Women in search of motherhood

Waiting for pregnancy

It is estimated that about 2 out of 3 pregnancies are intentional, i.e. expected and sought. The awareness of the possible arrival of a pregnancy should trigger in the woman a series of measures aimed at protecting the health of the unborn child even before the pregnancy is in progress because the oocytes can accumulate toxic damage and then transmit them to the future embryo. It is a question of responsibility.

Women seeking pregnancy should immediately abstain from smoking and alcohol consumption, limit the intake of drugs to the bare minimum and avoid exposure to food and industrial toxicants even more carefully.

In addition to these measures, the Federal Office of Public Health (UFSP) promotes the opportunity to take folate supplements at the rate of 400 micrograms per day with the specific aim of preventing the onset of neural tube defects, first of all. all the spina bifida. The supplement benefits the general state of health, does not give any intolerance, costs a few euros a month and can prevent serious illnesses for your child. It should be taken without hesitation, always.

Impryl contains 400 micrograms of folate, moreover in an active and soluble form, and satisfies the above requirement. It also contains vitamin B12, in the form of methylcobalamin, which should always be associated with folate support which could mask a B12 deficiency.

When pregnancy doesn’t come

The lack of a pregnancy after a long period of unprotected complete intercourse configures a problem of couple’s low fertility. From a statistical point of view the probabilities that the problem is male or female are substantially the same and in almost half of the cases both coexist. Nonetheless, we still live in an era of frequent diagnostic and therapeutic persistence on the female side, partly the result of cultural heritage, while a male problem is sometimes considered a last resort. Therefore, the first thing that a woman unable to get pregnant must do is convince her doctor and her partner to immediately tackle the other side of the problem as well.

On the female side, the doctor will check if the patient ovulates regularly, if there are endocrine or adnexal problems, eventually he will perform chromosomal and / or genetic investigations. These investigations may highlight a problem that can be corrected surgically or with medical therapy. In other cases, a concomitant condition may be highlighted that has a negative effect on fertility, typical examples are polycystic ovary syndrome and endometriosis. Even if these conditions are not always “curable”, knowledge of the problem will guide you towards the most appropriate treatment strategies.

When ovulation is impaired

Partial ovulatory irregularity and occasional anovulation are almost normal and do not necessarily imply reduced fertility. The doctor will be able to easily understand the extent of the problem by monitoring a few cycles with the aid of hormonal and / or ultrasound tests. In women over the age of 35 and in all suspected cases it will be appropriate to estimate reproductive age with greater care through the antral follicle count and / or the anti-Müllerian hormone (AMH) dosage.

Cycle irregularities physiologically tend to increase with advancing reproductive age and can be an alarm bell that suggests a certain hurry. On the other hand, they are also frequent in very young women, often within a polycystic ovary syndrome. Most of these situations can be improved with the aid of medical therapies. Women who suffer from severe ovulation disorders or lack of ovulation may need a more articulated diagnostic and therapeutic path and sometimes have to resort to Medically Assisted Reproduction (MAR) techniques.

When we resort to MAP

Medical and surgical treatments may not be able to restore fetility naturally and require the use of medically assisted procreation (MAP) practices. Depending on the case, the specialist will focus on first level techniques such as Intra Uterine Insemination (IUI) or towards the more complex in vitro fertilization such as In Vitro Fertilization with Embryo Transfer (IVF) and Intra Cytoplasmic Sperm Injection (ICSI).

From a strictly clinical point of view, the IUI procedure is indicated for couples in which the female partner has a good ovulatory capacity and the male partner has good quality spermatozoa. The IUI technique is unable to remedy defects in male semen and should not be offered in the presence of male hypofertility, unless it is adequately treated. On the other hand, it is possible to partially remedy ovulatory defects by preceding insemination by female stimulation with FSH hormone in order to guide ovulation. If higher doses of FSH are used the woman will produce more than one egg and this can increase the chances of at least one being fertilized. The stimulated IUI cycles, which are advantageous in terms of effectiveness, however, present potential dangers if things go wrong. It is indeed difficult to predict how many follicles will develop and how many of these will fertilize. Almost all front-page cases with multiple high-order pregnancies (3 or more fetuses) are the result of failed IUI cycles and not in vitro fertilization (where more than two embryos are almost never transferred). Given the importance of the quality of the gametes for the success of IUI, both partners will have to pay close attention to their metabolic balance by following a healthy and varied diet. In the presence of deficiencies, supplements can also help.

