The term infertility is an adjective used to define a poor effectiveness in conception. This problem may affect only one of the two partners or both.
We talk about infertility when the couple is unable to conceive within 12 months with regular relationships and without the use of contraceptives. Some authors postpone the limit up to 24 months.
Infertility is not always justifiable. Sometimes there are interference factors that hinder conception but, in most cases, the couple and the doctors cannot motivate this difficulty (it could be multifactorial).
What to do
- Before considering the presence of any pathologies it is necessary to make sure that:
- Sexual relations are regular: to be honest, this criterion is strictly subjective. Not all couples have the same rhythms; moreover, these can change considerably even during the history of the couple itself. There is no limit to be respected but generally one is led to believe that an acceptable frequency falls within a weekly time frame (at least once a week).
- No contraceptives are used: of any kind whatsoever. This clarification is necessary as both for women and for men, there is the possibility of using contraceptives (more or less safe) without the partner noticing. Before beginning attempts at conception it is always better to establish a dialogue to understand if it is a unanimous choice.
Taking the basic assumptions for granted, in order to increase the chances of conception it is necessary:
- To have relationships in the ovulation period: this lasts about 24 hours and is not always easily recognizable. The most recommended systems are:
- Ovulation calendar: in a regular cycle of 28 days the time of ovulation coincides with the 14th day. This parameter changes according to the average duration of the cycle.
- Detection of the basal temperature: during the ovulation of the woman the temperature is 0.2-0.5 ° C higher than the norm.
- Analysis of cervical mucus: the presence of a "transparent gelatin" in the cervix (scrutinable from the vagina) indicates the moment of ovulation.
- Fertility test: consists of wetting urine with a special strip that reacts to the specific hormone concentration indicating or not the ovulation activity.
- Other systems that are less simple to perform are:
- Examination of the saliva: in the fertile period, observing the microscopic saving can be seen the presence of a fern-shaped pattern (similar to crystals) caused by the presence of specific hormones.
- Verification of the position of the cervix: in the fertile period it rises, widens and takes on a softer consistency.
- Some obvious but inaccurate signs are also: increased sexual desire and increased breast tension.
- Have reports even two or three days before and two or three days after the day of ovulation.
- Keep sperm quality high: this can be achieved by ejaculating about once a day:
- Refraining for several days in an attempt to "accumulate" as much as possible is not a correct choice since it favors the stagnation of seminal fluid.
- It is also inadvisable to ejaculate just before sexual intercourse aimed at conception, as the newly synthesized sperm may contain many incomplete spermatozoa.
- Choosing the most suitable sexual relationship management system for the couple:
- Having sex every day is fertile: it is suitable for easily adaptable couples. It is probably the most effective method. It requires to be able to detect the moment of optimal fertility with certainty.
- Having sex every week: it works especially for very "regular" couples who struggle (for various reasons) to change their habits. In this way you are guaranteed to guess at least one day of the fertile period. NB : Ejaculating sperm quality is not optimal once a week.
- To continue to have relationships for the pleasure of doing so: many couples "break out" in an attempt to conceive as soon as possible. It mainly affects men; sometimes women who do not reach orgasm easily fall victim to it, as increasing the frequency usually reduces the duration of intercourse. It occurs when the rhythms become so high that they cause boredom and almost aversion. Let's not forget that the chances of getting pregnant are around 20% every month and often the search lasts over six months (sometimes a year and cases that exceed two years are not very rare).
- Lower the stress level to a minimum: this applies to the couple in general but it is a useful device especially for women. It is no coincidence that many conceptions take place during the holidays and the rest. After all, stress compromises the hormonal axis that is directly involved in female fertility.
- After the act, it could be useful for the woman to remain in a lying and declined position (with a thickness under the hip).
- Feed properly: reproduction is a very laborious and expensive process. The human organism does not effectively support the processes of fertilization and pregnancy in a state of malnutrition. No nutrients should be missing and are particularly important: certain vitamins, fatty acids and essential amino acids.
- Weight and Body Mass Index (IMC or BMI) Normal: this is especially true for females, but males are not totally immune:
- The body of an underweight woman (BMI <18.5) may stop ovulation due to amenorrhea. A female without a menstrual cycle can normally be fertile but the chances are much lower.
- The same applies to obesity. This condition is related to type 2 diabetes mellitus and polycystic ovary (a pathology capable of reducing fertility). These are not conditions that reduce fertility in a short time but it is advisable to take preventive action to prevent the polycystic ovary from manifesting itself.
- Practicing physical activity: it is shown that an active lifestyle prevents infertility but the mechanism is not clear. It probably depends on the fact that athletes globally follow a healthier lifestyle. Of course sports activity facilitates blood circulation and tissue oxygenation.
- If possible, seek conception at an appropriate age: old age progressively decreases the possibility of conception and increases that of complications.
- Preventing and treating sexually transmitted diseases: applies to men and women. Both can remain damaged (even permanently) due to genital infections.
