Fertility treatments for the couple facing Infertility

 

Fertility treatments are being done at an alarming rate in infertility units!. This partly stems from the fact that today infertility is now considered a public health problem and as per the WHO and CDC….

 

Infertility affects at least on in 6 couples actively trying for a child

 

Once a diagnosis of Infertility is made the overall chance that a fertility treatment could be successful for a man or women stands at around 50%


Fertility Treatments


 

Fertility treatment for women

 

Fertility treatment options for women are as follows..

 


A. Medications for improving female fertility

B. Surgical treatment for improving female fertility

C. Assisted Reproductive Technologies (ART)


Fertility treatment with medications

 

Medicines for inducing the ovulation process can be used to treat women with absence of menstruation or those women who ovulate irregularly.

 

Women who ovulate on their own may also be treated with ovulation-inducing medications to increase the number of follicles produced for a particular cycle, which leads to the release of multiple eggs. This process is termed as superovulation and is used in conjecture with assisted reproductive techniques.

A. Fertility treatments with Clomiphene Citrate :

Clomifene citrate (CC) is recommended for women diagnosed with unexplained infertility and women who suffer from PCOS (Polycystic ovarian syndrome). CC can also be used to stimulate the development of multiple follicles in women who are planning an IUI or IVF.

Clomifene citrate works by competing with estrogen (a core female hormone) for the estrogen receptors in the brain. Therefore, the body is believed into thinking that there is not enough estrogen being produced. The pituitary gland then secretes more follicle-stimulating hormone (FSH) and luteinizing hormone (LH) into the blood.

This high level of these hormones then stimulates the ovaries to develop follicles that contain eggs. The rising LH levels eventually trigger egg release.

As an add on an injection of human chorionic gonadotrophin (hCG) can also be given to help the triggered release of the egg (ovulation). Following this event, egg fertilization may happen naturally when intercourse occurs or when an IUI is doned.

DOSAGE: One tablet of clomifene citrate is usually taken for 5 consecutive day, beginning somewhere around the 5th-day post menstruation. The exact long-term effects of treatment with clomifene remains unclear and usually, no more than 6 cycles of clomifene treatment is normally adviced.

Numerous large-scale studies have clearly shown that over 70% of women suffering from PCOS would respond to Clomiphene citrate treatment.

B. Fertility treatments with Gonadotrophins :

 

Fertility treatments

 

Two core hormones that are necessary for ovulation are follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones are also known as gonadotrophins.

FSH based medications are small proteins and they would be easily destroyed by digestive enzymes in the stomach if taken orally; therefore gonadotrophins are given strictly only by injection under the skin or directly into the muscle.

Gonadotrophins are normally used to stimulate egg production in women who have problems ovulating naturally, or can be used for stimulating multiple egg production when a procedure like IVF is planned.

Serial ultrasound scans along with blood tests are usually done to monitor follicle growth especially when Gonadotrophin are used.

 

fertility treatments

Side effects of gonadotrophins includes ovarian hyperstimulation syndrome and the risk of multiple pregnancies. Other possible minor side effects include mild headaches, some abdominal pain or bloating, tenderness of the breast, or swelling or rash at the injection site along with mood swings.

C. Fertility Treatments with Dopamine Agonist:

Elevated levels of prolactin is also known as hyperprolactinaemia.A high prolactin level interferes with normal ovulation and leads to infertility. This incidence of increased prolactin level among an infertile women population ranges from anywhere between 3.8% to 11.5%.

Drugs that are dopamine agonists such as bromocriptine or cabergoline which when taken orally, may be used to treat this condition, as it reduces the baseline secretion of prolactin, thereby allowing the women to ovulate regularly and thus conceive.

Now lets look at a few surgical treatment options..

Fertility Treatments following a Surgical Approach

Normally numerous surgical approaches exist for treating female infertility..

The various procedures and their brief description is listed below,,

Hysterosalpingography (HSG) : While this procedure is not strictly a surgery in this a small amount of fluid is injected into the uterus and fallopian tubes to detect abnormal changes in their size and shape or to determine whether the tubes are blocked. The procedure may also be considered a treatment as the fluid can flush out the tubes and remove any blockages.

