Frequently Asked Questions (FAQ)

When it is needed to think about not having children?

A couple is considered sterile when after two years of free non protected sexual intercourse a pregnancy has not occurred. This definition based on time is valid for couples with the female partner younger than 30 years. If the female partner is older than 30 years it is necessary to evaluate the possibility of infertility after one year of free sexual intercourse without a pregnancy.
Human species has per se a low fertility rate:
-The possibility of conception is only 20-25% if the sexual intercourse occurs in the fertile period of the ovulatory cycle;
-Only one couple over 5 (20%), among those who are searching actively for pregnancy reaches that goal in a chosen month;
-About 90% of couples obtain a pregnancy in the first year of free and unprotected sexual intercourse. 
The WHO estimates that the problem of infertility comprises 10% of the couples in the world.

At what age fertility begins to decline?

Over 38 years for women and 50 years for men. Indeed, sterility in countries such as Italy is strongly related to social and financial circumstances which tend to make increase the age at which the decision to have children is taken.


Which are the most common causes of sterility?

In about 55% of cases sterility is due to a female pathology; in about 25% of cases is of male origin; in 18% of cases there are female and male causes; in the rest of the cases it is not possible to identify the real cause of sterility.
About 50% of sterile women have ovulation problems, 25% have a Fallopian tube pathology and in 12% there is endometriosis; the rest of cases of female sterility are due to cervical mucus abnormalities and uterine diseases.
The most frequent cause of male infertility is oligo-asteno-teratozoospermia (anomaly of the number, motility and morphology of sperm). The causes of male oligo-asteno-terato-zoospermia are many, but in most cases the origin remains unexplained.

When it is advisable to attempt the techniques of Medically Assisted Reproduction (MAR) in a sterile couple?

Only after having tried all the possible means to resolve the problem with the most natural methods. Often a detailed evaluation of the couple by the doctor permits to recognize causes of sterility that are easily and inexpensively resolvable, without recur to MAR. According to the Italian Society of Fertility and Sterility and Reproduction Medicine (SIFES and MR) about 50% of sterile couples end up performing one of the techniques of MAR.
In reality, this percentage may be considerably lowered when a detailed and comprehensive evaluation of the possible causes of sterility are considered professionally and when adequate therapeutical measures are considered.

Which possibilities of success have the techniques of MAR?

The techniques of MAR are diverse and it is advisable to start with the simplest ones
(Intrauterine Insemination -IUI- , Intraperitoneale -DIPI- , and combined Intrauterine and Intraperitoneale IUI -DIPI) and only in a second time consider the more complex techniques (GIFT, ZIFT, TET, IVF/ET,ICSI, MESA, TESA ). This criteria is obviously not valid when evaluating cases of sterility due to Fallopian tubes pathologies (where the choice of IVF/ET is required) and in cases where sterility is due to a severe male factor (in these cases is advisable to utilize directly IVF/ET or ICSI ).
The rate of pregnancy per cycle is about 9,5% (a little less of one pregnancy every 10 attempts) in cases of Insemination associated with follicular growth induction with Clomiphene Citrate and it is doubled ( 18%, little less than two pregnancy every 10 attempts) when induction of multiple follicular growth is stimulated with Gonadotropins.
IVF/ET and in the majority of cases the other more complex techniques of MAR including GIFT, ZIFT, TET, ICSI have a more elevated success rate. Based on data from the European Registry of MAR from 1998, the percent of pregnancy by embryo transfering (IVF/ET, ICSI, TET ) is of 27% (little less than 3 pregnancies for every 10 embryo transfering); in the same year the American Registry of MAR has reported a pregnancy rate for embryo transfer of 37% . Therefore, it seems that there are no substantial differences on pregnancy rates regarding GIFT e lo ZIFT. Finally, for MESA and TESA, an evaluation of the effectiveness is difficult since the percentage of sperm and/or spermatides recovery has to be considered during the first step of the technique (the one that includes the male partner). In case when embryos can not be obtained and transfer is needed, the percentage of pregnancies per transfer is the same as that obtained with IVF/ET and ICSI (higher with MESA, about 27% and less with TESA, about 20%) . 

Is it possible to obtain a child in women who although becoming pregnant do not conceive and have several abortions?

Yes! There have been many progresses in the diagnosis and in the therapeutical approach of subjects suffering of the Recurrent Abortion Syndrome (two spontaneous consecutive abortions) and Habitual Abortion ( three or more spontaneous consecutive abortions). In particular, in this field immense progress has been made in cases of Abortion Syndromes linked to immunological causes, with therapies that currently are widely used and safe. 

Is it possible to know with anticipation during pregnancy if a baby is affected with malformations or severe diseases?

Prenatal diagnosis is one of the fields where Obstetrics has made the major advances; to date the possibility of diagnosis, prevention and, in particular cases, prenatal therapeutical approaches are ample and unexpected if we consider the limits in the same cases some years back. 

Are there efficacious remedies for male sexual anomalies, in particular impotence and precocious ejaculation?

These are situations that are not any more approached passively. Currently there are several means to individuate with the maximal precision the cause of these pathologies; therefore also the therapy for these diseases is possible in the majority of cases with simple, inexpensive, and non invasive solutions.