Infertility is defined as the inability of a couple to achieve and bring to term a pregnancy. According to the World Health Organisation (WHO), a couple is considered infertile when they have been unable to conceive and have a baby after two years of unprotected sexual relations. This is a definition taken from the results of a study conducted in the United States by M.J. Whitelaw and published in the Sixties. Even the, around 56% of healthy couples conceived within the first month of sexual relations; 78% within the sixth month and 86% within the twelfth month. Today this situation no longer remains the same as society's habits have changed and the methods of prevention of undesired pregnancy have been diversified. Couples that after two years of trying to conceive have still not had a child are advised to see a specialist. Centres specialising in reproductive medicine are able to identify the infertility problems and guide the couples towards a solution to allow them to achieve their dream and become parents.
The time factor plays a fundamental role in reproductive ability, particularly in the case of women. Maternal age and infertility are strictly linked as the woman's ability to reproduce is strictly dependent on the biological age of her ovaries. If at 25 years of age a fertile couple has a 20%-25% chance of conceiving per ovulatory cycle, this percentage drops by half above 35 years of age and tends to drop further still as they reach the age of 40.
Turning to specialists in reproductive medicine is the first step in facing infertility problems. Medically Assisted Procreation (MAP) is the group of techniques available to couples to overcome their infertility problems and head towards a pregnancy.
Infertility is not a rare condition: it is estimated that around 15% of couples of fertile age suffer difficulties in achieving conception, this means that on a global scale, around 100 million people are infertile. It is calculated that these numbers are increasing, not only due to social trends - particularly common in the West - putting off the decision to become parents, but also owing to the negative impact that unhealthy lifestyles, pollution and chemical agents have on both male and female reproductive ability.
Given the desire for a child that does not arrive, only specialised consultation and targeted and in-depth examinations can identify the causes preventing pregnancy.
Medically Assisted Procreation is a relatively recent solution to infertility problems. The first "test tube baby" was born in 1978 with an in vitro fertilisation technique. Since then however, medical science has taken giant steps, identifying new techniques and new tests to intervene in the most complex cases of infertility. Today Medically Assisted Procreation is a set of recognised scientific methods, through which more than five million babies have been born around the world.
90% of the causes of infertility are evenly attributable to female, male and combined factors, whereas in the remaining 10% of cases the causes remain unknown.
►HORMONAL: failure to ovulate caused by hypothalamic-pituitary gland (e.g hyperprolactinemia, stress, anorexia), thyroid, ovarian (e.g. micropolycystic ovaries, endometriosis, luteal phase defect), and metabolic conditions (e.g diabetes and obesity);
►TUBAL: caused by inflammatory processes, adhesions, endometriosis and surgical operations;
►UTERINE: congenital malformations (e.g. septum, sub septum and bicornuate uterus) or acquired malformations (e.g. polyps, fibroids and adhesions) of the uterine cavity;
►CERVICAL-VAGINAL: closure of the cervical canal caused by inflammation, diathermocoagulation, cervical cone biopsy or biochemical changes to the cervical mucus;
►GENETIC: chromosomal anomalies and gonadal dysgenesis;
►IMMUNOLOGICAL FACTORS: presence of antisperm antibodies in the cervical mucus or in the woman's blood that affect the motility of the sperm and their ability to penetrate the egg.
►HORMONAL: congentical or acquired imbalance in the production of sex hormones;
►TESTICULAR SECRETORY: abnormal sperm or seminal plasma production owing to congenital causes (e.g. small or absent testicles), chromosomal (e.g. Klinefelter Syndrome), genetic causes (e.g. microdeletions of the Y chromosome), inflammations (e.g. sexually transmitted diseases, mumps), varicocele (dilatation of the testicular veins), cryptorchidism (failure of one or both testicles to descend into the scrotum), testicular torsion (blocking of the flow of blood that may seriously damage the testicle), smoking, alcohol abuse, exposure to high temperatures, ionising radiation and microwaves, toxic substances (e.g. pesticides, solvents, chemotherapy), non-prescription and prescription drugs (e.g. antipsychotics, tricyclic antidepressants and anabolic steroids);
►TESTICULAR ESCRETORY: excretory system defects (obstruction to release of sperm from the testicles) with normal characteristics of the sperm and seminal plasma owing to congenital causes (agenesis of vas deferens), genetic causes (e.g. cystic fibrosis), inflammations (e.g. chlamydia trachomatis, gonococco, mycoplasma), surgical operations (e.g. vasectomy) and neoformations (e.g. epididymal cysts).
►ERECTILE: inability to achieve or maintain an erection owing to psychological, organic (e.g. neurological damage, diabetes, hypertension, traumas and surgical operations), hormonal (e.g hyperthyroidism, hyperprolactinemia) or pharmacological causes (e.g. antidepressants) or alcohol and drug abuse;
►EJACULATORY: failure to ejaculate owing to psychological problems or pharmacological causes (e.g. antidepressants), retrograde ejaculation, i.e. into the bladder owing to surgical operations on the prostate or bladder, neurological damage or diabetes;
►IMMUNOLOGICAL: development of antibodies on the surface of the sperm cells that interfere with the motility of the sperm.