Infertility is a condition of the reproductive system that impairs the conception of children, and it effects.The diagnosis of infertility is usually given to couples who have been attempting to conceive for 1 year without success.
Generally,If a couple is infertile, this means that they have been unable to conceive a child after 12 months of regular sexual intercourse without birth control.

Many people may be infertile during their reproductive years. They may be unaware of this because they are not seeking to create a pregnancy. On any one occasion, the chance of pregnancy is just one percent.

Many people may be infertile during their reproductive years. They may be unaware of this because they are not seeking to create a pregnancy. On any one occasion, the chance of pregnancy is just one percent.
Conception and pregnancy are complicated processes that depend upon many factors: 1) the production of healthy sperm by the man, 2) healthy eggs produced by the woman; 3) unblocked fallopian tubes that allow the sperm to reach the egg; 4) the sperm's ability to fertilize the egg when they meet; 5) the ability of the fertilized egg (embryo) to become implanted in the woman's uterus; and 6) sufficient embryo quality.

Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.

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The natural conception
Where does the conception take place under natural conditions?
The natural conception takes place when the sperm cells, after intercourse, swim up through the neck of the uterus and into the uterine tubes where they meet the egg and fertilise it. After the fertilisation of the egg in the uterine tube the egg cleaves, and after a couple of days the fertilised egg has moved down though the uterine tube and into the uterus. In the uterus the egg adheres to the endometrium and develops into a baby. This process is illustrated below:

In order for this process to take place it is important that the woman produces mature eggs, has an ovulation, has passage through the uterine tubes, and that the man’s sperm quality is all right.

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The Causes of Infertility

Most infertility results from physical problems in a man or woman's reproductive system.The causes of infertility can more or less be divided into 3 equal parts. A female part, a male part and a third unexplained part.

Infertility can be caused by poor sexual or lifestyle habits that are easily remedied. For example, the couple may be using a sexual lubricant that interferes with the survival of the man's sperm. Or, they may not be having sex often enough. Other easily treated illnesses or lifestyle habits that may contribute to infertility are:

Heavy use of alcohol, tobacco or drugs.

Starvation diets or anorexia in the woman.

Tight underwear or pants in the man, which raises the crotch temperature and reduces sperm count.

Stress. In a woman, this may cause her periods to be irregular. In a man, stress may reduce his sperm count.

Most of these problems can be resolved with medical treatment or lifestyle changes, such as wearing boxer shorts, avoiding a sexual lubricant, or trying some simple stress reduction methods such as physical exercise or relaxation techniques.

Changing the timing of sex and the couple's sexual techniques may also increase the chance of pregnancy. Sometimes the semen from the man fails to reach the woman's cervix. Placing a pillow under the woman's hips after intercourse may help prevent spillage of semen.

Research shows that having sex every day or even several times each day both before and during ovulation is the best way to achieve pregnancy. The sperm count may be lower when sex is this frequent, but the constant release of semen may be more likely to fertilize the egg.

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The Female Reproductive System

The female reproduction system is, somewhat simplified, constructed through the interplay of three elements:
The hormonal interplay between the pituitary gland in the brain and the ovaries, where the eggs mature and the ovulation takes place.
The uterine tubes, where the egg is fertilised and transported to the uterus.
The uterus, where the fertilised egg adheres to the endometrium and becomes a pregnancy.
Illustrated is the normal functioning uterus:

The interplay of the hormones and their influence on the fertility
In the ovaries the egg is matured and fully developed prior to the ovulation. The egg is caught by the uterine tube, which leads the egg to the uterus. If the egg is fertilised, it will adhere to the endometrium in the uterus and further develop. See below:

This process is steered by the hormones. If you know something about the influence of the hormones, it will be easier to understand the examinations and treatments you are going through.

Most of the superior sex hormones are formed in the pituitary gland, which is a gland in the brain. The hormone is transported via the blood to its destination (the organ), where a reaction takes place and a signal is sent back to the pituitary gland. Illustrated below:

The individual hormones are briefly described:
GnRH-Gonadotropin releasing hormone. GnHR causes release of FSH and LH in the pituitary gland.

FSH (Follicle stimulating hormone) – is formed in the pituitary gland and stimulates the growth of the follicles, which mature the eggs.

LH-Luteinizing hormone – is formed in the pituitary gland and causes ovulation.

Prolactine is formed in the pituitary gland and is in interplay with the breasts and the ovaries. Prolactine causes growth of the mammary gland during pregnancy and stimulate the milk production after childbirth. A too high level of prolactine can restrain the ovulation.

