Infertility Awareness Month: Why don’t I get pregnant?

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June is World Infertility Awareness Month, an initiative whose aim is to publicise as widely as possible the essential information that we should all be aware of in order to be able to successfully plan our motherhood and fatherhood.

The most common situation in our consultations is that of couples who have been trying to have a child for more than a year without success. The degree of fertility of each person is individual and conditions the ability to achieve pregnancy. After a year of trying, only half of them succeed, and one in five will succeed with medical help. In addition to the degree of fertility, there are determining factors that we should all take into account if we are thinking of trying to get pregnant:

The age of our eggs does not correspond to the age on our ID cards 

According to data from the National Statistics Institute (INE), Spain has one of the lowest birth rates in the world and, moreover, Spanish women are having their first child later and later.

The delay in the age of motherhood makes it necessary to carry out an accurate assessment of ovarian reserve, since at 35 years of age only 10% of eggs are left and the fewer eggs are left, the poorer their quality. Female fertility declines with age, most noticeably in the 10 to 15 years before menopause, with a decrease in the quantity and quality of eggs. Many women discover this too late.

Knowing their real ovarian age, women can decide whether they want to become mothers earlier, vitrify their eggs or assume that, if they want to become mothers in the future, they will need to undergo assisted reproduction treatment with donor eggs.

A simple blood test will reveal our ovarian reserve: the levels of anti-Müllerian hormone (AMH) are analysed and compared with those established as normal for each age. Institut Marquès has carried out a revision of the AMH comparative tables, updating the parameters for European women. Women who are interested in finding out their real ovarian age first hand can access these tables themselves.

The importance of the male factor

In 6 out of 10 couples who resort to fertility treatments to become parents, the semen presents alterations to a greater or lesser degree and male infertility is associated with more than 50% of cases of conjugal infertility.

Institut Marquès has been a pioneer in the study of the quality of Spanish men’s sperm, demystifying the causes that are classically attributed to this problem (stress, alcohol or tight trousers, for example) and demonstrating that chemical toxins are the real causes of poor semen quality. These toxins affect the development of the testes in foetuses when a woman is pregnant. The level of exposure varies greatly depending on the geographical area and is much greater in industrialised areas.

Fortunately, assisted reproduction offers us different techniques that can help us to overcome the male factor. At Institut Marquès we have a unit specialised in Andrology that supervises each treatment.

Genetic factors and assisted reproduction

Genetics plays an essential role when we are looking for a pregnancy. Firstly, as time goes by, especially from the age of 37 onwards, the risk of the eggs having chromosomal abnormalities increases significantly. From the age of 40 onwards, there is little chance of achieving a successful IVF pregnancy with your own eggs.

In patients with infertility issues caused by their age, a genetic analysis of their embryos is recommended after undergoing In Vitro Fertilisation. The Preimplantation Genetic Test (PGT) is also particularly recommended in cases of recurrent miscarriages, repeated failures in IVF cycles or in cases with a male factor. This genetic analysis of the embryos allows us to select and transfer to the mother’s uterus those that do not present any chromosomal abnormalities.

To carry out the PGT, an embryo biopsy is performed. In the case of embryos at blastocyst stage, it means that we must freeze them to wait for the result of the test. At Institut Marquès we also offer the PGT Express, which allows the biopsy and analysis of all the chromosomes when the embryo is three days old. This way, it is possible to transfer it fresh only two days later (without freezing it), when it reaches the blastocyst stage.

Other indications for genetic testing of embryos are patients with an altered karyotype (PGT-SR) or patients with genetic diseases (PGT-M) who want to have children, avoiding the birth of an affected child.

Endometriosis and fertility

Endometriosis can lead to alterations in the reproductive function and impair the fertility of the woman who suffers from it. It is the cause of infertility in 25% of our patients. The mechanisms by which endometriosis causes infertility are controversial and depend, to some extent, on the severity of the disease.

Endometriosis occurs when cells from the endometrial tissue, which lines the uterine cavity, grow outside the uterus and develop in other organs. This tissue can rupture and cause bleeding, most commonly affecting the ovaries, fallopian tubes and bowel. It is a benign chronic disease that can, in some cases and at certain times, be very painful. Treatment with contraceptives or hormones that interrupt the menstrual period can slow down the progression and alleviate the symptoms of the disease.

Whenever possible, avoiding surgery helps to preserve ovarian function and fertility in patients with endometriosis. However, if it is essential to opt for this option, it should be remembered that, even in expert hands, surgery reduces ovarian reserve. For this reason, it is recommended that women who want to become mothers consider the possibility of vitrifying oocytes before proceeding with this type of intervention.