Salpingolysis : The process of removing adhesions around the outside of the tube (nearest the uterus).

Fimbriolysis : The process of removing adhesions from the fimbrial end of the tube (nearest the ovary).

Salpingostomy (or Neosalpingostomy) : Forming a new opening in the tube that is completely blocked at its outer fimbrial end.

Salpingectomy : The removal of one or both of a woman’s fallopian tubes

Tubal anastomosis : Rejoining a tube after cutting out a blocked part.

Tubal canalization: Pushing a wire through a blockage.

For any disease that affects the tube fertility is usually impaired and surgery can or may repair the tubes thereby removing any blocks in the tube.

 

Success rates for all these procedures remain rather low

These surgeries that involve the fallopian tubes also sometimes increases the risk of ectopic pregnancy, which is defined as a pregnancy that occurs outside of the uterus. These pregnancies are also called tubal pregnancies as they most commonly occur within these tubes.

Other Surgeries include laparascopically removing patches of endometriosis (uterine lining tissue found in places were it is not normally supposed be found) has been found to moderately improve the chances for conception. Surgery can also be done to remove uterine polyps, fibroids and other massess that may interfere with fertility.

Fertility Treatment with Assisted Reproductive Technology (ART)

Broadly stating fertility treatments that involve ART is divided into three main categories.

A. IUI (Also called Intrauterine insemination)

B. IVF (Also called In vitro fertilization)

C. ICSI (Also called Intracytoplasmic sperm injection)

A brief description of all these treatments is given below

What is IUI?

In an IUI treatment cycle, a man semen is collected by masturbation and is prepared so that the motile sperm fraction is separated from the non motile sperm and the prepared sperms are then injected into the women’s uterus close to the time of her ovulation. This procedure helps and aids in achieving a pregnancy. The success rate of this procedure is around 15% to 17%.

What is IVF?

An IVF procedure involves the following treatment steps

A. Giving hormonal injections to stimulate multiple egg release in the women

B. Taking multiple Ultrasound scans to monitor the egg growth

C. Egg retrieval once a certain critical growth of the egg is achieved

D. Processing the mans semen and separating a good fraction of motile sperm

E. Placing the egg and sperm together in a culture dish in specialized device called the incubator overnight so that fertilization takes place

F. Transferring the embryos formed back into the mothers womb.

G. Pregnancy test after 14 days

 

ivf | test tube baby
In an ivf procedure about 100,000 sperms are kept adjacent to the egg in a specialized dish holding both gametes suspended in a specialized culture media. The sperm has to swim, attach, penetrate and then fertilize the egg. ivf is more natural in the sense it mimics natural fertilization to a certain extent.

What is ICSI?

An ICSI procedure involves the following treatment steps

A. Giving hormonal injections to stimulate multiple egg release in the women

B. Taking multiple Ultrasound scans to monitor the egg growth

C. Egg retrieval once a certain critical growth of the egg is achieved

D. Processing the mans semen and separating a good fraction of motile sperm

E. Manually selecting a single good sperm and injecting it into a single egg so that fertilization is achieved

F. Transferring the embryos formed back into the mothers womb.

G. Pregnancy test after 14 days

 

icsi ivf
icsi – ivf involves the injection f a single sperm directly into the egg. icsi -ivf is used to treat severe forms of male infertility

 

IVF/ICSI Success

Both IVF and/or ICSI is used in the treatment of severe male or female infertility. Today many fertility clinics are claiming exorbitant success rates with these procedures. This kind of false information gives a lot of undue hope to the couple and when their expectations fail….everything is lost

The success rate of both these procedures in terms of taking a live baby back home from such treatments seldom exceeds 35 to 40% even in the best of international treatment centers.

I sincerely hope you enjoyed reading this short summary of the various fertility treatments that are currently available. It is always wise to visit an infertility specialist and get an expert fertility evaluation before you blindly decide to go with any fertility treatments and/or fertility therapies.

References

  1. Fertility treatments overview  – WebMD
  2. http://obgyn.ucla.edu/infertility

 

 

If you want a free consult you are welcome to contact us below

You are also welcome to visit us at Dr. Shah’s Clinic for Male infertility and Sexual health, T-nagar, Chennai at the address below for an in-person consult