What is it about ?
Fertility is the ability to conceive children.
- We speak of reduced fertility (subfertility) when a couple needs more than a year to conceive a child. About 1 in 7 couples experience this situation at some point in their life.
- We are talking about sterility in case of inability to conceive a child. Infertility is rare.
Menstrual cycle and fertilization
For fertilization to take place, first of all, a new egg must develop and mature in the woman’s ovary. This process takes place in a pocket called a follicle. A peak in hormonal production triggers the release of the egg from the follicle, which is collected by the fallopian tube. This phenomenon is calledovulation and takes place 14 days before the end of the menstrual cycle (and therefore the start of the next period).
- If an egg has been fertilized in the fallopian tube, the egg and sperm will quickly develop into an embryo, which will implant in the uterus 5 days later. This embryo will produce hormones and thus prevent menstruation from occurring a week later.
- If he there was no fertilization, the egg will not implant in the uterus after 5 days. In the absence of hormonal production, menstrual bleeding will occur.
An unfertilized egg survives for about 24 hours. Sperm can survive for a few days in the uterus (3-6-7 days). The fertile period of a couple therefore begins more or less a week before ovulation until the day of ovulation included.
Causes
The most common causes of reduced fertility are:
- problems related to ovulation (20-30% of cases), for example caused by cysts on the ovaries (polycystic ovary syndrome (PCOS)), a lack of hormones, an excess of the hormone prolactin,…;
- problems with the fallopian tubes (10-15% of cases), which can happen during or after an infection, or after an ectopic pregnancy ;
- the’endometriosis (10-20% of cases), a condition characterized by the presence of uterine lining cells (endometrial cells) outside the uterus, where they form foci of uterine tissue;
- poorly fertile sperm of poor quality (20-40% of cases), for example because of undescended testicles or varicose veins in the testicle;
- general ailments, for example diabetes, the’epilepsy, intestinal diseases, celiac disease (gluten intolerance), being overweight or underweight;
- sexual problems, such as pain during sex, the’inability to get an erection or ejaculation, a frequency of sexual intercourse less than once a week.
Smoking and alcohol play a role in male and female fertility.
- Excessive smoking disrupts the functioning of the ovaries and reduces the quality of sperm.
- A excessive consumption of alcohol can reduce female fertility and disrupt sperm production.
Where and how often?
For every 100 couples who regularly have sex without contraception, 80 to 85 couples conceive a child in the year when the woman is under 38 years old. 7 to 10 couples conceive a child in the following year, without medical assistance.
When there is a fertility problem, the cause is found in women 1 in 4, in men 1 in 4, in both 1 in 4. And the cause remains unknown 1 in 4.
How is the diagnosis made?
Examinations for fertility problems are started only in the absence of pregnancy after a year of unprotected sex. In some cases, for example when the woman has not no periods (amenorrhea), exams can start earlier.
The general practitioner will ask you questions about your medical history, the medications you are taking as well as various sexual and psychological aspects. He will carry out a number of examinations to be able to direct you to the most appropriate specialist.
First exams and tests
To begin with, tests are offered to both partners. Sometimes fertility problems are due to several factors. It is therefore important to detect them all quickly. The following examinations are carried out:
In women
- a clinical examination, including measurements of height, weight, blood pressure and hair growth;
- a blood test ;
- a vaginal exam, including visual assessment and palpation for abnormalities in the vagina.
If there are symptoms of infection or if you have had an infection in the past, a smear and a sexually transmitted infection (STI) test is done.
In humans
- semen analysis (semen analysis);
- examination of the genitals if you have abnormal spermogram results or symptoms in the genitals.
Additional tests
If these tests show no cause of infertility, further tests will be done at the hospital or fertility clinic. These tests include, among other things, a vaginal ultrasound for the woman and a second spermogram for the man if the first result is abnormal.
What can you do ?
If you want to have a child and you or your partner are not pregnant after a year of unprotected sex, it is advisable to contact your doctor.
Period of fertility
A couple’s fertile window begins 3 to 7 days before ovulation and lasts until the day of ovulation inclusive. You can calculate this period like this: the usual length of your cycle in days (for example, plus or minus 28 days) minus 14 days (the time between ovulation and the next cycle, in all women) minus 3 to 7 days (the lifespan of sperm in the womb). For a cycle of 28 days, the calculation is therefore: 28 – 14 – 7 = 7. You are therefore fertile from the 7the day to 14e day included, counting from the first day of the last menstrual period. During the fertile period, you should ideally have sex 2-3 times a week
Influencing factors
Among the factors that negatively impact fertility, there are a few that you can personally influence.
