Every fifth couple in the world are looking forward to having a baby. It is estimated that in Poland the problem of infertility affects over a million couples. Often the only chance of getting pregnant and having a baby for them is the so-called artificial insemination, i.e. the in vitro method.
A little over 2,000 annually married couples in Poland decide to undergo the procedurein vitro(in vitro fertilization). There are many reasons for this. Sometimes these are religious beliefs because the Catholic Church is against the use of assisted reproductive techniques. It is also often ignorance. GPs, especially in small towns, do not tell their patients that despiteinfertilitythey may have a chance of having a baby. Those, left on their own, give up having children or start wandering around 18 centers that carry out such procedures in Poland. Not knowing which are the best for them, they waste time, patience and money. Most often, however, couples do not decide to undergo the procedureartificial inseminationdue to lack of financial resources.
Treatment of infertility using in vitro method - at your own expense
WHO has recognized infertility as a social disease. In many European countries, assisted reproductive methods are subsidized or fully reimbursed. In Poland, we have to pay almost everything from our own pocket - for drugs, tests, visits and the entire procedure. This gives the sum of approx. 9 thousand. PLN, but the costs are usually higher, because the first attempt is often unsuccessful. And the procedure must be repeated, sometimes several times. You pay in private and state institutions, slightly less in the latter.
Desperate prospective parents often take out loans in order to have a child. They feel cheated by the state because they pay taxes, insurance premiums and get nothing in return. Resentful people write on the internet forum that their money covers the costs of treating diseases "at their own request", such as lung cancer in heavy smokers or liver cancer in alcoholics, and that no one cares about their disease without fault.
Where does infertility come from
Infertility is said to occur when a couple has sex with each other two or three times a week without any protection, and yet the woman does not get pregnant within a year. Doctors estimate that approx. 30 percent. the causes of the problemswith fertility is on the side of the woman and so much on the side of the man. In approx. 30 percent. cases are said to be marital infertility (the "fault" lies on both sides) and in 10-14 percent. cases cannot be explained as a cause of infertility.
A woman's fertility decreases with age, because with time, there are more and more cycles of non-ovulation. In turn, in men, the condition of semen deteriorates (reported by WHO). There is less and less sperm in the ejaculate, and moreover, they are of lower quality, less mobile, viable, with defects in structure.
Causes of infertility
At the woman
- ovulation disorders or anovulation (including polycystic ovary syndrome and other endocrine disorders),
- obstruction of the fallopian tubes,
- endometriosis,
- congenital or acquired defects of the reproductive organ (e.g. intrauterine adhesions, fibroids),
- immunological disorders (including cervical mucus hostile to sperm, presence of antibodies hindering fertilization and implantation of the embryo),
- embryo hostile endometrium,
- taking medications that disrupt the menstrual cycle.
At the man
- varicose veins,
- reproductive and systemic infections (e.g. mumps in boys),
- cryptorchidism (no testicles in the scrotum),
- twist of the testicle around the spermatic cord,
- testicular injuries, overheating of the scrotum,
- obstruction of the sperm exit route,
- hormonal disorders,
- retrograde ejaculation (semen travels to the bladder),
- chemo- and radiotherapy, taking certain medications,
- environmental impact (e.g. contact with heavy metals).
Secondary infertility
A woman who has already given birth may have problems getting pregnant again. This is the case, for example, because:
- is older;
- postpartum inflammation or surgery caused adhesions in the reproductive organ;
- after delivery, which was accompanied by profuse bleeding, the hormonal balance was disturbed;
- my husband's sperm count decreased and his sperm quality decreased (because he has a harmful job).
It could also be that the first child was simply a couple - they both have a genetic defect that makes it impossible to keep the pregnancy, but it manifests itself in 25 percent. offspring and in her first pregnancy she might not have made herself known. Genetic problems can also be suspected if a woman gave birth to her first child and then miscarried several times in a row.
The causes of infertility may be seemingly trivial
Rarely, but it happens that the couple do not go out, e.g. they cannot calculate the fertile days, becauseadheres to the principle of abstinence (the less we love each other, the better the quality of the seed ?!). Then a matter-of-fact conversation with the doctor is enough and the woman usually becomes pregnant.
The reason for problems with conception is also … the psyche. Constant stress, depression - possibly caused by repeated unsuccessful attempts to get pregnant - disrupt the secretion of hormones that control the work of the ovaries and testes. Doctors estimate that psychotherapy has a positive effect in about 1/3 of cases of marital infertility. However, only 6-15 percent of them have such problems. couples attending fertility clinics. The rest must be tested. There are a lot of them, but you don't always have to go through all of them.
Infertility diagnosis
At the fertility clinic, the man is examined first. For the simple reason - it requires less research. The potential dad has a semen quality test, and if necessary, a blood laboratory test, a blood hormone check, an ultrasound scan, and a karyotype (chromosome set). Sometimes a test is also performed for the presence of antibodies that attack your own sperm. When there is no sperm in the semen, a testicular biopsy is performed.
The potential mom has more research and is more complicated. This starts with a gynecological examination, general he alth assessment, and blood analyzes. It is checked if a woman is ovulating and when. The doctor also orders to check the level of hormones on individual days of the cycle and transvaginal ultrasound. He can also refer you to other tests. Hysterosalpingography is an assessment of the shape of the uterus and the patency of the fallopian tubes based on X-rays. Similar information is provided by hysterosalpingosonography performed with the use of ultrasound. Laparoscopy is the assessment of the uterus, ovaries and fallopian tubes using a laparoscope inserted into the abdominal cavity.
