We try not to use the term “infertile”. We can say that after 12 months of regular sexual intercourse without using contraception, there is suspicion that some factor is hindering conception.
Infertility affects about 20% of couples.
The couple who struggle to conceive should be evaluated to find the cause of the problem. And for that, we use some basic survey tests, such as:
- Hysterossalpingography: is the placement of contrast within the uterus to enable viewing the uterine cavity and permeability aspect of the tubes.
- Ultrasound scan: allows one to evaluate the uterine and ovarian aspect.
- Spermogram: shows information about quantity, motility and morphology of spermatozoa.
- Hormone exams: it is necessary to evaluate all the hormones that may influence ovulation or during the course of a pregnancy.
No. About 60% of cases are due to problems with the woman, 20% with men, and the rest are a combination of factors from both genders.
Endometriosis, ovulation disorders (ovulatory factor), changes in the tubes (tubal factor) and uterus (uterine factor).
Endometriosis is the presence of endometrial tissue outside the uterus, or the growth of tissue that covers the uterus elsewhere, such as ovary, intestine and outside of the uterus. Endometriosis can lead to: pelvic pain (at the “bottom of the belly”), pain during intercourse, urinary or intestinal cyclic change (related to menstruation) and infertility. Importantly, none of these symptoms is necessary as there are women who have difficulty conceiving that do not have any other symptoms.
Late pregnancy, obesity or underweight, exposure to sexually transmitted diseases, smoking and cancer treatments.
The woman’s oocyte reserve is established before she was born and reduces in her lifetime. Besides the loss in quantity, there is also loss in the quality of the oocytes, which leads to a lower chance of getting pregnant. The oocyte, unlike spermatozoa, do not multiply. In general, there is greater chance of pregnancy before age 35.
Yes. High performance athletes who practice strenuous exercise such as distance running may experience what is called amenorrhea, or absence of menstruation.
This occurs when the level of body fat drops to levels below those needed to assist in ovulation.
No. The retroverted uterus is common and does not cause infertility. The problem is that women with this type of womb are more likely to have endometriosis, a disease that can cause infertility.
Yes. If abortion is performed in unsafe conditions, such action may leave sequelae such as tubal damage, damage to uterus wall and infections.
Yes. Research indicates that women who suffer from morbid obesity have more fertility problems. This is because of the levels of body fat, which relate directly to the production of insulin released by the pancreas and cause Polycystic Ovary Syndrome (PCOS).
No matter the time that women use the pill, it does not interfere in the process. In some cases, the pill can even help in preventing the onset of endometriosis and ovarian cysts.
It is possible to get pregnant with only one ovary and a fallopian tube.
Most do not, but there are exceptions. There are families who have heredity polycystic ovary syndrome, fibroids, endometriosis and premature loss of oocytes (premature ovarian failure) that can cause infertility.
Yes, it can cause suffering to the couple.
After a year of trying. If the woman is 35 or older, this period should be six months.
Among them are the evaluation of ovulation (menstrual history and serum hormones), the study of tubas (HSG), the evaluation of the uterus (transvaginal ultrasound) and imaging (transvaginal ultrasound or MRI specialist with bowel preparation) in cases of detection of endometriosis.
There are many treatments for infertility, including IVF – In vitro fertilization, intrauterine insemination and scheduled coitus.
Varicocele, infection, exposure to toxins, duct obstruction, hormonal changes and genetic factors.
Varicocele is a dilation of the veins of the pampiniform plexus, such as the varicose veins that bring blood from the testicle.
Drugs used in chemotherapy, ionizing radiation, heat or exogenous hormones. Besides these factors, infections that cause inflammation of the testicles (orchitis-Epididymo) may also be involved.
There is interference, but in a much less important level than in women. The reduction in concentration and motility of spermatozoa or increasing genetic problems with age, particularly after age 60, may occur, but has little influence on the ability to generate a pregnancy.
The main test is a sperm count, which should be performed after sexual abstinence of 2 to 5 days and ideally repeated with an interval of 15 to 30 days. This exam assesses the volume of semen, number, concentration, movement (motility), form (morphology) of the sperm and the presence of inflammation.
