The infertility assessment of a heterosexual couple allows the medical team to define the modalities of appropriate care: medical treatment or surgical treatment, accompanied, if necessary, by a change in lifestyle: cessation of tobacco, weight loss… Medically assisted procreation (MAP) may be necessary.
ADVICE GIVEN TO THE COUPLE IN CASE OF INFERTILITY
The assessment of the decline in fertility of the heterosexual couple is essential. It is analyzed by a team of doctors. It makes it possible to evaluate the desired time frame for treatment, the chances of natural conception and offers infertility treatment, adapted to the couple.
In the absence of anomalies noted during the assessment, the goal is to reassure the couple and de-dramatize the situation.
In the event of abnormalities in the fertility assessment and whatever the therapeutic project, the doctor proposes, if necessary, a better lifestyle.
Stop smoking and stop taking drugs, if necessary
Smoking cessation for women is desirable because tobacco decreases natural fertility and has a negative effect in the case of IVF (in vitro fertilization). Likewise, weaning smoking is recommended in men before any ART (medically assisted procreation).
Stopping taking drugs: cannabis, heroin, cocaine, hallucinogens is essential.
Achieve or maintain a healthy weight
- Weight loss in the event of obesity: obesity decreases the chances of pregnancy, alters the results of in vitro fertilization, and increases the risk of complications during pregnancy.
- The return to a normal weight in case of excessive thinness in women.
Have sexual intercourse at an appropriate frequency
A frequency of every other day during the fertile window ensures the best chance of fertility. Daily intercourse does not increase the chances of conception.
Adopt a healthy diet
It is recommended that the woman adopt a balanced diet and reduce her consumption of coffee (or caffeine equivalent provided by other beverages) if the consumption is greater than 5–6 cups per day (especially if combined with tobacco use).
Have daily physical activity in a healthy environment
- The woman should avoid intense physical exercise but can maintain regular physical activity.
- For men: it is recommended to avoid wearing too tight pants that compress the testicles causing an increase in testicular temperature harmful to the production of spermatozoa.
- It is recommended to avoid exposure to pesticides and organochlorine pollutants.
MEDICAL TREATMENT FOR INFERTILITY
The medical treatment takes care of a disease that may have been responsible for a decline in fertility ( STI for example) as well as disorders of ovulation.
Ovarian induction or ovarian stimulation treatment is used in cases of ovulation disorders (for example in polycystic ovary syndrome ). It consists of inducing ovulation with medication. In practice, taking a drug, such as clomiphene citrate, stimulates and triggers ovulation. The risks of multiple pregnancies and prematurity are increased after ovarian stimulation.
In the presence of a fibroid of the uterus, embolization of the uterine arteries can be proposed.
SURGICAL TREATMENT IN CASE OF INFERTILITY
It is considered when the decline in fertility is due to an “operable” cause:
- uterine fibroid (myomectomy),
- malformation of the uterus,
- obstruction of a fallopian tube,
- ovarian surgery by “drilling” in the event of polycystic ovary syndrome. It consists of making micro-perforations in the superficial layer of the ovaries to obtain normal ovulation and spontaneous pregnancies. This type of surgery allows ovulation to be restored in approximately 50% of cases,
- varicocele(dilation of a vein at the level of a testicle)…
RECOURSE TO MEDICALLY ASSISTED PROCREATION (MAP) OR MEDICALLY ASSISTED PROCREATION (PMA)
In the event of failure of the medical or surgical treatments undertaken or immediately in certain situations of infertility, medically assisted procreation (or medically assisted procreation) is offered.