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Infertility treatment (general information)

In general the most cases of infertility (both female, male and combined) could be treated – nearly 90% of all infertility cases are overcome through treatment, including surgical and modern medical techniques.

Infertility treatment methods and approaches could be very different depending on main infertility factors – multiple test results, age of both the man and woman, how long the couple has been trying to get pregnant, the overall health of the partners and preference of the partners. Nowadays the infertility treatment options include:

  • Ovulation Induction – for enhancing the ovarian production of healthy eggs;
  • Ovarian Drilling – for treating damaged ovaries;
  • Artificial Intrauterine Inseminations (IUI) – for increasing the chances for egg fertilization by the sperm;
  • Surgery – for repairing damaged reproductive organs (for women and men);
  • Assisted Reproductive Techniques (ART) – for imitation of natural fertilization in vitro (in tubes);
  • Egg donation and/or sperm donation and/or surrogacy – using healthy eggs and/or sperm from healthy donors OR using surrogacy.

INFERTILITY TREATMENT – Ovulation Induction

Infertility treatment

Infertility treatment

In cases of women with ovulation problems the ovulation induction could be used with different types of fertility drugs and injections. Fertility drugs are used to stimulate the follicles in ovaries resulting in the production of multiple eggs in one cycle. The medications also control the time of ovulation, so sexual intercourse, intrauterine inseminations, and in vitro fertilization procedures can be scheduled at the most likely time to achieve pregnancy.

Before starting the ovulation induction some side effects should be discussed including the increased chances for multiple births and the development of ovarian cysts. In some cases the ovarian hyperstimulation syndrome (OHSS) could be noted which include severe pain in the pelvis, abdomen and chest, nausea, vomiting, bloating, weight gain and difficulty breathing. All side effects could be managed by doctors.

Some common medicines (drugs and injections) used to treat infertility in women include:

Clomiphene Citrate (Clomid, Serophone)

Clomid can provoke/encourage ovulation in women who do not ovulate regularly or who cannot ovulate at all by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medication comes in a tablet form. Common side effects include headaches, blurred vision and hot flashes.

Tamoxifen is an alternative to clomifene that may be offered to women with ovulation problems.

Human menopausal gonadotropin or hMG (Repronex, Pergonal)

This medicine is often used for women who don’t ovulate due to problems with their pituitary gland. hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.

Metformin (Glucophage)

Metformin is used for women who have insulin resistance and/or PCOS. This medication has been shown to reverse the endocrine abnormalities seen with polycystic ovary syndrome within two or three months. Metformin is given to patients as an insulin lowering medication. This drug helps lower the high levels of male hormones in women with PCOS. Metformin helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin.
Metformin can result in decreased hair loss, diminished facial and body hair growth, normalization of elevated blood pressure, regulation of menses, weight loss and normal fertility.
Metformin can be used if you have not responded to clomifene. It is particularly beneficial for women with polycystic ovary syndrome (PCOS) and a body mass index (BMI) of over 25.

Bromocriptine (Parlodel)

Bromocriptine is used for women with hyperprolactinemia which could create problems with ovulation. Parlodel is a medication used to lower prolactin levels. It will also reduce pituitary tumor size, should one be present. An oral medication taken with meals, Parlodel has few side effects.

INFERTILITY TREATMENT – Ovarian Drilling

Ovarian drilling, done during laparoscopy, is a procedure in which a laser fibre or electrosurgical needle punctures the ovary 4 to 10 times. This treatment results in a dramatic lowering of male hormones within days and is often performed in women who have polycystic ovary syndrome (PCOS). Studies have shown that up to 80% of patients will benefit from such treatment. Many women who fail to ovulate with clomiphene or Metformin therapy will respond when these medications are reintroduced to the system after ovarian drilling. Side effects are rare, but may result in adhesion formation or ovarian failure if there are complications during the procedure.

INFERTILITY TREATMENT – IUI

Sperm donation

Sperm donation

In most cases artificial intrauterine insemination (IUI) is recommended if 1) infertility cannot be explained (so called “unexplained infertility”); 2) the man has a low sperm count, or decreased sperm mobility; 3) the man is impotent (erectile dysfunction, an inability to maintain an erection), or premature ejaculation; 4) the woman has mild endometriosis; 5) women have problems with their cervical mucus.

During IUI the sperm is passed through a tube that enters the cervix and extends into the womb. This procedure is performed to coincide with ovulation in order to increase the chance of conception. The woman may also be given a low dose of ovary stimulating hormones in order to increase the likelihood of conception.

Side effects could include temporary cramps after or during IUI, which are similar to period cramps.

IUIs can be performed either with the partner’s sperm or with donor sperm.

INFERTILITY TREATMENT – Surgery or Procedures

Hysteroscopy

The hysteroscopy is an outpatient procedure in which the narrow fiberoptic telescope is inserted into your uterus through your cervix, to look for and sometimes remove adhesions inside your uterus or some polyps. Samples of endometrium also could be taken for future laboratory tests.

In general the surgery is recommended if 1) woman’s fallopian tubes are blocked; 2) man’s sperm ducts are blocked and it’s interfering with sperm production or movement.

