Human Reproduction has probably been the most debated field in medical science, as infertility has been a major scientific and social preoccupation throughout human history and difficulty with conception has always been considered a real problem.
Nowadays most people of childbearing age assume that once they decide to have a baby, stop using birth control and have unprotected sexual intercourse, pregnancy will occur on schedule.
Unfortunately for many people who can control other aspects of their lives , the ability to achieve pregnancy is beyond their control.
As a matter of fact, not everyone gets pregnant at the drop of a hat and having a baby has been turned into a real challenge for many couples. Moreover, for many reasons, women have their first pregnancy later in life and, as it is well known that with aging the incidence of infertility increases, this way they further decrease their chances to conceive naturally.
Medical science defines infertility as the inability to achieve pregnancy after a year of unprotected sexual intercourse. Beyond social, religious and political issues, the matter has become global: it has been estimated that for 15% of the couples in Europe and in the USA , 12.5 % in China and around 10% in Middle-East countries having a child is a daily struggle; not only getting pregnant may be difficult, but also continuing a pregnancy may not be that easy.
Since social and psychological factors have been playing an important role, infertility has become a complex clinical issue, a multi-faced clinical matter; because infertility can occur in either partner, they both should undergo a complete medical evaluation, the old belief that ‘infertility is a women’s problem’ is now nothing more than a myth as numbers and statistics speak clear : infertility is a women’s matter in 35% of the cases, a men’s matter in another 35%, in 20% of the cases it is a combined problem of the couple and it remains unexplained in the remaining 10%.
New technologies have been helping several couples to achieve their dream of becoming parents. This is the area of so-called ART: Assisted Reproductive Technologies, where physicians of different specialities play a key role together with the laboratory.
Within ART programmes, one of the most commonly performed is the Controlled Ovarian Hyperstimulation (COH), a multi-follicular development induced by means of a careful and monitored administration of hormones (gonadotropins) such as Follicle Stimulation Hormone (hFSH) and Human Menopausal Gonadotropin (hMG) .
Once the appropriate number and dimension of follicles is obtained, their ovulation is triggered with another hormone, the Human Chorionic Gonadopropin (hCG), and the oocytes are then collected (ovum pick-up, OPU).
Among the others, ART include in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and cryopreservation.
These are real multi-step methodologies where the retrieved oocytes are first cultured with sperms in a culture dish (IVF) to be fertilized and either transferred as embryos immediately into the uterus ( IVF-ET In-Vitro-Fertilization Embryo- Transfer), or frozen to be transferred in a second time ( FET, Frozen-Embryo-Transfer).
On the other hand, ICSI ( Intracytoplasmatic Sperm Injection) is usually performed due to poor sperm motility or count, or abnormal sperm morphology and consists in the injection of a sperm inside the cytoplasma of the oocyte to obtain its fertilization.
Finally, in order to prevent progesterone deficiency in the early stages of pregnancy, Luteal Phase Support (LPS) can be carried out: the most common substance used in this technique is progesterone that is administered exogenously (by intramuscular, vaginal and as a unique future of IBSA also by subcutaneous route) from approximately the day of the embryo transfer up to 10-12 weeks of pregnancy.
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