Instituto FIVIR clinic Support Group

The semen analysis is a key study in the evaluation of a couple's infertility and is fundamental for defining the treatment that can help in achieving pregnancy.

The basic semen analysis (seminogram or spermogram) not only evaluates the number and motility of the spermatozoa but should also study the volume, color, liquefaction, viscosity, and pH of the seminal fluid, the presence of leukocytes in the ejaculate, or the morphology of the spermatozoa.

It should be understood that the seminal sample in an ejaculate not only contains cells from the testes but also fluid from the seminal vesicles and prostate and that alterations at these two levels can produce alterations in the physical and chemical characteristics of the sample.

One of the important aspects to evaluate in the basic semen analysis is the sperm morphology, that is, the appearance of the spermatozoa and, as a percentage, the number of cells that are abnormal. If this percentage is higher than 96%, which implies that there are less than 4% of normal cells, in the case of infertility, the recommended treatment is in vitro fertilization with sperm microinjection.

One of the differential characteristics in the production of sex cells between men and women is that, while the female sex is born with a certain number of cells that are depleted over the years, males produce spermatozoa daily from puberty onwards. This, together with the fact that the male reproductive organs are located outside the pelvis, determines the factors that can affect the quality of a semen sample.

On the one hand, the location of the testicles outside the body means that their temperature is below the temperature of the rest of the body, and this decrease is a determining factor in sperm production and sperm motility.

Those factors that can increase testicular temperature, such as the presence of varicose veins at this level, obesity, the use of very tight underwear, a professional activity that involves spending a lot of time sitting or even certain sports, such as cycling, will have a negative impact on seminal quality.

On the other hand, there is the daily production of sperm cells and implies that external factors that may affect the male at a given moment will interfere in the maturation process of the spermatozoa at a given stage. This is the reason why a single seminal study is not enough to establish the diagnosis of a male factor, since it must be confirmed with a second study that should take between a month and a half and two months.

Exposure to environmental pollutants (pesticides, fertilizers, solvents among others), consumption of toxins or even stress can have a negative effect on seminal quality.

Pregnancy is a natural state in which a new being is generated, grows and matures inside a woman. Although physiological, gestation implies an overload for all the structures of a pregnant woman and, although the organism has an amazing capacity to adapt to this new situation, there are pathologies that may appear and with which the obstetrician may recommend some kind of physical rest.

Absolute rest is total rest, the absence of physical activity and implies bed rest.

Relative rest is not such a drastic measure, but it does imply a notable reduction in movement and effort. Although it is not an indication of absolute immobility, the pregnant woman should assume that everything that involves exertion should be avoided.

The duration in both cases can be variable and only under medical prescription can a normal daily life be resumed.

Cervical cancer remains one of the most common cancers in women worldwide, with the majority of deaths (up to 90%) occurring in countries with low socioeconomic status.

The cervix is the lowest part of the uterus and is composed of different types of cells: those that line the endocervical canal and those that line the cervix in the intravaginal area. It is at the border of these two epithelia, the so-called transformation zone, where almost all cervical carcinomas originate. However, the cervix can be invaded by other cancerous lesions due to the invasion of tumors that originate in nearby locations such as the mucous membrane that lines the uterus, vagina or rectum, for example.

However, primary cervical cancer, i.e., cancer originating in the cervix, is a type of cancer that is associated with long-term persistence of infection with one of the 15 high-risk types of human papillomavirus (HPV).

Human papillomavirus is easily transmitted and it is estimated that up to 80% of women can become infected with one of the high-risk types of HPV. However, it is also known that not all women who acquire such an infection will develop uterine cancer since only in one case in 10 the infection becomes permanent and will eventually lead to the development of pre-cancerous lesions, which, if detected early, can be treated and prevent the progression of the disease to cervical cancer.

The freezing of ovarian tissue is part of the fertility preservation techniques that are currently available for those women who, in the face of oncological or surgical treatments, may put their reproductive capacity at risk.

The procedure consists of the surgical extraction of the most superficial layer of one of the ovaries and the conservation in liquid nitrogen with cellular protective means. Once the oncological or surgical process is over, that fragment of ovary will be placed again in the place from which it was extracted.

