Esterilidad
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Diagnóstico
y soluciones
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En el 85% de
los casos se debe a causas que pueden diagnosticarse con el estudio
adecuado de la pareja y aplicar así el tratamiento más indicado para
darle solución. En el otro 15% de los casos nos encontramos con lo
que se denomina esterilidad de causa desconocida, pero incluso en
estos es posible aplicar con éxito diversos tratamientos.
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El análisis de
la pareja estéril se realiza de forma integral y simultánea,
siguiendo un protocolo de estudio encaminado a descartar los
problemas más frecuentes, tanto en la mujer como en el varón. Cuando
la información así obtenida nos lo aconseja realizamos pruebas más
específicas, para conocer con detalle la identidad del proceso que
altera las posibilidades de concepción de la pareja.
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Es importante
resaltar que cada una de las causas que alteran el proceso
reproductivo tiene un tratamiento concreto, que en muchas ocasiones
se limita a la prescripción de determinados fármacos, o a sencillas
intervenciones quirúrgicas para corregir determinados defectos
anatómicos.
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Cuando los problemas de
la pareja no se solucionan por las vías anteriormente citadas del
tratamiento médico o quirúrgico, se recurre a la Reproducción
Asistida. Así se denomina genéricamente al conjunto de
procedimientos en los que es fundamental la colaboración de un
laboratorio de biología de la reproducción muy especializado, donde
los óvulos y/o espermatozoides son tratados para mejorar su
capacidad fecundante y los embriones obtenidos, cultivados para
mejorar su capacidad de implantación.
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Actualmente, la
esterilidad es un problema que afecta al 15–20% de las parejas en
los países desarrollados. Está considerada como enfermedad por la
Organización Mundial de la Salud (OMS), hecho que otorga a las
personas con este problema el derecho a ser tratadas.
STERILITY:
DIAGNOSIS AND SOLUTIONS |
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85% of
the cases of sterility is due to causes that can easily be
diagnosed with the right studies realized to the couple, so
that a proper treatment can be indicated to give solution to
the problem. The other 15% of the cases are denominated as
sterility due to unknown causes, but even in these cases it
is possible to give diverse treatments with great success.
The study of the infertile couple is preformed in an
integral and simultaneous form, following a study protocol
that focuses on discarding the most frequent problems, in
women as in men. When the information obtained suggests that
it is necessary to do more specific tests, we continue until
we know by detail the identity of the process that alters
the possibilities of the couple to conceive.
It is important to point out that each and one of the causes
that alters the reproductive process has a concrete
treatment, that in most of the cases it is limited to the
prescription of certain drugs, or to a minor surgical
intervention to correct certain anatomic defects.
When the problems cannot be solved by these means, medical
and surgical, we recur to Assisted Reproduction. The
Assisted Reproduction is denominated generally as a group of
procedures in witch is fundamental the collaboration of a
laboratory specialized in biology of reproduction, where the
eggs and/or sperms are treated to improve their fecundable
capacity, and where the embryos obtained are cultivated to
improve their implantation capacity.
Now a day, sterility is a problem that affects 15 to 20% of
couples in developed countries. It is considered by the
World Health Organization as a disease, a fact that gives
people the right to be treated.
SPERM ANALISIS
Our analysis is based in the criteria of normality
established by the World Health Organization (WHO) and the
strict morphology criteria by Kruger, including:
Routine Analysis: The acknowledgement of these basic
parameters helps us to comprehend the fertile potential of
the male, as well as the Assisted Reproduction technique
that offers the best possibilities. For that, it is
determined:
• Sperm concentration: The number of spermatozoids
ejaculated by volume unit; Motility: Established percentage
of acceptable mobile sperms.
• The concentration as well as the motility of the sperms in
a sample is evaluated with the help of a Contrast Microscope
in phases of 20x of augmentation, in a special camera that
does not affect the sperm behavior.
• Morphology: After making a plaque with the sperm, colored
with an adequate histological tintion, the sample is
analyzed in 100x of augmentation in search of morphological
defects in the sperms head, intermediate piece and the tail.
• Viability: We analyze the percentage of viable sperms in
the ejaculation.
ADITTIONAL TESTS:
In this test, it depends the future therapeutic decisions
regarding the characteristics presented in the sperm, and
here is where the importance of trying to obtain the best
possible outcome is.
• Immunological Studies: It detects the presence of anti
sperm antibodies in the semen and serum of the wife, with it
has been demonstrated to have a direct relation with
infertility.
• Biochemical Studies: Accessory Glandular Markers in the
male genital system, which it´s good function is fundamental
for the correct maturity of the spermatozoids.
• Diagnostic : This technique is obtained by selecting a
great number of mobile sperm possible, with good morphology,
as well as the washing of the seminal plasma (harmful for
the spermatozoids), as if it would be in artificial
insemination, but without introducing the sample inside the
uterine cavity.
• DNA Fragmentation: In some concrete cases, masculine
sterility can be associated to a rise in the spermatozoids
percentage with fragmented DNA. In this cases, before we
suggest to change the sperm donor, it is interesting to know
the level of fragmentation of the DNA of the spermatozoids.
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