When is medically assisted reproduction necessary?

Approximately 1 in 6: this is the proportion of couples who consult a gynecologist because they are unable to conceive a child.

Infertility is therefore anything but exceptional. From a medical point of view, we speak of infertility after a year of unsuccessful attempts.

However, this does not mean that a couple facing infertility cannot conceive a child: infertility does not necessarily mean sterility, which is the physiological inability of a couple to conceive.

Infertility: why?

Why is it sometimes difficult to get pregnant? Infertility cases can have many explanations... or in some cases they remain a mystery. And the very nature of these explanations helps us to understand the increase in infertility in recent decades.

These include factors that influence fertility:

• Various physiological causes, such as ovulation disorders, endometriosis, damaged or blocked fallopian tubes, malformation of the uterus, cysts, obstruction of the sperm ducts, etc.
• Obesity in men and women, as well as excessive thinness in women.
• Consumption of drugs, such as cannabis, heroin, cocaine, etc.
• Sperm quality. Some studies point to a decrease in sperm concentration, which has dropped by 50% in the last 40 years. The possible causes of this decrease, but also of the increase in the rate of testicular cancer and genital malformations? Endocrine disruptors, present in plastics and cosmetics, but also smoking, overweight and obesity.
• Tobacco, which in addition to reducing the quality of spermatozoa also has a negative impact on a woman's ovarian reserve.
• The increase in the age at which women wish to have a child, taking into account that the quality of the oocytes tends to diminish after the age of 35, which has an impact on fertility.

Medically assisted reproduction solutions

When a pregnancy project is unsuccessful, the first thing to do is to talk to a gynecologist. Pregnancy is and remains a complex process. Even when all the lights are green, the probability of getting pregnant during a cycle is only 25%. Have you consulted your doctor and has the fertility problem been confirmed? Fortunately, depending on the cause, there are solutions to help you get pregnant.

Medications to stimulate or regulate ovulation

In some cases, medications may be used to treat infertility, for example, if it is caused by irregular menstrual cycles. The same ovarian stimulation will also be recommended in the context of medically assisted reproduction, such as artificial insemination or in vitro fertilization (IVF). Pharmacological treatments may also be recommended in other cases such as endometriosis or hyperprolactinemia (which is an excessive production of hormones that stimulate milk production and inhibit ovulation).

Surgical operations: in women or men

Blocked fallopian tubes, polyps in the uterus or ovarian cysts... Surgery is sometimes an option, but it is not just for women. For example, male surgery can be used to solve a problem of blockage of the vas deferens through which sperm travel.

The principle of medically assisted procreation

If medical treatments or surgery are ineffective, medically assisted procreation is one of the options to make a maternity project possible.

The basic principle of this medically assisted procreation? Artificially arranging, in a medical context, the encounter between one or more fertilizable oocytes and spermatozoa. It should be noted that, by extension, this concept of MAP is sometimes used to refer to the medical treatment of infertility as a whole, such as the medicinal treatments mentioned above.

Artificial insemination, or intrauterine insemination

Artificial insemination is indicated in case of problems with sperm quality or cervical mucus. Cervical mucus is a substance produced in the uterus that facilitates the path of sperm to the egg.

In layman's terms, artificial insemination, also known as artificial insemination, is the intrauterine insemination (IUI), consists of introducing sperm into the uterus during the ovulation period. The sperm can come from the father or from a donor, if the infertility problem is caused by the quality or absence of sperm from the father.

In practice, the ovaries are first subjected to hormonal stimulation to facilitate oocyte maturation. Similarly, ovulation is monitored to determine the best time for insemination. Another determining factor for the success of the operation is the quality of the sperm. Before being injected into the vagina, the sperm is "prepared": the motile sperm is separated from other fluids, such as seminal plasma. After insemination, a progesterone treatment is usually prescribed to facilitate embryo nesting. Two weeks later, a pregnancy test is performed.

In vitro fertilization (or IVF): embryo transfer

In vitro fertilization, the encounter between the sperm and the egg takes place outside the uterus, in an artificial environment. The embryo is then reimplanted into the ovary, which is called embryo transfer.

Therefore, in this context of IVF, it is possible:

• Using the father's sperm and the mother's eggs.
• Using a sperm or egg donation.
• IVF can therefore be used in a wider range of infertility situations. In particular, it will be chosen in cases of endometriosis or tubal obstruction, which prevent the oocyte from circulating through the fallopian tubes, where fertilization by the sperm takes place. The possibility of egg donation also makes it possible to predict pregnancy when infertility is caused by the quality or even the absence of eggs, or in the case of a serious and potentially transmissible genetic disease.

How does the in vitro fertilization process work?

• Hormones are prescribed to induce hyperovulation in order to obtain several fertilizable oocytes.
• This stimulation can be achieved by means of a nasal spray.
• These oocytes are extracted by puncture. For this puncture, the physician uses an ultrasound probe containing a fine needle. The operation is performed under local anesthesia and, in some cases, under general anesthesia.
• On the same day as the egg retrieval, the sperm is collected from the father.
• The sperm are observed, in particular to assess their motility, and selected in a test tube. They are then placed in the same culture medium as the oocytes to induce fertilization.
• Insemination is the moment when the sperm and oocytes meet. After insemination, the eggs are cultured in an incubator to obtain embryos.
• If fertilization is successful, 1 or 2 of these embryos are implanted in the uterus, usually within 2 to 5 days. This is done by inserting a catheter into the vagina. It only takes a few minutes and does not require anesthesia. Unused embryos can be frozen and then implanted if the previous attempt fails.
• This avoids the inconvenience of egg retrieval.
• Progesterone treatment is usually started the day after embryo implantation to optimize the chances of nesting.
• Two weeks after the embryo transfer, a pregnancy test is performed.

Conventional or medically assisted pregnancy: what are the differences?

Once a pregnancy resulting from MAP is confirmed, a question arises: will this pregnancy be different from a spontaneous conception? In principle, no. But what about the probability of a multiple pregnancy, which is riskier than a conventional pregnancy (miscarriage, gestational diabetes, pre-eclampsia, etc.)?

In Mexico, specific measures such as limiting the number of embryos implanted (according to certain criteria, such as age) have made it possible to reduce the rate of these multiple pregnancies during MAP. This proportion is roughly comparable to that of spontaneous pregnancies.

Source: Partenamut

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