At present, the speed of programming ovarian stimulation cycles to obtain oocytes for cryopreservation means that the preservation of ovarian tissue is relegated to those cases in which oncological/surgical treatment must be applied immediately, when the patients are girls who have not yet had their first menstruation or in those patients with pathologies in which ovarian stimulation to obtain oocytes is contraindicated.

The inability to deposit sperm in the vagina during sexual intercourse has traditionally been one of the absolute causes of infertility.

Until the introduction of the most complex assisted reproduction techniques, the only option that could be contemplated was the use of a donor sperm sample.

With the development of in vitro fertilization (IVF) techniques, and especially with oocyte insemination by means of sperm microinjection (ICSI), the possibility of conceiving with a scarce number of spermatozoa is feasible.

In patients suffering from impotence that is not due to andrological medical treatment, nor psychological, an epididymal aspiration or testicular biopsy may be performed.

Epididymal aspiration consists of extracting the sperm stored in the epididymis using local anesthesia, where they acquire the ability to move after being generated in the seminal ducts.

Biopsy is reserved in cases of epididymal aspiration with negative results and requires access to mature sperm directly from the testicular tissue. Although it can be performed under local anesthesia, it can also be performed under anesthetic sedation, which allows the procedure to be performed at different points or on both testicles.

Menopause is defined as the absence of menstruation for at least one year, and this is a situation that usually occurs around the age of 51-52. We talk about early menopause when it occurs before the age of 40.

Although menopause is the final consequence of functional ovarian failure, and therefore it can be expected to happen over time, there may be a paradox that ovarian failure exists but that menstruations still occur with a certain regularity. It’s what we call occult ovarian failure.

Therefore, although related, both concepts cannot be confused since the definition of menopause is very specific and concrete.

One of the ways of transmission of the human immunodeficiency virus is sexual and, indeed, the seminal sample of an HIV+ male may contain a viral load that allows infection of his partner.
Seminal washing is a laboratory technique that is applied to couples in which the male may be affected by an HIV infection and also by hepatitis B or C virus. It is based on the fact that viruses are located in seminal plasma and non-sperm cells, but not in sperm.
When the spermatozoa are separated from both seminal components, we are sure that the risk of viral transmission has been reduced to the maximum and this is confirmed by the determination of the negative viral load in the treated sample in the laboratory, which shall be used for assisted reproduction.

Obesity has been shown to decrease the spontaneous fertility of a couple by altering the male factor, that is, by the seminal quality and also by altering the ovarian function.
In addition, gestation rates after assisted reproduction treatments are also reduced when this factor (obesity) is present.
It is probably the female factor that is most affected by a high BMI because alterations in the ovarian cycle are induced that lead to ovulatory dysfunctions and, in addition, a greater number of spontaneous abortions.
Although there is no standardised criterion, a BMI in women equal to or greater than 32 kg/m2 may to interfere with the achievement of gestation.

The infantile uterus is a congenital abnormality of the female genital tract included in the U1 group of the European Society of Reproduction and Embryology (ESHRE) and the European Society of Gynaecological Endoscopy (ESGE). This group to which it belongs is called the dysmorphic uterus and. More precisely, the infantile uterus, is defined as a uterus with a narrow but not thickened uterine cavity of the lateral walls and a 1/3 correlation of uterine body and 2/3 of cervix.
It can be differenciated from the hypoplastic uterus or "naïve uterus" which would include those cases of smaller uterus.
In either case, the chances of gestation remain intact because in the case of the infantile uterus of the ESHRE/ESGE classification, the uterine cavity is configured by a healthy tissue without areas of fibrosis, and because in the case of the hypoplastic uterus, this should be considered a variant of normality.

Obesity has been shown to decrease the spontaneous fertility of a couple by alteration of the male factor, that is to say, of the seminal quality and also by alteration of the ovarian function.

In addition, gestation rates after assisted reproduction treatments are also reduced when this factor (obesity) is present.

It is probably the female factor that is most intensely affected by a high BMI, since alterations are induced in the ovarian cycle leading to ovulatory dysfunctions and, in addition, a greater number of spontaneous miscarriages.

Although there is no standardised criterion, it is considered that a BMI in women equal to or greater than 30 may interfere with getting pregnant.