In the vast majority of men, no. The production of sperm (fertility) and testosterone (performance) is made by different cells in the testis. Couples without loss of performance may have some form of infertility problem that hinders pregnancy.
Yes. The heat generated by laptops on male waistline can affect semen quality, reducing its volume and motility.
Yes. The practice, excessively, can cause traumatic injuries or heating of the testicles or scrotum. In a study conducted by BostonUniversity, 40% of cyclists have lower quality sperm compared with 27% of sedentary men.
The quality and quantity of sperm produced by active smokers may be influenced by substances present in tobacco smoke, such as nicotine and THC, causing reproductive harm.
Yes. The infection may reach not only the parotid gland but the testes, causing atrophy as well. The “orchitis” (infection of the testicles) occurs in 20% to 30% of men, according to data compiled by the Epidemiological Surveillance of the Ministry of Health.
In some cases, yes. For example, in women who have Polycystic Ovary Syndrome (ovulatory dysfunction), ovulation induction is done with medications.
Prematurity is related to multiple pregnancies. Therefore, a single pregnancy through IVF has no increased risk of prematurity. A multiple pregnancy, spontaneous or after fertilization, has more risks.
IVF – in vitro fertilization, for example, has a success rate of 40% per attempt, on average, representing twice the chance of a couple month without trouble conceiving. The two main factors that affect the success of treatment are the quantity and quality of the oocytes and the woman’s age. Other relevant factors are the low quantity and quality of sperm, severe endometriosis and association of multiple causes of infertility.
The main thing is multiple gestation, for example treatments involve the induction of ovulation, and increases the chance of multiple oocytes and therefore multiple embryos. Another factor is the Ovarian hyperstimulation syndrome, which consists of an exaggerated response to medications used to induce ovulation. However, much has been done to mitigate this risk. It is worth noting that the chance of multiple pregnancy is less than the chance of pregnancy only.
No. The twin rate is 20%. Triplets or more represent only 4%.
Artificial insemination is the placement of prepared and concentrated sperm in the uterine cavity at the time of ovulation. Indicated mainly in cases with abnormal mild/moderate male alteration, in which we “prepare” and concentrate the spermatozoa, putting them “closer” to the oocytes.
The success rate of artificial insemination depends largely on the causes involved. Permeability is essential, at least in one of the tubes, as well as a minimum number of spermatozoa. Thus we have a rate ranging from 15 to 20%.
In vitro fertilization (IVF) is the so-called “test tube baby” technique where we derive the oocytes for fertilization in the laboratory, embryos are formed after a few days and transferred to the uterus. The success rate depends on several factors, the main one being the quality of the oocytes, which is directly related to patient age. With a good quality of oocytes there is 55 to 60% success per attempt.
Currently there is Pre-implantation Genetic Diagnosis (PGD), a genetic test that examines the chromosomes of the embryo and can be performed after the fertilization of oocytes in the process of IVF (in vitro fertilization), with the aim of preventing the development and birth of babies with chromosomal problems. Most often it is suitable for couples who have a history of inherited genetic diseases. This test identifies the gender of the embryo, however, it is not considered ethical do so fie such purpose alone.
ICSI means intracytoplasmic sperm injection, ie inject the sperm into the oocyte. We seek to increase the chances of fertilization. Through this procedure we can skip a large stage of nature and raise our fertilization and success rates. The success rates of ICSI are similar to IVF.
ICSI is indicated mainly in cases of important seminal changes, but it is often used to “guarantee” a better fertilization of oocytes.
Donated oocytes are used by women who can not produce them or ovulate when quality is not good enough to generate a healthy pregnancy.
Videolaparoscopy or simply laparoscopy is a procedure that involves placing a “camera” inside the abdominal cavity and assess intra-abdominal organs such as tubes, intestine, uterus, etc. We can perform diagnostic laparoscopy to merely observe and make a diagnostics (like endometriosis, for instance), or surgery, performing a procedure (extraction of cyst, endometriosis, miomas, etc). The big advantage of this type of surgery is its little aggression to woman (small “holes”).
