What are the causes of infertility?
Diagnosing the causes of partner infertility should not be like searching for a wise quote in a book at random.
Zofia Borowiec: Diagnosing the causes of partner infertility should not be like searching for a wise quote in a book at random. It may of course happen that while looking for a given sentence we find it by opening the book randomly, with our eyes closed. A much more sensible method of searching is to read the book and come across this sentence, additionally gaining its context. The same is true for looking for the causes of infertility – many randomly selected tests can be performed, but it is much more effective to systematically analyse the possible causes, the medical and life situation of the couple being treated, and to propose a treatment plan.
The cause can hide anywhere from hormonal imbalances, anatomical obstacles, immunological problems to chronic disease issues or even psychological barriers.
According to the recommendations of the Polish Gynaecological Society and the Polish Society of Reproductive Medicine: Infertility is the inability to achieve pregnancy during 1 year of unprotected intercourse. The problem affects about 20% of people of reproductive age, in Poland it is estimated to be about 1.5 million couples.
One year of waiting for pregnancy without the desired result is an indication to start diagnostics, which should involve both partners. In medically justified cases this period may be shortened, which should be considered e.g. when the woman’s age exceeds 35 years, there are menstrual cycle disorders, pathology of reproductive organs and when the male factor of infertility plays a role. Experts in the field of reproduction have developed recommendations for diagnosis and treatment that do not provide strict rules of conduct in the case of infertility, but rather point to arguments and sources of knowledge that support a particular solution to the problem.
The choice of procedure should be a well-considered decision by the doctor, with full acceptance of the methods by those trying to have a baby – that is, a joint action using the above guidelines.
In a woman, a thorough medical history is the starting point, followed by a physical and gynaecological examination, specific hormone level determinations, and appropriately selected imaging studies.
Evaluation of ovarian function should include clinical history of menstrual regularity and ovulation diagnosis (measurement of luteal phase progesterone levels and ultrasound).
Imaging studies of proven value in diagnosing the anatomical structure of the female reproductive system are ultrasonography and hysterosalpingography (HSG) or hystero-salpingo contrast sonography(SIS or HyCoSy).
If the doctor suspects fallopian tube pathology on the basis of clinical symptoms, s/he can additionally extend the diagnostics with laparoscopy with the examination of fallopian tube patency, while in the diagnosis of uterine abnormalities the main role is played by hysteroscopy.
The basic element of diagnostics carried out in a man is semen analysis, according to the rules specified by the WHO.
It should be noted that there is also a percentage of so-called infertility of unexplained origin – here, the treatment, after analysing all possible causes is one of the most serious challenges for clinicians.
Taking into account the principles of modern medicine (EBM – evidence based medicine), recommendations of scientific societies and bearing in mind the welfare of patients – it should be remembered that the main role is played by a balanced, individual approach to each couple and proposing the best diagnostic tests for them. And by doing so, you can increase the chances of success – a healthy, delivered in the right time and eagerly awaited baby that is the shared joy of the parents and the attending physician.