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Treatments for infertility
This will depend on many factors, including the age of the patient(s), how long they have been infertile, personal preferences, and their general state of health. Even if the woman has causes that cannot be corrected, she may still become pregnant.
Frequency of intercourse
The couple may be advised to have sexual intercourse more often. Sex two to three times per week may improve fertility if the frequency was less than this. Some fertility experts warn that too-frequent sex can lower the quality and concentration of sperm. Male sperm can survive inside the female for up to 72 hours, while an egg can be fertilized for up to 24 hours after ovulation.
Fertility treatments for men
- Erectile dysfunction or premature ejaculation - medication and/or behavioral approaches can help men with general sexual problems, resulting in possibly improved fertility.
- Varicocele - if there is a varicose vein in the scrotum, it can be surgically removed.
- Blockage of the ejaculatory duct - sperm can be extracted directly from the testicles and injected into an egg in the laboratory.
- Retrograde ejaculation - sperm can be taken directly from the bladder and injected into an egg in the laboratory.
- Surgery for epididymal blockage - if the epididymis is blocked it can be surgically repaired. The epididymis is a coil-like structure in the testicles which helps store and transport sperm. If the epididymis is blocked sperm may not be ejaculated properly.
Fertility treatments for women
Ovulation disorders - if the woman has an ovulation disorder she will probably be prescribed fertility drugs which regulate or induce ovulation. These include:
- Clomifene (Clomid, Serophene) - this medication helps encourage ovulation in females who do not ovulate regularly, or who do not ovulate at all, because of polycystic ovary syndrome (PCOS) or some other disorder. It makes the pituitary gland release more FSH (follicle-stimulating hormone) and LH (luteinizing hormone).
- Metformin (Glucophage) - women who have not responded to Clomifene may have to take this medication. It is especially effective for women with PCOS, especially when linked to insulin resistance.
- Human menopausal gonadotropin, or hMG, (Repronex) - this medication contains both FSH and LH. It is an injection and is used for patients who don't ovulate on their own because of a fault in their pituitary gland.
- Follicle-stimulating hormone (Gonal-F, Bravelle) - this is a hormone produced by the pituitary gland that controls estrogenproduction by the ovaries. It stimulates the ovaries to mature egg follicles.
- Human chorionic gonadotropin (Ovidrel, Pregnyl) - this medication is used together with clomiphene, hMG and FSH. It stimulates the follicle to ovulate.
- Gn-RH (gonadotropin-releasing hormone) analogs - for women who ovulate prematurely, before the lead follicle is mature enough during hmG treatment. This medication delivers a constant supply of Gn-RH to the pituitary gland, which alters the production of hormone, allowing the doctor to induce follicle growth with FSH.
- Bromocriptine (Parlodel) - this drug inhibits prolactin production. Prolactin stimulates milk production in breast feeding mothers. If non-pregnant, non-breast feeding women have high levels of prolactin they may have irregular ovulation cycles and have fertility problems.
Risk of multiple pregnancies
Injectable fertility drugs can sometimes be the victims of their own success and cause multiple births - when the woman gets pregnant she has twins, triplets, or perhaps more babies in one go. Oral fertility drugs also raise the risk of multiple pregnancies, but much less so than injectable ones. It is important to monitor the patient carefully during treatment and pregnancy. The more babies the mother carries inside her the higher is her risk of premature labor.
If a woman needs an HCG injection to activate ovulation and ultrasound scans show that too many follicles have developed, it is possible to withhold the HCG injection. Couples may decide to go ahead regardless if the desire to become pregnant is very strong.
Multifetal pregnancy reduction is possible if too many babies are conceived - one or more of the fetuses is removed. Couples will have to consider the ethical and emotional aspects of this procedure.
Surgical procedures for women
- Fallopian tube surgery - if the fallopian tubes are blocked or scarred surgery may repair them, making it easier for eggs to pass through them.
- Laparoscopic surgery - a small incision is made in the woman's abdomen. A thin, flexible microscope with a light at the end (laparoscope) is inserted through the incision. The doctor can then look at internal organs, take samples and perform small operations. For women with endometriosis, laparoscopy removes implants and scar tissue, reducing pain and often aiding fertility.
The following methods are currently available for assisted conception.
IUI (intrauterine insemination)
A fine catheter is inserted through the cervix into the uterus to place a sperm sample directly into the uterus. The sperm is washed in a fluid and the best specimens are selected. This procedure must be done when ovulation occurs. The woman may be given a low dose of ovary stimulating hormones.
IUI is more commonly done when the man has a low sperm count, decreased sperm motility, or when infertility does not have an identifiable cause. The procedure is also helpful for males suffering from severe erectile dysfunction.
IVF (in vitro fertilization)
IVF in action
Sperm are placed with unfertilized eggs in a Petri dish; the aim is fertilization of the eggs. The embryo is then placed in the uterus to begin a pregnancy. Sometimes the embryo is frozen for future use (cryopreserved).
Louise Joy Brown, born in England in 1978, was the world's first IVF baby. Before IVF is done the female takes fertility drugs to encourage the ovaries to produce more eggs than normal.
Time-lapse imaging triples the chances of having a baby for couples undergoing IVF treatment, researchers reported inReproductive BioMedicine Online (May 2013 issue). Described as a "major breakthrough", time-lapse imaging became available in 2013 in the UK for monitoring the development of IVF embryos before they are implanted in the womb.
In an Abstract in the journal, the authors wrote "Time-lapse imaging of human preimplantation IVF embryos has enabled objective algorithms based on novel observations of development (morphokinetics) to be used for clinical selection of embryos."
With this new technique, the scientists could develop a way of accurately identifying which embryos are more likely to have aneuploidy (abnormal chromosomes). Embryos with aneuploidy are much less likely to be successfully implanted.
The researchers, from CARE Fertility, said further large-scale studies are needed to confirm their findings.
Researchers from Mount Sinai Hospital in Toronto, Canada, reported in CMAJ that IVF is more successful if the woman has sufficient levels of vitamin D.
A study published in the Journal of Clinical Endocrinology & Metabolism (JCEM) found that women who are deficient invitamin D are half as likely to conceive using IVF compared with women without vitamin D deficiency.
ICSI (Intracytoplasmic sperm injection)
A single sperm is injected into an egg to achieve fertilization during an IVF procedure. The likelihood of fertilization improves significantly for men with low sperm concentrations.
Donation of sperm or egg
If there is either no sperm or egg in one of the partners it is possible to receive sperm or eggs from a donor. Fertility treatment with donor eggs is usually done using IVF. In the UK and a growing number of countries the egg donor can no longer remain anonymous - the offspring can legally trace his/her biological parent when reaching the age of 18.
This improves the chances of the embryo's implantation; attaching to the wall of the uterus. The embryologist opens a small hole in the outer membrane of the embryo, known as the zona pellucid. The opening improves the ability of the embryo to leave its shell and implant into the uterine lining. Patients who benefit from assistant hatching include women with previous IVF failure, poor embryo growth rate, and older women. In some women, particularly older women, the membrane is hardened, making it difficult for the embryo to hatch and implant.
Electric or vibratory stimulation to achieve ejaculation
Ejaculation is acheived with electric or vibratory stimulation. This procedure is useful for men who cannot ejaculate normally, such as those with a spinal cord injury.
Surgical sperm aspiration
The sperm is removed from part of the male reproductive tract, such as the vas deference, testicle or epididymis.