A. There is great vagueness in the prevailing perception regarding the two main causes of infertility.

The problem of infertility and miscarriages is very common, as it affects one in five couples. It is therefore logical to concern many scientists of different specialties and specializations, since in the majority of cases combinations of many sub-causes are involved. One of the most studied factors is thrombophilic predisposition and is usually examined intricately, as a matter of priority, by the majority of gynecologists.

Probably because the subject is clearer, maybe that’s why it is more “popular”. But other, much more complex factors, such as the immune and infectious ones, which occupy a greater area of responsibility in infertility, are unfortunately underestimated or treated more casually every day. In fact, researchers in the medical community worldwide have not determined neither the extent nor the clear role of these two factors. So, clinicians, on the one hand, are faced with the issue on a daily basis and, on the other hand, are constantly fed by various personal views and details, which, however, are not easy to adopt safely and place them in existing knowledge. Especially when many scientific positions annul each other in the official international literature!

B. Doctors who deal with infertility also deal with many important, but irrelevant, subjects.

The result is that the doctor of each specialty dealing with infertility, has mainly formed his own personal views based on his own experience, on how to analyze and deal with infertility and miscarriage; views that are usually different from the ones of the rest. As it is well known, this does not contribute well to tackling the problem in a large proportion of couples. Since almost no one deals exclusively (as a sole object) with the investigation of infertility in the context of daily intensification, the doctor rarely finds time and sobriety to evaluate the new data or even more to draw conclusions from the collective study of his own incidents. Infertility is such a multifactorial issue that approaches, and treatments were easily rejected in the past, because they did not cure the problem of infertility as a whole! In other words, in the daily practice and at the level of the fast medical cabinet, everything that serves the ease of approach and treatment has been integrated. Opinions such as “it happened” or even “you did not get pregnant, so you have to go for IVF” — which I personally characterize as at least unconsidered — unfortunately prevail.

What is most striking is that official guidelines from Western European scientific communities leading the way in other fields of medicine, but not in infertility research, have promoted the view “it happened”, and, in the economy, do not have government funding for research, while they adequately cover treatments such as assisted reproduction. Thus, couples with faulty investigation, are subjected to stimulations and unsuccessful attempts, while very important parameters such as the immune factor or infections, which are not bypassed by IVF, have not even been investigated. So the main reason in my opinion is the multifactoriality of the problem and the great complexity of most of the individual causes.

C. Unclear laboratory results and problems in their evaluation.

Another very serious issue that can often have grave consequences and is easily overlooked is the reliability of laboratory test results. Very often examinations are performed in non-specialized laboratories that do not have anything more to offer in the direction of infertility. Thus, an experienced specialist who is interested in something more, is obliged to either accept (with a percentage of uncertainty) the presented examinations or to re-order them with all the consequences (cost, dissatisfaction, etc.)

It is right for the clinician to know how to accurately evaluate any information that a laboratory can provide and the laboratory to provide as many facilitations as possible and clear information to the clinic, to in order to approach the causes. However, tests such as the sperm diagram or fragmentation of sperm DNA or even the microscopy of the immediate cervical preparation (and many other tests) require attention, from the way and timing of the collection to the carrying out of the test. Together with the experience of the doctor, all this plays an important role in the evaluation of the result and the subsequent co-evaluation with the rest of the laboratory and clinical data. The examination of the investigation of infertility requires specialization and care and attention to detail, in every laboratory and clinical step. I think that specialization should not concern the clinician only who deals with the investigation of infertility, but also the laboratory personnel that should work closely together and be close to the history and other clinical and laboratory data of the couple. I believe that to date “low reliability” results have contributed greatly to the ambiguity that characterizes the pathophysiology of infertility in the perception of clinical colleagues who treat couples, and thus have become promoters of the easily said “it happened”.

D. Lack of coordination of experts!

In addition to what has been mentioned, it is noteworthy that the causes involved in the problem usually do not correspond to the object of only one specialization. Couples are usually examined either by gynecologists or by andrologists-urologists or by related physicians, immunologists, hematologists, etc. In addition to infertility, doctors in these specialties deal with other objects as well on a daily basis, mainly surgery or obstetrics or assisted reproduction or other areas of pathology, and so a small proportion of them only are truly specialized in investigating infertility.

But again, since these two factors, the immune and the infectious ones, usually concern in parallel both the members of the couple, either separately or in combination with each other, there is rarely coverage by one or even two separate specializations. So, we would say that the majority of scientists recognize only one side of the problem, that of their specialization, while at the same time underestimate or ignore other aspects of the subject; and this is the other important reason.

As an analogy, we could say that, in practice, those who undertake the investigation of the causes of infertility, are like the musicians of an orchestra, which are all valuable, but there is no conductor. So there needs to be a pathologist role, exclusively for the investigation of infertility, as a key counselor of the couple, that would indicate at all times the succession of actions and treatments, even when the investigation reaches the necessary details that are definitely different from couple to couple. Their role should be to determine the path of each particular couple to success with the least consumption of drugs, money, time, etc. He / she should be responsible for evaluating the researchers’ views from the literature and integrating the new data into a proper research procedure.