- The fact ofstop smoking can have a great influence. Smoking cessation is also important for the fetus.
- Try to reach a normal body weight: being overweight and underweight both reduce fertility.
What can your doctor do?
Treatment depends on the chances of conceiving a child without medical assistance and the couple’s wishes. This choice can be very personal; some prefer to avoid treatment, others consider adoption to be the best solution. The doctor will clearly explain the steps of the treatment and the chances of success.
Possible treatments
Treatment of the origin of the problem
Here are a few examples:
- weight loss or gain depending on the initial situation;
- drug treatment in case of lazy thyroid (hypothyroidism) ;
- drug treatment for high levels of the hormone prolactin.
Hormonal treatment
If it is an ovulation problem, for example in the event of polycystic ovary syndrome (PCOS), this can be artificially stimulated. The most common drug used for this is clomiphene. It is an anti-estrogen. Taking clomiphene increases the secretion of hormones responsible for the maturation of the egg and the initiation of ovulation. This treatment increases the risk of multiple pregnancy.
Surgical intervention
- An operation may be considered when subfertility is due toendometriosis.
- Large uterine fibroids and mild damage to the fallopian tubes can also be treated with surgery.
- Sometimes an operation is done in preparation for in vitro fertilization (IVF) (see below).
Insemination
Insemination in the uterus (intrauterine insemination or IUI) is applied when the quality of the sperm is moderately reduced. The sperm is first prepared in the laboratory and then placed, at the right time, in the uterus by means of a thin catheter. Sometimes a woman’s ovulation is stimulated by hormone therapy to increase the chances of pregnancy.
In vitro fertilization (IVF)
In vitro fertilization can be used in virtually all types of subfertility. The technique consists of forming the embryo outside the uterus, more precisely in a laboratory test tube. In Latin, ‘in vitro’ literally means ‘in the glass’. An IVF treatment takes place in six consecutive stages:
- Stimulation : The growth of the eggs is stimulated by means of subcutaneous injections. The situation is regularly monitored by a ultrasound.
- Puncture of eggs : after an additional injection, the eggs are ready to be released from the ovary (ovulation). The eggs are aspirated using a needle inserted into the vagina. The semen sample is also provided on the same day.
- Insemination : the eggs and the sperm are brought together in a cup. We examine under a microscope whether there is fertilization. As soon as there is fertilization, we speak of embryos.
- Insertion of embryos : a few days after the puncture of the eggs, the quality embryos are placed back in the uterus.
- Follow-up treatment : 15 days after the puncture of the eggs, a pregnancy test can be done to check if the embryo has implanted. There is not much you can do during this time except wait.
Intracytoplasmic sperm injection (ICSI)
Intracytoplasmic sperm injection (ICSI) is a special form of IVF. This technique is mainly used in serious male fertility problems. It consists of inserting the sperm directly into the egg, using a needle. When a man has no sperm in his semen, it is sometimes possible to take it directly from the testicle through a biopsy.
Psychological support
Psychological support is very important in the context of fertility treatment. Almost all of the people confronted with fertility problems go through moments of more or less deep crisis. It’s like a grieving process. Indeed, a person who has no children when he wants to literally loses the children he has already imagined. This loss can go hand in hand with feelings of shame, sadness, worthlessness and humiliation.
In addition, the treatment itself is binding both physically and mentally. Sometimes the person has to make difficult decisions, which can have serious consequences for their life and that of a child.
Finally, psychological support is just as important when the treatment has no effect and it is decided to stop it. There are self-help groups where people who have been or are going through the same thing can meet and support each other.
Want to know more?
- Stop smoking. It’s possible – Tabacstop
- Alcohol, the point on your consumption – Stop or else?
- Calculate your Body Mass Index (BMI)
- Clomiphene – CBIP – Belgian Center for Pharmacotherapeutic Information
Are you looking for more specialized help?
- Smoking Assistance Center (CAF®) – FARES – Respiratory Affections Fund
- Tobacco specialists – FARES – Respiratory Affections Fund
- Find a registered dietitian – Professional Union of French-speaking dieticians
- Find a nutritionist doctor – Belgian Society of Nutritionist Doctors
- Alcohol aid – Le Pélican & Le center ALFA
- Find a psychologist – Commission des psychologues
- Mental Health Services – The Social Guide
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