In the event that all this is not enough to guarantee fertility (after a year or two from the beginning of the attempts), it becomes necessary:
- For her, carry out a gynecological check with the aim of researching:
- Limiting ovarian factors: compromise ovulation. They are due to hormonal alterations: polycystic ovary syndrome (PCOS), anovulation, ovarian failure, early menopause.
- Uterine factors: more involved in infertility than in infertility. They involve anatomical alterations of the uterus, such as congenital or acquired malformations, which are also responsible for repeated abortions.
- Tubal factors: anomalies that hinder the ovum-spermatozoon encounter. They are: absence, impermeability or obstruction, salpingitis.
- Cervical factors: anatomical or functional changes that interfere with sperm flow. They are waterproof and previous surgery.
- For him, carry out a check by the andrologist with the aim of researching:
- Genetic factors: directly or indirectly associated with sperm abnormalities: cystic fibrosis, Klinefelter syndrome, etc.
- Anatomical factors: implies obstructions of the passageways of the sperm and varicose veins. They can be congenital or acquired.
- Environmental factors: smoking, alcohol, drugs, etc.
- Other: as a viral disease from mumps (mumps), hormonal dysfunctions etc.
NB : The most commonly used analysis is the spermiogram, which evaluates: sperm volume, sperm count, sperm concentration, total motility, progressive motility, vitality, morphology, sperm pH, leukocytes, MAR test.
- Couple infertility:
- Combinations of several factors.
- Immunological and / or genetic factors: when both subjects are perfectly healthy, infertility may be due to immunological incompatibility (antibodies on the surface of spermatozoa and female cervical mucus) or genetic.
If the cause of infertility is reversible:
- Take advantage of medical treatments that can solve specific problems.
What NOT to do
- Devote yourself sporadically or in any case inadequately to sexual intercourse.
- Use contraceptives.
- Try conception especially in the period away from ovulation.
- Try conception only on the day when ovulation is hypothetically manifested.
- Relying on ovulation calculation systems with too much confidence.
- Ejaculate with low frequency (for example, only once a week).
- Ejaculate just before the conception attempt.
- Lose interest in sexual activity and practice conception in a forced manner.
- Go beyond the limit of endurance and interrupt the attempts for excessive commitment.
- Keep the general stress level high.
- Have nutritional deficiencies: generalized or specific.
- Being or becoming underweight.
- Being or becoming overweight.
- Be sedentary and lead an irregular lifestyle.
- Exceed with physical activity: for women this affects the body mass balance and hormonal balance.
- For men, some speculate that prolonged cycling (competitive levels) may compromise prostate health; it is a hypothesis that has not yet been scientifically proven.
- Smoking: nicotine and other substances contained in tobacco and paper impair sperm health; in particular they damage DNA and reduce mobility.
- Abusing alcohol: the correlation to infertility is less clear than smoking. However, considering that it is a harmful defect (however, to be stopped during pregnancy), it is advisable to stop before conception. Ethyl alcohol is a toxic molecule for all tissues and gonads are no exception.
- Try conception in old age.
- Contract or not properly treat sexually transmitted STDs (especially bacterial diseases).
- After a year or two from the beginning of the attempts, in accordance with when suggested in the previous chapter, DO NOT contact the doctor for a diagnostic procedure (for him and for her) in search of pathologies or limiting factors.
- With the awareness of being infertile due to pathologies or reversible limiting factors, DO NOT take advantage of specific medical treatments.
What to eat
- In the case of obesity, it is advisable to reduce the weight. To lose weight it is sufficient to reduce the caloric intake by about 30%, leaving the (balanced) distribution unchanged; we recommend a fat percentage of 25% and the choice of foods that do not solicit the insulin surge.
- In case of underweight, it is advisable to increase the total body mass. This especially concerns women. To increase mass it is sufficient to increase the caloric intake by about 10%, leaving the (balanced) distribution unchanged; we recommend a fat percentage of 30% compared to the total calories.
- Foods rich in omega 3: eicosapentaenoic acid (EPA), docosahexaenoic (DHA) and alpha linolenic acid (ALA). In addition to exercising an anti-inflammatory role, they appear to be directly related to good sperm composition and egg health. The first two are biologically very active and are found mainly in: Sardinian, mackerel, bonito, alaccia, herring, alletterato, ventresca of tuna, needlefish, algae, krill etc. The third is less active but constitutes a precursor of EPA; it is mainly contained in the fat fraction of certain foods of vegetable origin or in the oils of: soy, linseed, kiwi seeds, grape seeds, etc.
- Foods rich in antioxidants: by effectively combating the oxidative stress of the entire body, it is also possible to improve the composition of the sperm and the health of the egg.
