TREATMENTS FOR INFERTILITY

Many couples experiencing infertility problems can often be successfully treated by:

  • addressing lifestyle issues

  • medical therapies,

  • surgical techniques

Both women and men can contribute to difficulties in falling pregnant

How is infertility treated?

Dr Alexander will suggest a treatment suitable for your diagnosed problem.

Fertility treatment involves use of different artificial methods to help a woman conceive in conditions where she is unable to conceive naturally.

Depending on the test results, different treatments can be suggested. 85-90% of infertility cases are treated with drugs or surgery.

Drugs: Fertility drugs may be recommended to stimulate and regulate ovulation, in women who are infertile due to ovarian disorders.

It is important to talk with Dr Alexander about the drug to be used. You should understand the drug’s benefits and side effects. Depending on the type of fertility drug and the dosage of the drug used, multiple births (such as twins) can occur in some women.

Insemination: You could also be chosen for assisted insemination, where healthy sperm is collected, concentrated, and placed directly into your uterus, when your ovary releases eggs to be fertilized. This procedure is also known as intrauterine insemination (IUI), and can be in tandem with your normal menstrual cycle or fertility drugs.

Surgery: Apart from these, problems with your uterus, such as intrauterine polyps or scar tissue, can be treated with surgery. Sometimes a man has an infertility problem that can be corrected by surgery.

IVF Treatment

In vitro fertilization (IVF) is a procedure made famous with the 1978 birth of Louise Brown, the world’s first “test tube baby.” This type of assisted reproductive technique is often used when a woman’s fallopian tubes are blocked or when a man has low sperm counts.

IVF is a complex clinical procedure that helps to achieve conception by treating the existing infertility or genetic problems.

IVF is a time-consuming, costly and an invasive procedure, which takes around 2 weeks for the completion of a single fertilization cycle.

Indications for IVF

The most common indications for IVF include:

  • Damaged or blocked fallopian tubes

  • Ovulation problems

  • Premature ovarian failure (loss of normal function of your ovaries before the age of 40)

  • Severe Endometriosis (presence of endometrial tissue outside the uterus)

  • Presence of uterine fibroids  (benign tumors in the wall of the uterus)

  • Male factor infertility, including low sperm count and low sperm motility

  • Presence of a genetic disorder

  • To preserve fertility for patients with cancer or other health conditions

  • Unexplained infertility

IVF Procedure Stages

The stages involved in IVF treatment are:

Ovulation Monitoring

  • You will be monitored for signs of ovulation (release of an egg).

Ovulation Induction:

  • Dr Alexander may also ask you to take medication to stimulate the ovaries and improve egg production and chances of pregnancy.

  • The doctor may administer fertility drugs to boost the production of your eggs.  

Egg retrieval:

  • Your doctor will perform a follicular aspiration, a minor surgical procedure to remove the eggs from your ovaries. That can be done under local or general anaesthesia

  • A probe is inserted through the vagina and into the follicles under ultrasound guidance.  

  • Each follicle in the ovary is pierced in order to retrieve the egg.

Semen is collected

  • Semen is collected from your partner at the clinic.

  • The sperm sample is washed to select only the best sperm that look normal and highly active, from the low quality sperm.

  • There are higher chances of conceiving if a highly concentrated sample of healthy sperm is used.

Egg Fertilization:

  • The mature eggs are placed in a culture dish with the sperms

  • The eggs are mixed with the sperms in an environmentally controlled chamber to facilitate the process of insemination.

  • After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells.

  • The egg is fertilized a few hours after insemination.

If the chance of fertilization is low, intracytoplasmic sperm injection (ICSI) may be used where the sperm is directly injected into the egg.

Embryo Culture:

  • Division of the fertilized egg forms an embryo.

  • The development of the embryo is monitored and within 5 days, a normal embryo has several actively dividing cells.

Embryo Transfer:

  • Embryo transfer is performed 3 to 5 days after egg retrieval and fertilization.

  • A thin tube containing one or 2 embryos is inserted into the vagina through the cervix and into the uterus.  

  • After transfer, if an embryo attaches or sticks to the womb lining, pregnancy is the result.

Other techniques used in IVF include

intracytoplasmic sperm injection (a single healthy sperm cell is directly injected into a mature egg),

assisted hatching (the outer covering of the embryo is removed to facilitate embryo implantation into the uterus), and

using donor eggs or sperm. Gestational surrogates may also be considered for women for whom pregnancy poses high health risks, or for those who have a non-functional uterus.

Intra-uterine Insemination (IUI)

Intrauterine insemination (IUI) is a treatment for fertility, performed in couples unable to conceive despite trying for at least a year. IUI involves placing sperm in a woman’s uterus to facilitate fertilization (fusion of egg and sperm). IUI gives the sperm a head start in entering the womb, but will still have to reach and fertilize the egg on its own.

Who is suitable for IUI?

IUI is a fertility treatment indicated for couples with conditions such as unexplained infertility, abnormal/borderline sperm count or mobility, cervical problems and ejaculation dysfunction.

Intra-uterine Insemination Procedure

As the embryo transfer is carried out under the guidance of ultrasound, you will have a full bladder during the procedure.

Dr Alexander injects the sample of semen directly into the uterus through a catheter (long tube). After the procedure, you will be asked to remain lying on your back for a few minutes. This entire procedure may cause minimal discomfort and is completed in a short time.

Risks and Complications of IUI

IUI is relatively safe and is not associated with serious complications. However, certain risks may occur such as infection and vaginal bleeding due to the placement of the catheter inside the uterus.

IUI by itself may not be associated with a risk of multiple pregnancies. However, when coupled with ovulation-inducing medication, you are at a higher risk of multiple pregnancies. Other possible complications associated with specific steps of an IVF include:

  • Risk of premature and low birth weight

  • Ovarian hyperstimulation syndrome (OHSS) (a condition of ovarian enlargement accompanied by fluid accumulation in the abdominal cavity)

  • Miscarriage

  • Risks of egg retrieval include bleeding, infection, and damage to the bowel, bladder, or blood vessels.

  • Possibility of ectopic or tubal pregnancy

Assisted reproductive technology (ART)?

Assisted reproductive technology (ART) uses special methods to help infertile couples.

ART involves handling both the woman’s eggs and the man’s sperm.

Success rates vary and depend on many factors. ART can be expensive and time-consuming. But ART has made it possible for many couples to have children that otherwise would not have been conceived.