Hysteroscopy is the placement of “camera” inside the womb. Just like laparoscopy, it can be surgical or diagnostic. With this procedure we can evaluate the uterus and correct possible changes.
The vasectomy reversal is a surgical procedure performed through a small opening in the scrotal. With the aid of a microscope, we perform the realigning of the channel (vas deferens) ligated in the vasectomy. The anesthesia is applied by means of rachidian blocking and the patient is discharged on the same day. This method does not subject the woman to any treatment. The chances of multiple pregnancy drop and of conception occurring naturally increase.
In the case of homosexual women, you can not use the sperm of a family member or acquaintance of a partner to fertilize the oocytes of her partner through artificial insemination or in vitro fertilization. Donors should not know the identity of the recipient and vice versa and, necessarily, it is kept anonymous. In special situations, information about donor, for health reasons, can be provided exclusively to physicians, safeguarding civil identity.
For homosexual men it will depend on the unknown donor oocytes and gestational uterus that, unlike donated oocytes, should be second degree relative, a sister or mother. It is mandatory that the so-called “solidarious belly” has the approval of the Federal Board of Medicine. In other countries you can pay a woman to ‘rent’ her uterus or their oocytes, unlike in Brazil, where this option is prohibited.
It consists of an alternative treatment for women who can not conceive, for not having uterus or the presence of serious disease that sets contraindication to pregnancy, even though her oocyte is capable of generating a baby. It also refers to the only alternative treatment for male homosexual couples.
For the realization of surrogacy, the couple creates an embryo through in vitro fertilization technique (IVF), which is then transferred to the uterus of another woman, and nine months later she gives birth. After birth, the baby is returned to the biological parents.
The term “surrogate”, although widely used, is inadequate because it implies a business relationship that is not allowed in our country. In Brazil, we call it “replacement pregnancy” or “temporary donation of the uterus.”
The resolution of the Federal Board of Medicine (1.957/10) provides that the temporary donor uterus should be second degree relatives (mother, daughter, sister, grandparent or grandchild of the genetic donor – biological mother). The remaining cases must be authorized by the Regional Board of Medicine. The temporary donation of the uterus should not be of commercial or compensatory nature.
The semen donors must be between 18 and 45 years old and have no infectious or genetic diseases. The volunteer performs a series of tests, such as testing the reproductive system – to detect infectious diseases and STDs (Sexually Transmitted Diseases) – blood tests – which indicate possible hereditary diseases – and semen – that defines the quality of the sperm.
After all the tests, the subject is directed to a private room, where he performs the collection of semen. He then goes through a sort of triage with an urologist and answers a questionnaire relating to illness and personal issues.
Normally the banks select groups of young men with attested reproductive potential to perform the donation, which must be done without financial benefits between the parties and with the signing of a donation, consisting of relinquishing any right to the semen.
Used for the preservation of women’s fertility, oocyte freezing can be done in various situations, from postponing motherhood for personal reasons, to even cases of cancer treatments, which can cause irreversible damage to the ovaries.
The oocytes are usually obtained by hormonal stimulation. The ovarian stimulation is performed at about 10 days with daily injections of gonadotrophins from the first three days of the menstrual cycle. Then the oocytes are collected and cryopreserved (frozen).
The freezing of sperm in indicated for the following patients: patients who will submit to vasectomy, who will undergo cancer treatment or be absent when women undergo IVF. The collection is made in the sperm clinic by masturbation, testicular microdissection, or biopsy. The sperm is handled in the laboratory and preserved in liquid nitrogen, at -196ºC.
The Huntington seeks to organize all stages of treatment in order to reduce the wear of constant visits by patients to São Paulo.
From the partner search in the cities of origin, they participate in part of the treatments, or in examinations or delivery of drugs, according to each case.
In addition, Huntington provides on this website a manual of Tips for Visitors, which includes all services needed for a good stay by patients and caregivers in São Paulo.