- Vitaminics: the antioxidant vitamins are carotenoids (provitamin A), vitamin C and vitamin E. Carotenoids are contained in vegetables and red or orange fruits (apricots, peppers, melons, peaches, carrots, squash, tomatoes, etc.); they are also present in shellfish and milk. Vitamin C is typical of sour fruit and some vegetables (lemons, oranges, mandarins, grapefruit, kiwi, peppers, parsley, chicory, lettuce, tomatoes, cabbage, etc.). Vitamin E is available in the lipid portion of many seeds and related oils (wheat germ, maize germ, sesame, kiwi, grape seeds, etc.).
- Vitamin C and vitamin E seem to have a positive effect (independent of the antioxidant capacity) on the composition of the sperm and on the health (therefore also on the receptivity) of the egg.
- Salini: antioxidant minerals are zinc and selenium. The first is mainly contained in: liver, meat, milk and derivatives, some bivalve molluscs (especially oysters). The second is contained above all in: meat, fishery products, egg yolk, milk and dairy products, fortified foods (potatoes, etc.).
- Polyphenols: they are divided into simple phenols, flavonoids, tannins. They are very rich: vegetables (onion, garlic, citrus fruits, cherries, etc.), fruit and related seeds (pomegranate, grapes, berries, etc.), wine, oilseeds, coffee, tea, cocoa, legumes and whole grains, etc.
- Foods rich in vitamin D: plays a decisive role in the synthesis of steroid hormones and gonad products (male and female). They are rich in it: egg yolk, fishery products, cod liver, etc.
What NOT to Eat
- Bad fats: they are contained in margarines and hydrogenated oils. These are used as ingredients in: fast food (french fries, hamburgers, etc.), savory snacks (popcorn, bag fries, nachos, etc.), sweet snacks (chocolates, candy bars, snacks, etc.) and packaged baked goods (focaccia, croutons, croissants etc).
- Foods that promote obesity: it is advisable to eliminate all junk foods and beverages, in particular fast food, sweet or savory snacks and sweet and alcoholic drinks. It is also necessary to reduce the frequency of consumption and the portions of: pasta, bread, pizza, potatoes, derivatives, fatty cheeses, meat and oily fish, salami, sausages, sweets, etc.
Natural Cures and Remedies
- Supplements: all food supplements that contain the molecules mentioned in the "What to eat" paragraph are useful:
- Omega 3.
- Antioxidants (vitaminics, salines, polyphenols).
- It is advisable to emphasize especially the intake of vitamin E and vitamin C.
- Vitamin D.
- A beneficial role of magnesium and carnitine has also been hypothesized, but scientific evidence is faltering.
- Herbal medicine:
- Peruvian Maca: it is a root similar to Ginseng. It can be eaten or used in purified extract. Sperm production and sperm mobility seem to be increasing.
- Aiurvedic Medicine:
- Mucuna pruriens: it is a legume. It is said that its seeds boast different therapeutic characteristics; among these, an increase in fertility.
Pharmacological care
Bringing all the drugs together in a single paragraph is very complicated, as the causes of infertility are numerous and require different treatments. Below we will report only the most used ones:
- Drugs for ovarian and testicular stimulation: these are hormones or derivatives to be taken orally or intramuscularly (GONAL-F based on follicle stimulating hormone, GONASI and Pregnyl based on chorionic gonadotropin, LUVERIS based on luteinizing hormone, MENOGON a basis of Menotropina etc.). The effectiveness varies depending on the cause of infertility. In women, they can have significant side effects such as multiple pregnancies and gastrointestinal disorders.
Prevention
- For women, carry out a periodic gynecological check-up.
- Check the rhythm of the menstrual cycle in the female.
- Avoid sexually transmitted diseases.
- Avoid underweight and female amenorrhea.
- Avoid obesity, type 2 diabetes mellitus and polycystic ovary in women.
- Eat properly and in a balanced way.
- If present, treat varicocele or testicular cancer in humans.
- Do not delay attempts at conception until old age (over 35).
- Don't drink, don't smoke and don't take drugs.
- Reduce or avoid stress.
- Some suggest avoiding cell phones in trouser pockets; radiation can compromise fertility.
Medical Treatments
For infertility or sterility caused by anatomical factors it is possible to perform:
- Surgery:
- In man they are frequent: removal of varicose veins to the testicles (varicocele).
- In women: removal of uterine polyps, submucosal fibroids, adhesions to the uterine cavity, ovarian cysts, endometritis, etc.
- Assisted reproduction. The most known and used techniques are:
- Artificial insemination: consists in depositing the male seed inside the woman's uterus using a canula inside the cervical orifice.
- In vitro fertilization: it is based on the collection of an oocyte via the vagina and on the subsequent fertilization in the laboratory with a spermatozoon isolated from the sperm.
- Intratubal transfer of gametes: consists of laparoscopy collection of oocytes, selection of mature ones and transfer to a canula containing the male's seminal fluid. Everything is then placed inside a tube to release its contents.
- Intracistoplasmic spermatozoa: similar to in vitro fertilization but in this case the spermatozoon is injected directly into the egg.