Infertility treatment - insemination
If these tests do not reveal any irregularities, the partners undergo the so-called postcoital test. It involves examining the cervical mucus a few hours after intercourse. It may turn out to be a barrier to sperm cells. Then the couple can benefit from intrauterine insemination. The indications for this treatment are also reduced sperm parameters. It is also used when using frozen sperm from a donor or a partner, if the cause of infertility cannot be established or the partners cannot have sex, for example due to disability.
The condition for insemination is the patency of the fallopian tubes. The couple must also pass bacteriological and virological tests (HIV, hepatitis B and C, WR).
Before the procedure itself, you need to abstain for 2 or 4 days. Later, while the woman is ovulating, her partnerafter masturbation, he gives his semen to a sterile container.
Before insemination, semen is cleaned and subjected to a special treatment, thanks to which its parameters are improved.
Using a special catheter and a syringe, they are administered directly into the uterus. From there, the sperm travels to the bulb of the fallopian tube, where the egg is fertilized. The chance of getting pregnant the first time is 5-19 percent.
Treatment of in vitro (IVF) infertility
This method of fertilization is referred to as "in vitro", which means "in glass". It is used when a woman has no fallopian tubes or they are blocked; when ovulation is disturbed and the Graafian follicles do not come out of mature eggs; in severe, uncontrolled cases of polycystic ovary syndrome or endometriosis. IVF is also used when a man's semen has little motile sperm and it is impossible to perform intrauterine insemination. Doctors also recommend this technique to couples who have been looking forward to having a baby for several years and it is difficult to determine the cause of it.
First, a woman needs to undergo hormonal stimulation of the ovaries - she usually gets hormone injections. When the ova are mature, the doctor performs a puncture (puncture with a special needle on the Graaf vesicles) by entering the vaginal vault. The procedure is performed under ultrasound control, usually under general anesthesia. As many eggs usually mature during hormonal stimulation, the doctor usually collects several to a dozen eggs at a time. They go to a special nutrient fluid. The partner's sperm is then added to them. After approx. 18 hours, the doctor checks whether fertilization has taken place or not. Most often from 60 to 80 percent. the eggs are fertilized by sperm.
48-72 hours after puncture, when the embryos are divided into 2-8 blastomeres (cells), they are administered directly into the uterine cavity using a catheter. In younger women, without a burdensome medical history, the doctor inserts 1-2 embryos into the uterus. The older ones and those who have failed in vitro fertilization cycles - 3. The point is to increase the probability of an embryo implanting in the uterus. It happens that all the embryos will accept and twins (18%) or triplets (4%) will be born.
The remaining embryos are frozen in liquid nitrogen to be used if the first IVF test fails success (it is 20-40% successful).
Thanks to the IVF method in the USA, 10,000 births are born each year. children, in Western Europe - approx. 8 thousand. Our first IVF girl was born in 1987 at the InstituteObstetrics and Women's Diseases, Medical University of Bialystok. Since then, just over 2,000 were born in Poland. test-tube children.
Infertility treatment - micromanipulation
In other words, intracytoplasmic injection (ICSI) is used when the causes of infertility are reduced sperm parameters or a small number or questionable quality of ova collected during puncture.
If sperm production is retained in the testicle but semen is absent (e.g. obstructed vas deferens, retrograde ejaculation into the bladder), sometimes a testicular or epididymal biopsy may need to be performed to obtain sperm. It is done under general anesthesia. Sometimes the collected material is searched in the laboratory for a long time to finally extract the best sperm (sometimes it is possible to select only one).
The ICSI method consists in introducing a single sperm into the collected egg with a micropipette. It is introduced by piercing the transparent sheath into the cytoplasm of the ovum. The rest is the same as in the in vitro method. The effectiveness of ICSI is estimated at 30-90 percent.
Pregnancy after IVF
About two weeks after the embryos are brought into the uterus, a woman should have a blood test to find out if she is pregnant. However, this test does not always predict normal pregnancy development. In order to increase the chance of embryos implantation and the proper course of pregnancy - even before giving the embryos and for the first three months after conception, a woman must receive supportive drugs.
Pregnant women who undergo artificial insemination, usually give birth at term. Sometimes, especially with the so-called multiple pregnancy that they give birth earlier. Some decide to have a caesarean section.
Semen banks
When the male does not produce sperm or it is not able to fertilize the egg (even during micromanipulation) or is the carrier of a genetic defect that causes, for example, infertility or miscarriage in a partner, or if there is a high probability of transmitting the defect to the offspring - a couple can use semen deposited in a special bank (there are three in Poland).
Sperm donors are required to be up to 35 years old, not to use stimulants (cigarettes, alcohol, drugs), have their own children, be he althy, have at least secondary education and have a nice appearance. It undergoes comprehensive testing (including sexually transmitted diseases).
Note!
- Following a miscarriage, a couple should wait three to six months before trying to conceive again. A woman's body must have time to recover.
- A couple who already haschildren from the in vitro fertilization cycle, may give up the rest of the frozen embryos and donate them to another infertile couple.
How much does infertility treatment cost?
In state clinics
- Insemination - PLN 400 + medications
- in vitro fertilization
- 1 cycle: 2.5-3.5 thousand PLN + medications (PLN 2-3 thousand)
- intracytoplasmic injection
- 1 cycle: 3-4 thousand PLN + medications (PLN 2-3 thousand)
In private clinics
- insemination - PLN 700-900
- in vitro fertilization
- 1 cycle: 4.5-6.5 thousand PLN
- intracytoplasmic injection
- 1 cycle: 5.5-7.5 thousand PLN
"Zdrowie" monthly