The Numbers of Infertility

“Dear Doctor, I would like to know more about infertility. What are the main causes? Is it usually a woman’s or a man’s problem?“

“Good morning. Thank you for your contact.

Did you know that about 15% of Portuguese couples find it difficult to get pregnant? About 35% of the infertility cases are related to a female factor. Another 35% are male factors. About 20% are a combination of both female and male factors. In 10% of the cases the reason for infertility cannot be determined (unexplained infertility).

If you think you might have an infertility issue, you should seek medical advice, and perform simple tests and exams. If necessary, you will be referred to a specialized centre, where you can be advised of the best solution for your case. The best help for the infertile couple lies in the correct diagnosis of the cause of infertility and the choice of appropriate therapeutic alternatives.

Kind regards,
Paulo Vasco”

Egg Donation

“Good morning doctor. I am 29 years old and I’ve never been a mother. I would really like to be an egg donor. Is it possible to donate my eggs in your clinic? Do I need to have any special features?”

“Good morning. Thank you for your contact. To put it simply: yes, it is possible to be an egg donor at AVA Clinic. 29 Years old is a great age to donate eggs regardless of your physical characteristics, blood group or any other features. However, we do need to check if you are in good physical and psychological conditions so you can donate without any risks to you and to your recipients. These assessments will be done in a consultation by fertility specialists.

If you have any other questions regarding the donation process at our unit we suggest that you contact us directly without a commitment whatsoever.

Kind regards,
Paulo Vasco”

Early Menopause

“Good morning Dr. Paulo. I am now 40 years old and after several fertility treatments and a failed IVF treatment I was told I was going through early menopause and that the probability of collecting “good” eggs for IVF was as low as 1%.

My question is: can I resort to egg donation? And what are the success rates for cases like mine?”

“Good morning. Thank you for your contact.

Indeed, in the menopause the quality and the number of eggs is no longer sufficient to achieve a desired pregnancy. However, egg donation can make it possible. The success rates are usually high, ranging between 50 to 60% of positive pregnancy tests. Nevertheless, in order for a pregnancy to occur and progress to term, first we would have to guarantee that you are in perfect health and that your womb is receptive. Therefore, a careful clinical evaluation is always essential.

At AVA Clinic you will find all the conditions to do this evaluation and the egg donation treatment. I would suggest you book a consultation if you need any further clarification regarding this treatment. However previous tests and exams that you might have done are important. So we would ask you to bring them with you, as well as reports of the treatments you have done in the past.

Best Regards,
Paulo Vasco”

Post Vasectomy Pregnancy

“Good morning Dr. Paulo, I recently married my current partner who already has a son from another relationship. He later decided to have a vasectomy. Is there still a chance to reverse this situation and get pregnant with his sperm?”

“Good morning. Thank you for your contact.

It is indeed possible to reverse a vasectomy. However, there are limitations to the technique and depends greatly on how the vasectomy was done. Therefore, you should consult the urologist who performed the intervention. If the reversion is not feasible, it might still be possible to achieve a pregnancy with the help of assisted reproduction techniques, specifically with in vitro fertilization (with sperm microinjection) and a testicular biopsy.

Best Regards,
Paulo Vasco”

Pregnancy after 40

“Good morning Dr. Paulo. I recently turned 40 years old. Is it still possible to get pregnant with my own eggs or will I have to resort to egg donation?”

“Good morning. The answer is yes. A woman is fertile from the moment she begins to have a menses at puberty until she reaches the menopause (usually between the age of 45-55). The ability of a woman to conceive varies throughout her life, and is influenced mainly by her age. For example, the fertility potential of a woman between 26-32 years of age is around 20% per menstrual cycle, but at 45 a woman’s fertile capacity will be close to 0%. In addition to age, there are other situations that lead to a marked decrease in the number of eggs and prevent pregnancy. For instance; cancer, extensive surgery and/or exposure to toxic medicine or radiation. These can cause a major or definitive decrease in the number and quality of the eggs.

Most women still have a fair amount of eggs at 40. However, getting pregnant is more difficult because the quality and quantity of eggs is decreasing. Also the chances of errors occurring in fertilization and embryo development are higher, lowering the chances of pregnancy and increasing the chances for spontaneous miscarriages. You should therefore make an assessment of your gynaecological and reproductive health as soon as possible and not delay for too long a pregnancy.

Best Regards,
Paulo Vasco“

Endometriosis

“Dear Dr. Paulo, I was recently diagnosed with endometriosis on my last gynaecological consult. I wonder if this disorder can influence my fertility?”

“Good morning. Thank you so much for your contact.