Estradiol is formed in the ovaries. During a menstrual cycle estradiol causes growth of the en endometrium in uterus. A high level of estradiol in the middle of the cycle results in an increase of LH, which leads to ovulation.

Progesterone. During the menstruationprogesterone together with estradiol prepare the endometrium in uterus to receive the fertilised eggs. During a pregnancy progesterone restrains the contractions of the uterus.

Androgens are formed in the ovaries and stimulate growth of the hair and the sexual instinct. An overproduction of androgens restrains ovulation.

HCG (human chorion gonadotropin) is formed in the placenta and prevents that the follicles are destroyed during pregnancy. We analyse this hormone to find out if you are pregnant.

During the menstruation the ovaries contain several small follicles, each of them containing an egg. The pituitary gland releases the hormone FSH, which leads to development of one single follicle to be approximately 20 mm in size. When the follicle is mature, the ovulating hormone LH is released.

The hormones are interdependent, and for some hormones the rule is that an increase in one hormone results in a decrease in another.

Here you can see how the follicles and the hormones develops throughout a normal menstruation cycle:

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The Female Causes of Infertility

Women who have problems with maturation of the eggs and the ovulation can often be helped through medication. For some women irregular menstruation can be compared with a clock that is wrong. We set the clock right through medication, and the menstruation and the ovulation will become regular. Usually we combine the medical treatment with insemination (IUI) or in vitro fertilisation (IVF).

Here you can read more about:
Insemination (IUI)
In Vitro Fertilisation (IVF)

Tubal blockage
Some women have contracted or completely blocked uterine tubes. Other women have no uterine tubes, because they have been removed by an operation, for instance after an extra uterine pregnancy. If you have blocked uterine tubes, it can be difficult to become pregnant, as the egg is either destroyed in the uterine tube or will not be caught by the uterine tube and therefore disappear into the abdominal cavity. Similarly, it is difficult for the man’s sperm cells to penetrate the uterine tube, if it is contracted or completely blocked.

Therefore, you will not become pregnant.

There are several causes of tubal blockage. The woman can be born with a contacted passage, which might result in extra uterine pregnancies, and the uterine tubes are to be removed. Likewise, inflammation of the internal female organs, for instance because of a chlamydia infection, an abdominal operation, or endometriosis can lead to adhesions of the uterine tubes. Operations in uterus can also damage the function of the uterine tubes.

If your problem is tubal blockage, you can still become pregnant, but it will not happen through natural fertilisation. In case of tubal blockage the treatment will be in vitro fertilisation, where the egg is fertilised outside the uterus in a laboratory, after which the fertilised egg will be transferred into the uterus for normal growth.

Here you can read more about:
In Vitro Fertilisation (IVF)

PCO
PCO means Polycystic Ovary. PCO is a disease that affects every 7th woman, the extent being varying. PCO is the most frequent cause of lacking or disturbed ovulation.

PCO means that you have an abnormal high number of follicles, which disturb your ovulation. In a normal cycle one egg overtakes the other eggs during the maturation and this leads to ovulation of one single egg. In PCO patients the follicles mature at the same pace, this causes the process to stop and ovulation will not take place.

Women with PCO have a higher level of male sex hormones, and other symptoms like hirsutism and acne are often seen in PCO patients. A tendency to obesity, where the fat is centred on the abdomen is also seen. Some women have no noticeable symptoms of PCO.

There are various degrees of PCO and degrees of PCO symptoms. The degree of PCO therefore influences the chosen individual treatment. Typically, it is a combination of medical treatment, which induces maturation of the egg and then ovulation. The choice could be to combine the medical treatment with either insemination (IUI) or in vitro fertilisation (IVF).

If you have PCO and are overweight, we recommend you to loose weight, as the fat transforms male hormones, which will destroy the maturation of the egg. If you are a PCO patient and overweight, we can help you to loose weight in our PCO clinic together with other PCO patients.

Here you can read more about:
PCO (paper)
Insemination (IUI)
In Vitro Fertilisation (IVF)

Endometriosis
Endometriosis can be a painful, chronic and mysterious disease. We believe that it affects 2-4% of all women.

Endometriosis arises when part of the endometrium also is present in the abdominal cavity outside the uterus. Usually the endometrial tissue occurs in the abdomen, on the ovaries and on the uterine tubes. This tissue is influenced by the hormones like in the endometrium and grows towards the menstruation. Unlike the endometrium the endometrial tissue cannot get rid of the bleeding and instead of disappearing through the uterus the blood runs into the abdominal cavity. This results in a form of infection and cysts of blood in the abdominal cavity and can be very painful.

