It is common to place the focus on female fertility and the age of women, when looking for a baby, however, the health of the man also has great importance. Increased sedentary lifestyle, alcohol and tobacco consumption, stress and anxiety are some of the factors that affect the quality of semen, thus putting male fertility at risk.

According to the World Health Organization (WHO) between 30% and 50% of men of childbearing age have a lower seminal quality. For this reason, it is vital to make men aware of the importance of knowing and taking care of the state of their seminal quality.

Thanks to advances in science and technology, there are many alternatives to help people with all kinds of fertility problems. The best options for you depend on your personal situation and the cause of your infertility.

Sometimes only one partner needs treatment, and in other cases, both have to use a combination of treatments.

Intrauterine insemination is a simple procedure also called “IUI” for short. Also known as “donor insemination,” “alternative insemination” or “artificial insemination.”

Currently the two main indications for IUI are mild male factor and unexplained infertility.

This procedure involves placing sperm directly into the uterus while you are ovulating, which helps the sperm get closer to the egg. This reduces the time and distance that sperm must travel, which facilitates fertilization of the egg.

Before undergoing the insemination procedure, you may take fertility drugs that stimulate ovulation. Semen is collected from your partner or a donor. Semen goes through a process called “sperm washing” that collects a concentrated amount of healthy sperm from semen.

During the intrauterine insemination procedure, the doctor slides a thin, flexible tube into the uterus through the cervix.

Use a small syringe to insert the sperm through the tube directly into the uterus. Pregnancy occurs when a sperm fertilizes an egg, and the fertilized egg implants itself in the lining of the uterus. The insemination procedure is done in the doctor’s office or at a fertility clinic, and it only takes 5 to 10 minutes.

It is very fast and you do not need anesthesia. Intrauterine insemination is generally not painful, but mild colic occurs in some cases.

Before a man’s sperm can fertilize a woman’s egg, the head of the sperm has to attach to the outer surface of the egg. Once fixed, the sperm pushes through the outer layer to enter the inner layer of the egg (cytoplasm) where fertilization occurs. Sometimes sperm cannot get through this outer layer for a variety of reasons.

The outer layer of the egg may be thick or hard to pass through, or the sperm may not be able to swim. In these cases, a procedure called intracytoplasmic sperm injection (ICSI) may be done along with in vitro fertilization (IVF) to help fertilize the egg. In ICSI, a single sperm is injected directly into the cytoplasm of the egg.

Intracytoplasmic sperm injection (ICSI) is an assisted reproductive technique, which is performed by injecting a sperm into the cytoplasm of the oocytes.

In the process of this technique, a small needle, called a micropipette, is used to inject a sperm into the center of the egg, once fertilization occurs, the fertilized egg (now called an embryo) grows in the laboratory for 1 to 5 days. before being transferred to the woman’s uterus (womb).

ICSI is indicated in situations where the man produces very little amount of sperm or the sperm do not move normally. also when the sperm have difficulty attaching themselves to the ovum, or if there is an obstruction in the male reproductive system that prevents the sperm from leaving.

The word fertilization means that the sperm has fixed and entered the egg and In vitro means outside the body. In vitro fertilization (IVF) is one of the best known types of assisted reproductive technology (ART), where the union of the egg and a sperm occurs in a laboratory dish.

The first step of in vitro fertilization is to stimulate through special drugs, for 12 to 15 days so that your ovaries produce several mature eggs ready for fertilization. This is called ovulation induction or ovarian stimulation. Through an ultrasound and blood tests, hormone levels and egg production can be monitored.

Once the ovaries have produced enough mature eggs, the doctor removes them from your body (this is called “egg aspiration”). Egg retrieval is a minor surgical procedure performed in a doctor’s office or fertility clinic, under anesthesia.

The doctor uses the ultrasound equipment to have a guide through the image, in the vagina a thin tube is placed inside the ovary and the follicles where the eggs are. The needle in this tube is connected to a suction device that gently removes the eggs from each follicle.

In the fertility laboratory, the specialist places the eggs with the previously trained sperm, that is, the best quality ones are chosen, these can be from your partner or from a donor. The eggs and sperm are stored together in a special container, and fertilization occurs.

These will grow and develop in 3 to 5 days, and then 1 or more embryos are placed in the uterus (this is called an embryo transfer). The doctor slides a thin, flexible tube through the cervix into the uterus and inserts the embryo.

If either embryo implants into the lining of the uterus, pregnancy occurs. The embryo transfer is done at a fertility clinic and is not painful. After the procedure, daily progesterone pills are indicated to help the embryo survive in the uterus.

In vitro fertilization can have some possible side effects. This includes the following:

• Inflammation
  
• Abdominal pain
  
• Breast tenderness
  
• Mood swings
  
• Headache
  
• Bleeding

There is a risk of multiple pregnancies when more than one embryo is placed in the uterus.

IVF can be difficult to cope emotionally, it is important that the team of specialists has the support of a psychologist to support the patient and the couple at all times.

This procedure has a success rate between 40 and 60%, it all depends on the age of the patient, if the eggs used for the procedure are their own or if they are from a donor.

Egg freezing, also called oocyte cryopreservation, is a procedure performed to preserve the reproductive potential of women for the future.

The eggs are extracted from the ovaries, they are frozen without fertilizing and preserved in optimal conditions, to be able to be used in the future. These (the eggs) can be thawed, combined with a sperm, in a laboratory specialized in fertility and implanted in the uterus, a procedure called in vitro fertilization (IVF).

This process does not modify or alter the quality of the cryopreserved oocytes. The laboratory is in charge of maintaining them. This procedure is recommended in women between 28 and 35 years old, because between this age range the woman is at her peak of fertility and the eggs are the best quality, however, each patient is different for what it is. studied in depth.

