulating. Besides, women are taking more time to decide when they want to become mothers, and according to our previous comments, every year their possibilities decrease.

But, which is sterility incidence? Approximately 15-20% of couples at reproductive age are not able to have children, which means that one out of five suffers from sterility.

We know that in 30% of these cases, the disease is found in women, the other 30% in men, and in the 40% left, both members of the couple have the problem

ESPECIALIDADES | Medicina Reproductiva

Routine test for studying infertility

We refer to spermogram in Andrology Laboratory section.

Hysterosalpingography is an ultrasound of uterus and tubes, which is carried out through collocation of a liquid made of Iodine in the uterine cavity. This substance is radiopaque, in other words, it can be seen perfectly through x-rays, and this is why when it fills the uterus and tubes, we can observe if there are uterine deformities or tubarian obstructions. Carried out by expert professionals, it is unconfortable but not at all painful.

Regarding hormonal profile, we have already mentioned that ovaries are glands that make ovules and also produce two hormones; estrogens and progesteron. Each time an ovule gets mature and is released from the ovary, an event called ovulation takes place.

Sometimes the woman may have some difficulty and ovulation does not take place, in this case we are in presence of anovulation; or the woman does not ovulate properly, and therefore unsufficient progesteron is produced: this is called improper luteal phase.

In these and other cases, it is indispensable to carry out an exam in blood of hormones which are more or less related to reproductive function. Hormones habitually studied are FSH, LH, prolactin, testosterone, estradiol, thyroid hormones and dehydroepiandrosterone sulfate.

Except for premature menopause, in general all the other ovulatory disorders are correctable with medication. This medication will have to imitate nature in order to make the ovary allow maturation and release of the ovule.

Post coital Test is performed between 2 to 10 hours after sexual realtionship. It is very important that intercourse can be as “normal and spontaneous” as possible.

Abstinence prior to that intercourse is the same requested for spermogram, that is, between three to five days.

After this intercourse, the woman goes to the doctor’s office where a small amount of mucus is collected (totally unpainful procedure) in order to observe it under the microscope.

We look for “fern leaves” features mentioned before, mucus quantity and stretchiness are observed, and then we count how many fast mobile spermatozoa there are in a microscopic area of 40X. More than 10 spermatozoa per area must be counted so that the test can be regarded as satisfactory.

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