Couple fertility

A couple who have had free, unprotected intercourse for over a year and are unable to conceive is defined as infertile and must start carrying out the first tests with their gynecologist or in a reference centre. However, if the woman is over 35 years old, or if one of the partners knows they have problems that can reduce their fertility, the diagnostic process must be started as soon as possible. In particular, IN WOMEN, in addition to age which is the most important factor, particular attention must be paid to the presence of:

• cases of early menopause in the family
• autoimmunity problems (celiac disease, autoimmune thyroiditis, diabetes…)
• surgical interventions on the abdomen and pelvis (appendectomy with peritonitis, myomectomy...)
• diagnosis of endometriosis, or in any case significant painful symptoms during menstruation, ovulation, sexual intercourse
• menstrual irregularities, periods of amenorrhea, extremely long cycles, intermenstrual bleeding
• previous pelvic/adnexal inflammation
• overweight/obesity

Instead, IN MAN we have to worry if:

• As a child, my testicles did not descend regularly, requiring surgery or medical therapy
• you have had surgery in the past or know you have a varicocele
• have had testicular/prostatic infections or major trauma to the testicles
• is overweight/obese
• smokes a lot, for a long time, or uses drugs
• does a job that exposes him to potentially toxic substances

If the pregnancy does not occur, the woman is over 35 years old, or there are one or more factors that can influence fertility, it is best to contact her doctor for advice, then her trusted gynecologist who can start prescribing the first fertility tests. basis, or immediately direct you to a specialized center for couples' infertility problems. There are many tests that lead to a diagnosis of an infertility factor, because there can be many different causes that prevent a pregnancy; usually we start by excluding the most important problems, then we proceed with increasingly more targeted diagnostics. The basic exams are:

• NELLA DONNA in addition to the gynecological examination with a transvaginal pelvic ultrasound to evaluate the uterus and ovaries and exclude obvious pelvic factors, we proceed with a COMPLETE HORMONE ASSESSMENT to be carried out in the menstrual phase of the cycle, to exclude ovarian and thyroid problems, and the STUDY OF TUBAL PATENTITY , under ultrasound guidance.
• NELL’UOMO, an examination of the seminal fluid carried out in a seminology laboratory, then completed by an andrological evaluation with prostatic and testicular ultrasound.

Fortunately, science allows us to identify and resolve most of the problems that prevent pregnancy, and offers us the therapies and assisted fertilization techniques to carry out the necessary attempts. The most difficult situations for a couple are linked to the absence of oocytes in the woman (a very reduced/absent ovarian reserve) or sperm in the man (azoospermia with testes that do not produce sperm): in these cases we cannot use the couple's gametes and we have to resort to donors external to the couple, or to adoption. The couple will have to be well informed and will decide if and which paths they want to take. In all other cases, there will be medical therapies (anovulation, endocrine problems,...) or surgical therapies (myomas, endometriosis, polyps...), or the use of level I assisted fertilization techniques, if possible, or level II.

If at the end of the diagnostic process no absolute factors of infertility have emerged, the woman is young, the seminal fluid is regular, the tubes are open, but a menstrual irregularity has been diagnosed, with cycles without ovulation, sometimes linked to an ovarian structure microcystic, excellent results can be achieved with a very simple and effective technique, which consists in stimulating the ovaries in a mild manner, with drugs administered orally or subcutaneously, ultrasound-monitoring the ovarian response, and advising the couple on the best days to have sexual intercourse .

If ovarian stimulation with targeted intercourse has not worked, and there is room for other simpler attempts because the couple is young, no worrying infertility factors have been identified and the partners prefer to carry out simpler and less invasive treatments, we can proceed with intrauterine insemination (IUI), which is part of the level I techniques. It is a simple, repeatable, outpatient treatment, in which the woman's ovaries are stimulated with light dosages, as in the case of targeted intercourse, the ovarian response is monitored and, if not excessive, the follicular burst is induced and the liquid is deposited seminal, treated and concentrated in the laboratory, on the uterine fundus, then brought closer to the tubal tract where it meets the oocyte. In level II techniques, however, the spermatozoa and oocytes are brought together outside the woman's body, in the laboratory (IN VITRO FERTILIZATION, precisely, IVF and ICSI), and then the embryo that forms is transferred to the uterus. With in vitro techniques it is also possible to carry out further more targeted studies on the embryo, to obtain information on any genetic diseases affecting the partners, or linked to maternal age, and to exclude the implantation of embryos with genetic pathologies or chromosomal; these diagnostic procedures include PREIMPLANTATION GENETIC DIAGNOSIS (PGT-M or PGT-A).