In the case of severely compromised ovulation, with or without an associated male problem, and in those in which repeated IUI cycles have not been successful, the doctor may decide to resort to in vitro fertilization techniques such as IVF and ICSI, the latter being indispensable. in the presence of a severe male factor. In both cases the woman will be overstimulated with FSH to support the development of a large number of follicles. When maturation is reached, the oocytes are collected and fertilized in vitro. The embryos obtained will be cultured in vitro for a few days and the best of the developed ones will be transferred to the uterus. The in vitro culture of the embryo for longer times, ie about 5 days, has the advantage of allowing the removal of some cells for the execution of genetic and chromosomal tests that will guide the choice of the embryo to be transferred.

The two techniques, IVF and ECSI, differ only in the procedure used for fertilization.

In the case of IVF, fertilization is achieved by combining an aliquot of semen with one or more oocytes in a test tube. Fertilization will still require sperm of at least decent quality. However, an oocyte with little oxidative damage will be able to concentrate the DNA damage repair activities on the male genes and remedy a modest quality ejaculate.

In the case of ICSI, fertilization occurs by injecting the chromosomes of a sperm into the egg cell and allows fertilization even with sperm that would not be able to do so naturally, for example due to the absence of motility. The problem of sperm quality is minimized through selection techniques aimed at skimming the ejaculate to obtain an enriched fraction of potentially good cells.

Subsequently, the final choice is made under the microscope with morphological criteria. The results in terms of fertilization rates are excellent and it is almost always possible to generate embryos. The problem is that sperm selection techniques are unable to distinguish sperms based on oxidative DNA damage and a good-looking sperm chosen from the good fraction can still cause severe oxidative damage with potential compromise of the viability of the DNA. obtained embryo. Critics of the ICSI technique speak of it as a “forced” fertilization with spermatozoa that natural selection would certainly have stopped. It therefore becomes important to use oocytes which are in turn low in oxidative damage so as not to saturate the DNA repair capacity, with the problem that these oocytes in turn derive from overstimulation which can compromise their quality. In fact, the hormonal stimulation of the ovaries forces them to mature several follicles at the same time and creates an increase in metabolic demand. To cope with the increased demand, women undergoing stimulation should be even more attentive to their diet by avoiding excess food but also micronutrient deficiencies.

When pregnancy arrives

The arrival of a pregnancy represents for a woman a moment of joy but also of profound responsibility for the new life she carries in her womb. For nine months the fetus will interact with the world only through the placenta and will therefore be passively dependent on the mother’s behaviors. The adaptation of lifestyle and eating habits becomes a categorical imperative.

The mother’s nutrition plays a fundamental role in the development of the fetus both because she must ensure an adequate flow of substances and energy necessary for growth, and because she carries some key substances that have a regulatory role on the differentiation of tissues.

Folate supplementation in the first trimester of pregnancy was the first nutritional intervention which has been recognized as having full clinical efficacy and is now mandatory or strongly recommended in almost all countries of the world.

This supplementation has been shown to be able to prevent the onset of neural tube defects (eg spina bifida, cleft palate) with an effectiveness of over 50%.

The effect of folate supplementation is believed to be linked to an improved methylation of embryonic DNA which in turn carries signals for the activation or repression of specific genes (epigenetics). Folate, by favoring the recycling of homocysteine ​​and its use for the production of usable methyl groups, allows a better efficiency of these processes.

Impryl, not just folic acid

Impryl, in addition to 400 micrograms of activated folate (methylfolate), also contains the other food substances used by the metabolism for the recycling of homocysteine, the production of active methyls and the synthesis of the physiological antioxidant glutathione.