| 1.
What is infertility and what is sterility?
2. What is the infertility frequency?
3. Which are the main reasons?
4. What is the suitable frequency of sexual relations
to obtain a gestation?
5. When is it necessary to consult
a specialist?
6. Which tests are made at the
first consult?
7. What is the usual treatment?
8. How big is the risk of getting
a multiple pregnancy?
9. How much does the treatment cost?
10. How long will it take to
obtain a pregnancy?
11. Is it dangerous to have more
than one treatment?
12. Are drugs used in assisted
reproductive techniques dangerous?
13. Can the sex of the offspring
be chosen?
14. Does Spanish law permit single
women to have these treatments?
15. Can characteristics of the donor be chosen?
16. Are donation and reception
of ova or semen completely anonymous?
17. Can disabled have children
by assisted reproductive techniques?
18. And seropositives?
1.
What is infertility and what is sterility?
Although both terms seem similar they differ clearly in. While in sterility
no gestation is obtained, in infertility there is pregnancy, but it doesn’t
end up with normality. Starting from this difference we reach the following
classification:
• Primary sterility: no consequence of pregnancy after one
and a half year’s
relations
• Secondary sterility: no consequence of pregnancy during
the following 2 to
3 years of gestation and delivery of the first baby
• Primary infertility: a pregnancy is obtained, but this
doesn’t end up with a
normal newborn
• Secondary infertility: a pregnancy is obtained, but this
doesn’t end up with a
normal newborn after a normal pregnancy and delivery.
2. What is the infertility frequency?
Couples, with infertility problems, that wish a gestation, range between
15% and 17% although the absolute impossibility in succeeding it is situated
between 1% and 2% ON the whole.
3. Which are the main reasons?
There are several kinds of reasons: medical, psychical and immunitary,
as well as general and sociocultural.
Among the medical reasons we find ovarian (15-38%), tubal (20-35%), uterine
(5-10%) and cervical (3-30%) in the woman. Disorders at a testicular level,
include alterations in excretory viae because of duct obstruction, accessory
glandes pathology, ejaculation alterations, immunological caused alterations,
erection alterations and structural or functional defects of the spermatozoa
in the male.
Between 0,1% and 28% are psychical reasons (diseases or conflicts) that
alter the reproduction capacity affecting hypothalamus.
Isoinmunization, capacity of response before an extraneous body, creates
antibodies in 48% of the women, obstructing a good penetration of spermatozoa
in cervical mucus, restraining fecundation.
Among general causes we find: extreme obesity, anorexia nervosa, thyroid
alterations, drug or medicament abuses, alcohol, tobacco, lack of certain
vitamins, stress and bad coital technique
.
The most indicated sociocultural factor is making plans to have children
at a late age, seeing as the possibility of a pregnancy begins to decrease
after 35 years.
There is also a kind of sterility of unknown origin, where there is no
reason to be found after having studied the couple.
4. What is the suitable frequency of sexual relations
to obtain a gestation?
There is no adequate frequency, although it is established that the possibilities
of gestation increase during roughly the middle of the cycle, when ovulation
occurs. The best way to have sexual relations in the couple is by natural
frequency, since obsession with ovulation control might create counter-productive
anxiety for gestation.
5. When is it necessary to consult
a specialist?
Consulting a specialist is recommended when there is no gestation after
a year’s sexual relations.
6. Which tests are made at the
first consult?
At the first consult laboratory tests are made to reject pathologies that
might dissuade pregnancy, and to understand the immunitary state of the
patients to identify infectious diseases that could be transmitted to
the fetus.
These tests include a complete hemogram, group and Rh factor, biochemistry
and a hemostasia study. Serology, hepatitis markers, systematic urine
and uroculture if appropriate.
Semen analysis and capacitation test.
7. What is the usual treatment?
The kind of treatment depends on each patient and it is chosen after each
particular case study, always deciding the simplest solution applicable.
If we are talking about a painful process, it depends on the woman’s
sensibility bearing in mind the possible use of anesthesia.
8. How big is the risk of getting
a multiple pregnancy?
In accordance with the national rates a twin pregnancy is around 14% and
a triple is less than 3%.
9. How much does the treatment cost?
Economic investment depends on the kind of infertility and the treatment
to be used, such as the frequency of its application.
10. How long will it take to
obtain a pregnancy?
There is neither a certain time nor an established limit. It depends on
the woman’s age and the technique used, among other factors.
11. Is it dangerous to have more
than one treatment?
No.
12. Are drugs used in assisted
reproductive techniques dangerous?
After the achieved studies to verify side effects of used hormonal drugs
for ovarian stimulation, there has only been found two: excessive ovarian
response (as an exception) and multiple pregnancy (that increases to 12%).
13. Can the sex of the offspring
be chosen?
According to present Spanish legislation, genetic manipulation is only
permitted with authorised therapeutic purposes, which means that neither
sex nor any other genetic character can be chosen.
14. Does Spanish law permit single
women to have these treatments?
Yes.
15. Can characteristics of the donor be chosen?
The medical team chooses characteristics of the donor according to characteristics
of the beneficiary couple.
16. Are donation and reception
of ova or semen completely anonymous?
Yes, donation both of semen ova is absolutely anonymous.
17. Can disabled have children
by assisted reproductive techniques?
The couple, where one or both suffer from a disability, and in addition
there is an infertility problem, can benefit from assisted reproductive
techniques just like the rest of couples. A totally different situation
is produced when disability requires use of a technique to obtain gestation;
for example, a medullar injury in the male. In this case there are methods
to get semen that allow us to introduce it into the vagina. If semen is
altered, artificial insemination has to be done proceeding its positioning,
into the woman’s uterine after it has been prepared.
18. And seropositives?
The couples with discordance HIV who want to have a child can also benefit
from assisted reproductive techniques.
The following are the alternatives of available reproduction methods for
couples with discordance HIV:
• Artificial insemination of the woman with washed sperm
of her HIV infected
partner: this method involves introduction of the sperm
into the uterine, after
it has been washed to remove seminal plasma and non-spermatozoa
cells. After achieving a sequence of cleanings the semen
undergoes
analyses of PCR to reject presence of viral burden
• In vitro fertilisation with prepared semen of the HIV infected
partner
• Artificial insemination with donor’s semen
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