What are the main treatments used for infertility?
Fertility treatments can be grouped into three categories:
Medicines (drugs) that may improve fertility
Medicines are mainly used to help with ovulation. Ovulation is when the ovary makes and releases an egg (ovum).
Clomiphene citrate and adjuvants
are medicine that has been used to help with fertility for many years. It is taken as a tablet. The chance of pregnancy with this medication is around 40-50% in selected patients..
Medicines that contain gonadotrophins
are another type of treatment. These need to be injected and tend to be used when oral medications does not work, or prior to IUI and IVF to cause ovulation.The pregnancy rate is much better than the oral medications.
The situations where surgery may be an option include:
– Surgery may help to improve fertility in women with endometriosis.
Fallopian tube problems
– Surgery to the fallopian tubes may help some women with infertility caused by fallopian tube problems like tubal block and in cases where prior sterilization operation done. These days, most surgery to the fallopian tubes is done by ‘keyhole’ surgery.
Polycystic ovary syndrome
– A special operation on the ovaries ‘ovarian drilling’ may be suitable for some women with polycystic ovary syndrome. The procedure is done as a key hole surgery.
– For women with fibroids, sometimes surgery to remove the fibroid may be considered.
A cause of male infertility
– One cause of infertility is due to male factor is poor semen characteristics; one of the reason for this can be varicocele. A surgery to rectify varicocele sometimes improves the semen characteristics.
Intrauterine insemination (IUI)
This is the process by which washed sperm is placed in the woman’s uterus. It is done by using a fine plastic tube which is passed through the cervix into the uterus. Fertility medicines may also be given beforehand, to maximize the chance of ovulation occurring. The sperm used can be either from the male partner, or from a donor.
In vitro fertilisation (IVF)
In vitro fertilization (Test tube baby) means fertilization outside of the body.IVF involves taking fertility medicines to stimulate the ovaries to make more eggs than usual. When the eggs have formed, a small operation is needed to get them (‘egg retrieval’). Each egg is mixed with sperm. The egg/sperm mixture is left for a few days in a laboratory dish (often referred to as a ‘test tube’). The aim is for sperm to fertilize the eggs to form embryos.One or two embryos which have formed are then placed in the woman’s uterus using a fine plastic tube passed through the cervix. Any other embryos which have formed in the dish are, if you wish, frozen for further attempts at IVF at a later date (if the initial attempt fails to result in pregnancy).
Intracytoplasmic sperm injection (ICSI)
This technique involves an individual sperm being injected directly into an egg. (It is injected into the cytoplasm – the outer part of the egg.) ICSI can be used when a male partner has a very low sperm count as only one sperm is needed. If needed, a sperm can also be obtained from testis.
Egg / Embryo donation
This involves stimulating the ovaries of a female donor with fertility medicines, and collecting the eggs which form. The eggs are mixed with and fertilised by sperm of the recipient’s partner (similar to IVF). After 2-3 days, embryos are placed in the uterus of the recipient via the cervix. Couples who have had successful IVF treatment may decide to donate any spare embryos to help other infertile couples.
Complications of infertility treatments
Twins and multiple pregnancy are more common in some forms of infertility treatment, including drug treatment. This is because in some of the drug treatments, the ovaries may be stimulated so that more than one egg is released and therefore more than one egg may be fertilised. Also, in some assisted conception treatments, more than one embryo is put back into the woman’s uterus and therefore more than one pregnancy can develop.
A pregnancy that develops in the fallopian tube is a little more likely in women who are undergoing treatment for infertility. This is especially if the cause of infertility is due to a problem with the fallopian tubes.
Over-stimulation of the ovaries
There is a small risk that some of the drugs used to treat infertility such as the gonadotropin drugs can ‘over-stimulate’ the ovaries and can lead to a condition known as ovarian hyper stimulation syndrome. The condition can usually be treated easily and does not lead to any major problems. However, occasionally it can be more serious and can lead to liver, kidney and breathing problems or thrombosis.
The overall risk of an abnormality (a birth defect) occurring following assisted conception is small. Around 3.5% of IVF babies have a birth defect compared to 3 % of babies born without assisted conception.