Complications

Multiple Births. About 38% of all ART births are multiple ones, with 5.8% being triplets or more. The increased incidence of such births poses a risk for complications, including caesarean sections, prematurely, and low birth weight. If the treatment produces multiple embryos the mother must decide if she will carry all of them to term, which increases health risks for both her and the developing fetuses. Aside from complete abortion, her only other option is embryo reduction, in which the physician removes one or more embryos, which can endanger the remaining embryos. The best approach is to limit the number of implanted embryos in the first place.

Risks for the Woman

In one study of women who conceived only one child, the only risks that IVF posed for a mother were a higher rate of urinary tract infections before delivery and a much higher rate of caesarean sections (41.9% for IVF vs. 15.5% for natural conceptions). Other complications associated with ART procedures include spontaneous abortions (12.9%) and ectopic pregnancies (0.5%). It should be noted that infertile women in general have a poorer than average chance for full–term pregnancies regardless of whether they conceive spontaneously or with fertility treatments.
Risk for Birth Defects and Developmental Issues in Children. Although, in general, analyses of studies indicate that there is no higher risk for birth defects with ART procedure, long–term studies are needed on the newer procedures. To date, frozen eggs do not appear to pose a risk for developmental problems in children conceived using them, but follow–up studies are needed. Of concern are recent studies indicating that men with low or non–existent sperm counts due to genetic factors and who conceive using ICSI are at risk of transmitting these same genetic defects to their offspring.

Environmental Factors

Exposure to Chemicals. Some experts believe a decline in fertility may be due to the exposure of male fetuses during pregnancy to environmental chemicals with o estrogen–like effects. Such chemicals include pesticides, such as DDT, aldrin, dieldrin, PCPs, dioxins, and furans. Although tests of single chemicals containing oestrogen have reported little dangers, other studies indicate that combinations of estrogen–containing chemicals may be very harmful. Overexposure to oestrogen reduces the number of Sertoli cells (the cells necessary for the initial development of sperm). In addition to the effect on fertility, some researchers believe such overexposure may also contribute to testicular cancers. Aside from the o estrogen–like chemicals, other environmental pollutants or stresses can affect sperm quality and count, although the effects of most have not been proven.

Oxygen–Free Radicals

High levels of oxygen–free radicals (damaging particles that are naturally released and are produced by certain environmental toxins) have been found in the semen of 40% of infertile men. Such particles are known to injure cells, including causing genetic changes that increase the risk for heart disease and cancer. Evidence now strongly indicates that they can also damage sperm.

Exposure to Heavy Metals

Trace amounts of metals in semen seem to inhibit the function of enzymes contained in the acrosome, the membrane that covers the head of the sperm. Chronic exposure to heavy metals such as lead, cadmium, or arsenic can affect sperm quality. The effect on fertility of small particles of metals released into the air from incinerators or manufacturing plants or present in urban air pollution is not yet known.

Radiation Treatment

Radiation treatments and x–rays affect any rapidly dividing cell, so cells that produce sperm are quite sensitive to radiation damage. Cells exposed to significant levels of radiation may take up to two years to resume normal sperm production, and, in severe circumstances, may never recover. Genetic Factors

Genetic Factors

Aside from inherited diseases that cause infertility, certain genetic factors may play a large role in many cases of male fertility. Much research has focused on a group of deletions in certain regions of the Y chromosome known as AZF. This defect appears to be a major genetic cause of severe male infertility and may be responsible for between 2% and 21% of cases of inadequate sperm. Another area of genetic research targets the gene for apolipoprotein B, which is known to play a key role in cholesterol metabolism, may also be a factor in infertility. It should be noted that genetic mutations may occur not only through inheritance but also from environmental assaults.

Guidelines for Treating Male Infertility?

Many men diagnosed as sterile in past years would be considered treatable now, even some men with spinal cord injuries. Unless a man produces no sperm at all, recent developments in treatment have made fertility possible for many men willing to undergo treatment and bear the expense. Before undergoing more advanced procedures, some simple lifestyle changes should be attempted.

Timing Sexual Activity for Best Results

Both male and female hormone levels fluctuate according to the time of day and they also vary from day to day and month to month. Male hormone levels along with sexual interest are highest in the morning. In men, sexual activity (as well as conception) is highest in October. A woman’s sexual peak is usually around the second week of her menstrual cycle, when there is a surge in female hormones. (A menstrual cycle is counted starting from the first day of a woman’s period.) This surge also triggers ovulation, studies indicate conception is most likely when intercourse occurs during the two days before or on the day of ovulation.

Lifestyle Changes

A man who wants to increase his sperm count should avoid cigarettes and any drugs that may affect sperm count or reduce sexual function. Getting sufficient rest, moderate exercise, and a healthy diet low in fat and rich in whole grains, fruits, and vegetables is always a good idea. Overweight men should try to reduce. Those who exercise excessively might cut back (but not stop altogether). Stress may contribute to reduced sperm quality. It is not known if stress reduction techniques can improve fertility but they may help couples endure the difficult processes involved in fertility.
Some research has focused on antioxidant vitamins C and E. Vitamin C may help the body absorb trace elements of zinc, copper, magnesium, potassium, and calcium, which improve the vitality and longevity of the sperm. In one study, vitamin E improved fertility in men who had normal sperm count but evidence of excess free–oxygen radicals. Men with low levels of zinc might consider supplements. Benefits of herbal remedies, such as ginseng, have not been proven.
To prevent overheating of the testes men should avoid hot baths, showers, and steam rooms. Although studies now indicate that tight underwear and pants pose no threat to fertility, there is no harm in wearing looser clothing. To avoid low sperm count per ejaculation, sexual episodes should be limited to once every two to three days, except during periods when the women estimates she is ovulating. Recent studies have indicated that having intercourse every day or even several times a day, before and during ovulation improves pregnancy rates. Although sperm count per ejaculation is low, a constantly replenished semen supply is more likely to result in a fertilized egg.

Planning for Treatment Outcomes

There is often no way to predict which couples will eventually conceive, some with multiple problems will overcome great odds, while seemingly fertile couples fail to conceive. Many of the new treatments are remarkable, but a live birth is never guaranteed. The emotional stress of failure can be devastating even on the most loving and affectionate relationships. Even in the absence of failure, the road to pregnancy can be very difficult. Couples must be prepared to make many sacrifices, both financial and emotional, before undergoing this process. A successful pregnancy often depends on repeated attempts. Some couples become addicted to treatment, and continue with fertility procedures until they are emotionally and financially drained. Partners should decide in advance how many and what kind of procedures they believe will be financially and emotionally acceptable and attempt to determine a final limit. They should also explore in advance alternatives such as adoption, childlessness, and donor sperm. Determining all options as early as possible in the process can reduce anxiety during treatments and feelings of hopelessness if they don’t work out. It should be noted that even a successful pregnancy may not end emotional difficulties, particularly if it results in a multiple birth.