Do the sterile person have a chance for giving birth? : Q&A with Dr. Poonkiat

Nowadays, the advance in the assisted reproductive technology makes the chance become possible. Considered with the cause of the problem and how serious it is. I will explain the infertility in both male and female divided into natural sterilization and intentional sterilization.

Natural Sterilization:

The congenital disorders, making people unable to have a child.

Female caused by:

• Chromosomes disorders for example: Turner’s Syndrome – the abnormality on chromosome “X” which is the cause of anovulation. As well as the other syndromes making genetic and hormonal abnormalities. Therefore, the patient will have the anovulation and unable to be pregnant.

• Organic abnormalities such as agenesis in uterus or fallopian tubes, vagina obstruction.

• Infection causes the fallopian tube stenosis, Chocolate Cyst or the infection and inflammation from the curettage.

Male caused by:

• Chromosomes disorders: no sperm production.

• Organic abnormalities such as congenital undescended testicle, congenital vas deferens stenosis or serious damage of the testis.

• Infection induced sterilization for example: mumps – the inflammation from virus will destroy the sperm as well as the severe infection from having sex.

Solution

The solution depends on the symptoms and the cause of problem. The patient needs to consult with doctor then the doctor will consider as case by case and decide whether the patient can attend the treatment with the assisted reproductive technology or not. For example: the gestational carrier for female who has the vagina obstruction but the ovary is normal, ICSI for female who doesn’t have the fallopian tubes, chromosomes disorders might affect the ovarian stimulation, how well the embryo is growing up.

For male, it will be difficult if the problem came from the chromosome disorders because the patient is unable to produce any sperm. However, in case there are some sperms but incapable to collect by natural method. The doctor will use PESA (Percutaneous Epididymal Sperm Aspiration), TESA (Testicular Sperm Aspiration) by taking out the sperm directly from the testis. The selected option relies on the severity of problem and the proficiency of the doctor.

Intentional Sterilization:

After having enough children, the couple may need to do the sterilization. The procedures are blocking or removing the fallopian tubes in female sterilization, cutting and sealing the vas deferens in vasectomy for male. These are the permanent sterilization. However, once you come back for having a baby. Sterilization reversal or the infertility treatment will be used to help you absolutely.

Female Sterilization Reversal: Major abdominal surgery using the laparoscope. It is the complex operation, causing very painful, requiring a lot of money while the success rate is only 40-70%. Depends on how long you have been steriled, how much damaged on the fallopian tubes is (it will be shown after the operation). Next, patient may have some risks after the surgery which are the low success rate of pregnancy, ectopic pregnancy due to uneven fallopian tubes leading the embryo growing up in the incorrect position. Especially, the elderly mother and the sperm quality are the significant factors accordingly.

Importantly, patient should consult with the doctor before attending the operation. It would be better to discuss whether the sterilization reversal is worth for yourself or not. As it is the complicated surgery and many people have spent a lot of money, their bodies have been received so much painful but still not reach the achievement. Therefore, I would recommend “ICSI”. Less pain, lower risk, several embryos obtained then patient can try “ICSI” more than one cycle including the chromosomes abnormalities screening. Increasing the pregnancy rate. Furthermore, the risk of ectopic pregnancy will be reduced as well.

Vasectomy Reversal for Male: Although there is no major surgery but it is still quite difficult and the success rate is not very high, only 50% as the vas deferens is tiny. Also, the people who did the vasectomy for more than 2 years, they might have the chance of the atrophy on vas deferens. Together with their testis are unable to produce any sperm after the vasectomy thus even the vasectomy has been reversed, the patient may not collect the sperm. So, the patient should visit the doctor then the doctor may suggest you to attend the sperm aspiration from the testicle directly (PESA/TESA) instead of the vasectomy reversal. You can use “IUI” treatment if there are a lot of sperms collected or “ICSI” for low sperm count. Considering with other factors also.

Any couple who are having sex constantly over 1 year but wife is still not pregnant. I recommend you to consult with the doctor in order to identify the medical problems or being sterile then proceed the infertility treatment later on. Please do not hesitate as the longer time you wait the lower pregnant opportunity you will receive especially in case the wife is over 35 years old.

For the couple who have changed their mind and prefer to have more children after the sterilization. Please visit the doctor to discuss which treatment is the best option for both parties.

Dr. Poonkiat Punyamitr

Obstetrician & Gynecologist, Infertility Treatment Specialist at Prime Fertility Clinic

Reference: Prime Fertility Center Co., Ltd.
https://www.primefertilitycenter.com/en/qa-with-dr-poonkiat-can-the-sterile-person-have-a-child/

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