Egg freezing has several steps: stimulation of the ovaries, egg collection, and freezing.

Synthetic hormones are prescribed to stimulate the ovaries so that they produce multiple eggs, instead of just one, as is often the case on a monthly basis. Blood tests and imaging studies are performed to observe hormonal changes and the number of follicles produced due to such stimulation.

Then the maturation of these ovules is achieved through an injection of human chorionic gonadotropin and the ovules are collected.

It is done by transvaginal ultrasound aspiration, during which a probe is inserted into the vagina to identify the follicles.

A needle is then guided through the vagina and being inside a follicle, it is suctioned through a device attached to the needle to extract the egg from the follicle. Multiple eggs can be retrieved, in a single cycle.

After harvesting the unfertilized eggs, they are frozen at subzero temperatures to stop biological activity and preserve them for future use.

The process used to freeze the eggs is known as vitrification. Rapid cooling uses high concentrations of substances that prevent the formation of ice crystals during the freezing process (cryoprotectants).

It is usually done when:

• You have an autoimmune or other disease such as endometriosis that can affect your fertility.
• Treatments for cancer or another disease that lead to cycles of chemotherapy and radiation therapy, which can affect your ability to get pregnant.
• You are undergoing a procedure with assisted reproductive techniques such as in vitro fertilization.
• You want to postpone your motherhood and you want to preserve younger eggs to be used in the future.

The freezing of both eggs and sperm from anonymous donors allows the formation of gamete banks that are used by couples who require them at any time.

The donation of semen and eggs is a voluntary act, where a healthy man or woman, with certain characteristics and specific requirements, freezes their eggs or sperm, depending on the case, which are donated to the institute or medical center to be selected by the specialist and be used in assisted reproductive techniques and be able to make the dream of a person or couple with fertility problems come true.

These donors are usually between 21 and 30 years old, and their selection as donors not only involves medical tests, but also psychological tests, among others. The samples are stored at very low temperatures with liquid nitrogen using high technology and safety equipment that allows them to maintain their quality and viability.

There is a study, called the Preimplantation Genetic Test (PGT, for its acronym in English), where the DNA of the embryo fertilized in vivo is studied in the laboratory, in order to improve assisted reproduction programs. Not only can the sex of the embryo be determined, if not very important, it also allows the detection of genetic and chromosomal alterations of embryos, preventing the transmission of serious hereditary diseases or the transfer of an embryo that cannot give rise to a healthy baby, reducing the risk of miscarriage.

The PGD is recommended for patients who want to choose the sex of their baby or when there is a history of spontaneous abortions, failed IVF cycles, in patients older than 37 years, and men with alterations in the sperm.

Through PGD, since this study allows us to study the DNA of the embryo, the sex of the embryo can be determined depending on its genetic expression in XX or XY before transferring it to the maternal uterus.

There are several alternatives for the LGBT community. Couples made up of 2 women have several options. Among these options we have assisted reproduction techniques such as Artificial Insemination and In Vitro Fertilization with donor sperm, another alternative is the ROPA Method, and for couples made up of two men, surrogate motherhood or surrogate uterus is available.

It is a method similar to in vitro fertilization (IVF) where the reproductive cycles of both women, both donor and recipient, are synchronized. The donor woman is the one who provides the ovum and is subjected to ovarian stimulation to perform a follicular puncture and obtain ovules, while the recipient woman will be the one who will undergo the embryo transfer and achieve pregnancy.

Surrogacy, also known as a surrogate uterus, consists of a previously studied and selected woman, called recipient or surrogate, lending her uterus so that through an assisted reproductive technique the embryo is transferred or the sperm inseminated, the baby grows of another couple.

There are two types of Surrogacy:

Total surrogacy: It implies that the pregnant woman is inseminated with her own eggs.
Partial surrogacy: The recipient exclusively lends her uterus, and the embryo is donated.

Some of the reasons for recommending surrogacy are the absence of a uterus or irreversible damage to the uterus of women and male homosexual couples.

Embryodonation is an assisted reproduction treatment by which the woman or couple seeking to achieve pregnancy receives the embryo, obtained thanks to the previous fertilization in the laboratory of a donor woman and a man or a couple who, after having achieved several or a pregnancy, he decides to freeze and donate his embryos to those who have difficulties.

These embryos are frozen or vitrified through flash freezing in liquid nitrogen at -196ºC, preserving the quality they had prior to the freezing process. The embryonic selection is carried out according to the characteristics of the donor couple or woman and the recipient couple or woman. Not all vitrified embryos can be donated. Watt aspects are considered to be able to embryo selection, such as genetic and pathological antecedents, risk of infections, age under 35 years, among others.

Embryodonation is recommended in cases of couples with fertility problems, as well as lone mothers and in couples of women in whom there is a cause of female infertility or an advanced reproductive age (from 40 years).

Advances in medicine have allowed people with HIV to have healthy children as long as they follow the appropriate treatment and have an undetectable viral load. In these cases, pregnancy planning is recommended to follow different strategies, depending on whether she, he or both have the virus.

Seminal washing in men

Through assisted reproductive techniques, whether through Artificial Insemination, in vitro fertilization or egg donation, seminal washing is a technique carried out in a laboratory that allows the semen used for the fertilization of the ovum to be free of the viral load and cannot transmit the disease to the future embryo.

Retroviral treatment in women

Retroviral treatment should be chosen and adapted according to the situation of each woman. The one who wishes to achieve pregnancy and the one who was already pregnant, in order to ensure the efficacy of the treatment and prevent unwanted effects on the newborn. The patient must be treated by a multidisciplinary team including HIV specialists, gynecologists, obstetricians and pediatricians.