Symptoms of endometriosis are typically:

It is still unclear what causes endometriosis, but the disease is thought to be hereditable.

Since there are various degrees of endometriosis and since endometriosis occurs on different places from woman to woman, it is an individual evaluation to find the best treatment. A successful treatment in one woman might not be the right treatment for another. Endometriosis can be treated medically and/or through a laparoscopy. A laparoscopy is a minor surgical procedure, where part of the endometrial tissue is removed. A laparoscopy is performed in hospital and in full anesthesia.
Here you can read more about:
Laparoscopy

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The Male Reproductive System

The normal sperm production
The sperm cells are produced in the testicles. At the ejaculation the sperm cells run through the epididymis, here the sperm cells are mixed with liquid from the prostate and the seminal vesicle and are then ejected through the urethra. One single ejaculation normally contains approx. 4 millilitre yellow-white thick liquid. This liquid is called the sperm or the semen. Normally, one ml semen will contain approx. 50 millions sperm cells.

The quantity of semen does not necessarily tell anything about the quality of the sperm cells. A man with a large quantity of semen might have a poor sperm quality, and vice versa a man with a small quantity of semen might have a good sperm quality. The quantity of semen can vary between 2 to 8 millilitre and is still considered normal.

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Male causes of infertility

Male causes of infertility are usually poor sperm quality.
Poor sperm quality can be caused by:

Lacking sperm production in the testicles
Non-descended testicles
Infections
Fewer
Testicle cancer
Antibodies in the sperm cells

Lacking sperm production in the testicles
Lacking sperm production in the testicles is the most frequent cause of poor sperm quality. Usually the man has no symptoms of his poor sperm quality, besides from being infertile. On closer examination we often notice that the testicles are somewhat smaller than normal in these men, and that the superior sex hormone FSH has an increased level. If you have a too low FSH level, a series of hormone injections will restore the sperm quality.

We do not know any treatment that will restore a normal production of sperm cells when the harm is done. We know very little about why some men have a poor sperm quality. One theory is that the man has a defect in the Y-chromosome; another theory is factors in the environment.

If you work with for instance crop sprays or heavy metals this can affect your sperm quality. If you work within such areas and you have a poor sperm quality, it is advisable to avoid crop sprays and heavy metals.

Non-descended testicles
If boy children’s testicles are not descended to the scrotum at birth, these boys run the risk of having poor sperm quality later in life. This condition should be treated as early as possible, because the more years the testicles have been exposed to an increased temperature, the bigger the chance of poor sperm quality.

Infections
Infections like chlamydia or gonorrhoea can result in a stop of the passage for the sperm cells in the epididymis or the sperm duct. Mumps in grown-up men can lead to sterility because the sperm producing tissue is destroyed. In some cases the sterility can be solved through an operation or through extraction of the sperm cells directly from the epididymis or from the testicle.

Fever
Even shorter periods of high fever can reduce the sperm quality in men for up to three months. Similarly, very long and frequent visits to a sauna can reduce the quantity of sperm cells because of the effect of the heat.

Testicle cancer
Men with testicle cancer will often have, or get, reduced sperm quality after irradiation or chemotherapy. For some it will only be for a period of time, whereas other men never will restore their sperm quality. It is therefore important that men with testicle cancer carefully consider having sperm cells frozen prior to irradiation or chemotherapy.

Antibodies in the sperm cells
Some men produce antibodies in the semen, which makes the sperm cells clot. We do not always know why the man produces antibodies, in some cases it is because the man has been sterilised and the sperm ducts have been cut. If you have been sterilised and want to have the sperm ducts restored, some men will remain infertile, as antibodies against the sperm cells have been produced during the period of sterilisation.

About the treatments available
There are various forms of treatment, depending on how poor the man’s sperm quality is. At moderately reduced sperm quality insemination (IUI) is often used. At reduced sperm quality in vitro fertilisation is used. At very reduced sperm quality Micro insemination (ICSI) can be used. If there are no sperm cells in the man’s semen, the sperm cells can be extracted directly from the epididymis – this procedure is called TESA.Finally, some couples choose to make use of sperm donation.

Here you can read more about the treatments:
Insemination (IUI)
In Vitro Fertilisation (IVF)
Micro insemination (ICSI)

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