Endometriosis is a disorder that is characterized by the appearance of tissue, similar to the tissue that normally lines on the inside of your uterus (the endometrium), outside of your uterus. Most commonly it affects the fallopian tubes, ovaries, peritoneum, bowel and bladder. When found in the ovaries, it forms cysts filled with stagnant blood, called endometriomas. These focal points of endometrium that grow outside of the womb, behave in a similar way to that of the endometrium that lines the inside of the uterus. It thickens throughout the menstrual cycle and bleeds during the menstruation period, inducing intense bleeding and pain in the organs where it is allocated.

The causes of endometriosis are unknown, but there seems to be some kind of relation with retrograde menstruation (when blood flows backwards into the pelvis instead of out of the vagina during menstruation). Immunological and psychological factors can also be related and there seems to be some family predisposition, due to the higher rates seen between sisters and mothers. And finally, to answer your question: endometriosis is one of the main causes of pelvic pain and indeed also female infertility. Up to 10-15% of women in reproductive age are diagnosed with endometriosis, and around 30 % of these cases will experience infertility caused by this disorder.

Best Regards,
Paulo Vasco”

Recurrent Miscarriages

“Good morning Dr. Paulo. I am 41 years old and I had a child 20 years ago. Me and my partner have been trying to increase the family for a while but always without success. Since we started trying I’ve had three miscarriages. Why do you think it’s difficult to fall pregnant?”

“Good morning and thank you for your contact.

Miscarriage is a frequent complication and it is mostly associated with malformations of the embryo. Although there are many causes for this problem, recurrent miscarriages are strongly associated with women’s age. At 41 the risk is indeed very high, which can explain the difficulty in taking the pregnancies to term.

Something that could increase your chances of getting pregnant is IVF. A treatment where fertilization is observed in a lab and embryo development is followed for a few days, allowing us to choose the most appropriate embryos to be transferred. Albeit being a solution you should be aware that even if you resort to IVF the success rates at 41 years old are only around 15%.

Best Regards,
Paulo Vasco”

Tubal Ligation

“Good afternoon,  I got my tubes tied about four years ago when I had surgery for a cyst. Now I would really like to be a mother again. Is it possible? Thank you.”

“Good afternoon and thank you so much for your contact,

With the little information you provide in your e-mail, the answer to your question is somewhat difficult. Nevertheless, I can assure you that there are two technical solutions to become pregnant after a tubal ligation:

1. The Tubal Ligation Reversal –  which is a complicated surgery with relatively low success rate.

2. In Vitro Fertilization (IVF) –  easier solution and with higher success rates.

However, in order to determine if all the conditions are met to achieve a pregnancy, a careful evaluation of the couple’s fertility is necessary. This is only possible in a medical consultation assessment and often with the support of clinical exams and tests. I therefore suggest that you book a consultation with a fertility specialist before taking the next step.

Kind regards,
Paulo Vasco“

Uterine Fibroids

“Good morning doctor. I am 26 and recently found out that I have uterine fibroids. I am now afraid that I won’t be able to have kids. What would you advise me to do regarding this problem? Thank you.”

“Good afternoon. Thank you for your contact.

Uterine fibroids are the most frequent uterine pathology, and can be the cause of pain; recurrent miscarriages and infertility. Some more aggressive forms can culminate in the definitive disability to procreate and even lead to a need for uterus ablation. Uterine fibroids are muscle nodules, resulting from the autonomous growth of a group of muscle fibres that evolve a grow. They can be just one or multiple; they can have fast or slow growth; they can reach large dimensions or not; they can appear in other organs where muscle fibres exist. There is no age at which they are more frequent and their growth is influenced by female hormones and there seems to be a family pattern which points to the existence of a genetic factor, although food and environmental reasons have also been highlighted.

So to answer your question, the existence of a fibroid itself does not mean you will not be able to conceive. Nevertheless, it is something that should be monitored, so it’s development can be controlled and eventually taken care of. I therefore suggest consulting an expert for the correct evaluation of your problem.

Kind regards,
Paulo Vasco“

Twin Pregnancy

“Good morning.I would like to know more about IVF. I wish to have twins. Is it possible in your clinic?”

“Good afternoon. Thank you so much for your contact.

In vitro fertilization (IVF) is the choice of treatment to solve fertility issues when simpler methods such as scheduled coitus or artificial insemination do not work. In IVF, eggs and sperm are collected and are brought together in a lab to facilitate cell fertilization and embryo creation. The best embryo or embryos are then selected and placed inside the uterus after a few days. About 30 to 40% of these embryos will implant and result in an ongoing pregnancy. Usually 1 or 2 embryos are transferred to the uterus. The latter option might slightly increase the chance of becoming pregnant but it will also increase the risk of a twin pregnancy. However, this does not always happen. Only around 20 to 25% of pregnancies achieved with the transfer of 2 embryos will result in a twin pregnancy. Of these pregnancies only about half result in the birth of 2 children.

In other words, nature is sovereign in these situations and it is not possible to guarantee that even with the transfer of 2 good quality embryos you will get pregnant and deliver 2 babies.

Best wishes,
Paulo Vasco“