Infertility is defined as the inability of a couple to conceive a child after 12 months of regular and unprotected sexual intercourse. According to this definition 15% of couples of reproductive age are infertile. Another concept, fecundity, is expressing the chance to get a pregnancy to be completed with a child in a given menstrual period. The definition of infertility is rigid because it is related to a fixed period, of 12 months, but approximately 90% of couples conceive after one year of cohabitation, but there is a possibility of spontaneous conception in the coming years, although the rate decreases with each year of fecundity.
The emergence of life remains a miracle, while non-appearance of a successor for a couple represents a problem. Failure of conception creates a series of socio-emotional problems, feelings of guilt, worthlessness, social isolation, resulting in lower socio-professional performance and the emergence of tensions in the couple. Statistics show that 40% of infertile couples present a female etiologic factor, for the other 40% etiologic factors is masculine and for the remaining 20% is a combination of female and male factor.
When the medical practitioner is facing with infertility, he has to address and investigate both partners. The evaluation of both partners wants to be “a golden rule” and nothing should be omitted. Management of infertility often requires teamwork, which will not miss: the general practitioner, endocrinologist, gynecologist, urologist, internist and laboratory physician, all contributing in both the diagnosis and the treatment management.
Infertile couple’s evaluation should take into account all the links in the process of conception: ovulation, tubal transport of the egg, production and viability of sperm, the release of the sperm into vagina at the appropriate time, cervical mucus receptivity, fertilization and uterine receptivity for implantation.
Evaluation of male fertility:
Usually the first investigation in a male infertility is a semen analysis. Analysis is relatively simple, inexpensive, noninvasive and the result is obtained in a short time. It will indicate the male fertile capacity, expressed in sperm count, motility and morphology of sperm.
If these results are normal, these tests (which are many, complex and often laborious) will head to the couple’s female factor. If semen analysis is not normal, then will be done a series of tests designed to detect changes in sperm parameters. This require the consultation of urological and / or endocrinology specialist. It will be made hormonal dosage of: testosterone, free testosterone, SHBG (sex hormone binding globulin), FSH ( follicle stimulating hormone), LH (luteinizing hormone), prolactin, estradiol, thyroid hormones, adrenal hormones, etc. according to the recommendations of endocrinologist doctor. If there are establish changes, the endocrinology treatment will be adapted to the hormonal disorders which are found.
If the hormonal tests are normal, then will be appealed to a complex urological consultation to rule out any congenital or acquired obstruction of the ducts deferens, prostate damage (infection / inflammation), a possible varicocele or anatomical defects of the penis. If the urological consultation do not indicate any cause, then should be sought a number of other laboratory explorations such as immunological tests, postcoital test, determination of sperm antibodies and eventually a testicular biopsy.
Treatment of male infertility:
Male infertility treatment is aimed, primarily, to the etiologic agent, to the actual cause (if it can be put out), going along with partner treatment (if is required).
Good results have been cited in the following situations: nontesticulare endocrine disorders, varicocele, retrograde ejaculation, penile anatomical defects. In other situations were used in vitro fertilization, artificial insemination with sperm donor, intratubal gamete transfer or adoption.
Assessment of female fertility:
In parallel with investigation of male infertility is necessary the testing of a possible female infertility, which can have many causes. The investigations can start with a simple test: measuring the endovaginal temperature, which may indicate the existence of ovulation. Hormonal determinations can be made in different periods of the menstrual cycle: dosage of estradiol, FSH, LH, progesterone, SHBG, prolactin, testosterone, 17-hydroxyprogesterone, thyroid hormones, adrenal hormones, etc., depending on medical advice of the endocrinologist and the gynecologist. In parallel can be done investigations which assess the tubal patency, physiological condition of the cervix and endometrium (the exclusion of endometriosis is important). Thus in many cases becomes important cervical examination, a vaginal cytology examination, genital ultrasound, hysterosalpingography, endometrial biopsy and laparoscopy. If after all these complex examinations can not determine the cause of female infertility, then will be made immunological determination, especially the dosage of sperm antibody.
Treatment of female infertility:
In terms of female infertility, treatment may include both causal therapy and other measures: inducers of ovulation, artificial insemination, in vitro fertilization, embryo transfer, etc..
The choice of appropriate therapy depends on a number of factors that meet the needs of infertile couples. These factors include the relative effectiveness of therapeutic means, the complexity and cost of different treatment options, woman’s age and personal and emotional choices. In addition, the therapy must be approached sequentially, should not be excluded the possibility of spontaneous conception and should be considered the cost-benefit-risk ratio.