Infertility

Infertility is the diminished ability of a couple to conceive a child over a period of time, whether due to a known cause or not. There are two types of infertility:

• Primary infertility – when someone who never conceived a child in the past has difficulty conceiving.
• Secondary infertility – when someone has had a pregnancy/pregnancies in the past but is having difficulty conceiving again.

What causes infertility in a typical female anatomy and physiology?

• Ovarian dysfunction (e.g. Polycystic ovaries).
• Tubal disease (commonly caused by Gonorrhea, chlamydia or any pelvic infection, e.g. appendicitis or diverticulitis).
• Endometriosis – causes scarring, intra-abdominal inflammation and blockage of the tube.
• Age-related changes – decline in quality and quality of oocytes (egg cells).
• Uterine abnormalities – e.g. congenital (from birth), acquired (uterine fibroid).
• Cervical abnormalities – the quality of cervical mucus is important for sperm penetration and maturation.

What causes infertility male anatomy and physiology?

• Abnormal semen parameters – abnormal sperm production and maturation are caused by low testosterone levels, obesity, and endocrine diseases. Numerous other factors influence sperm production and maturation, including alcohol abuse, smoking, drugs, and toxins.
• Ejaculatory Duct obstruction – causes impairment of sperm transport. This can be due to complication from surgery or infections.
• Erectile dysfunction – may be due to vascular, metabolic, or psychological problems.
• Loss of desire, with a consequent decrease in sexual activity.

Other risk factors for all genders include:

• Alcohol intake.
• High levels of stress.
• Sexually transmitted infections.
• Smoking (including passive smoking).
• Environmental factors such as exposure to certain pesticides, solvents, and metals.

Treatment depends on the underlying cause and includes:

• Medical treatment for lack of regular ovulation.
• Surgical procedures for endometriosis, repair of the Fallopian tubes, or removal of scarring (adhesions) within the womb or abdominal cavity.
• Assisted conception such as intrauterine insemination (IUI) or in vitro fertilisation (IVF).

Trans men who still have a uterus can still become pregnant although they may need to stop taking cross-gender hormones for a time.

A number of intersex variations may also lead to infertility.

In-Vitro Fertilisation (IVF)

What is IVF?
In vitro-fertilisation is a complex series of procedures used to help sperm fertilize an egg and help the fertilized egg implant in the uterus.

Why is it done?
IVF (In vitro fertilisation) is an assisted reproductive technology (ART) to help people with fertility problems and give a chance to have a baby.

What happens during IVF?
During the process of IVF, an egg is taken surgically from the ovaries and this is then fertilised in a laboratory with sperm. This fertilised egg is now called an embryo and is then placed in the womb to grow and develop.

Unfortunately, IVF does not always result in pregnancy, and in some cases may result in a multiple pregnancy (pregnant with more than one child). Apart from that, it is also physically, financially and emotionally demanding. Those considering and undergoing IVF are assisted by counselling sessions.

There are certain guidelines, that restrict who is eligible for IVF, and these include the egg donor's age. IVF is not recommended for egg donors in their forties, although it depends on their health, because the chances of a successful pregnancy are not that encouraging. Younger individuals are more likely to have healthier eggs, thereby increasing the chances of success.

IVF can lead to some complications in both the carrier and unborn child. There is an increased risk of stillbirth, neonatal death and disability in children born. There is also a higher chance of a late miscarriage, high blood pressure and pre-eclampsia in the pregnant individual.

Click here for additional information on Assisted Reproductive Therapy (ART) Services in Malta.