Fallopian tube surgery

If fallopian tubes are blocked or scarred because of untreated or badly treated pelvic inflammatory disease (PID), you may need to have surgery to repair the tubes. Surgery can be used to break up the scar tissue in your fallopian tubes, making it easier for eggs to pass along them. Possible complications from tubal surgery include an ectopic pregnancy.

Laparoscopic surgery

Very often the laparoscopic surgery is recommended for women who have endometriosis. It may also be used to remove submucosal fibroids.

In women with PCOS, laparoscopic ovarian drilling can be used if ovulation medication has not worked. This involves using either heat or a laser to destroy part of the ovary.

Correction of an epididymal blockage

The epididymis is a coil-like structure in the testicles that helps to store and transport sperm. Sometimes the epididymis becomes blocked, preventing sperm from being ejaculated normally. If this is causing infertility, surgery to correct the blockage can be performed.

INFERTILITY TREATMENT – ART

Modern medicine developed few types of Assisted Reproductive Technology (ART) including In Vitro Fertilization – IVF; Gamete Intra-fallopian Transfer – GIFT; Zygote Intra-fallopian Transfer – ZIFT; Tubal Embryo Transfer – TET and Intracytoplasmic sperm injection – ICSI.

IVF

IVF

In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman’s Fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. A sperm sample is obtained from the father. Eggs are put in a dish in the lab along with the man’s sperm for fertilization. Fertilization occurs in the laboratory when the sperm are mixed with the eggs. The fertilized eggs (zygotes) begin cell division. After 2-3 days, the zygotes are ready to be implanted into the mother’s uterus. Some clinics are waiting a full 5-6 days to allow more cell division before implantation. To improve the chances that an embryo will develop into a baby, approximately 3 fertilized eggs are introduced into the uterus at one time. Often this leads to multiple births.

Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman’s Fallopian tube. So fertilization occurs in the woman’s body. A sperm sample is obtained from the father. Eggs are harvested from the mother. Then, both the sperm and the eggs are injected into the mother’s fallopian tube in hopes that fertilization will occur naturally.

Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF. Fertilization occurs in the laboratory – sperm and eggs are united in the laboratory. Then the fertilized eggs (the very young embryo) are injected/transferred into the Fallopian tube instead of the uterus.

Tubal Embryo Transfer (TET). The main groups of patients selected for TET procedure are women who are keen to have gamete intra-Fallopian transfer (GIFT) but where there is doubt about the chance of fertilization, and women who encountered difficulties in previous embryo transfers through the cervix.
The TET procedure involves the transfer of embryos that are more advanced in development than those in ZIFT i.e. cleaved embryos. The aim is to achieve fertilization in-vitro (in the laboratory) and then replace the cleaved embryos in the Fallopian tube, the normal site for fertilization. It is suitable only for women who have at least one healthy Fallopian tube.
TET is carried out as a day-case procedure under a general anesthetic, using laparoscopy. You may experience some abdominal discomfort and pain for a few days after the procedure, but painkillers can relieve this.

Intracytoplasmic sperm injection (ICSI). This procedure is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or Fallopian tube.

During ART procedures sometimes donor eggs (eggs from another woman) could be used as well as donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who have ovarian problems and cannot produce eggs. Genetic diseases could be another indication for using donor eggs and/or donor sperm – donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple could also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.

INFERTILITY TREATMENT – Egg donation and/or sperm donation and/or Surrogacy

Egg donation

Egg donation

If you or your partner has an infertility problem, you may be able to receive eggs or sperm from a donor to help you conceive. Treatment with donor eggs is usually carried out using IVF.

Donor eggs, embryos and sperm can be used for women who have ovarian failure, men who do not produce sperm, or couples whose eggs fail to fertilize or couples with genetic diseases. Older women may also wish to use donor eggs from younger women to overcome the problems of ageing.

Surrogacy is an arrangement in which a woman carries and delivers a child for another couple or person. This woman may be the child’s genetic mother (called traditional surrogacy), or she may carry the pregnancy to delivery after having an embryo, to which she has no genetic relationship, transferred to her uterus (called gestational surrogacy). If the pregnant woman received compensation for carrying and delivering the child (besides medical and other reasonable expenses) the arrangement is called a commercial surrogacy, otherwise the arrangement is sometimes referred to as an altruistic surrogacy (Wikipedia).

INFERTILITY TREATMENT – Pre-implantation genetic diagnosis

Pre-implantation genetic diagnosis (PGD) is an embryo screening technique which can be used to identify embryos with chromosome abnormalities. A single cell is removed from an early-stage embryo and checked for genetic disorders using molecular techniques. Only the healthy embryos are transferred to the woman’s body. Genetic disorders that can currently be detected in this way include cystic fibrosis, Duchenne muscular dystrophy, thalassemia, haemophilia A, muscular dystrophy, hydrocephalus, Huntington’s disease, imbalances in the number of chromosomes (aneuploidy), and sex-linked disorders. Research is ongoing to develop reliable tests for other genetic disorders.


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