INFERTILITY TREATMENT

Infertility is condition which is defined as the ability to not get pregnant in spite of having frequent, unprotected sex with your partner for at least a year for most couples. This might be caused due to health issues in either the male or the female or due to a combination of other factors that prevent pregnancy.

In this article we will be discussing about some common infertility treatment methods, their procedure, mechanism of action, their advantages and disadvantages and their success rates.

  1. Assisted conception

Assisted conception treatments or assisted reproductive technologies (ART) include the following:

  1. Intrauterine insemination (IUI) – In the clinic, sperm cells are directly inserted into the uterus at the time of ovulation.
    1. This procedure is performed in cases where the quality of the sperm of the male partner is not good, given that they are not able to travel faster and further into the uterine cavity during normal sexual intercourse. Also, blockage in the female reproductive tract can obstruct the contact between the egg and the sperm, and this procedure can be of help.
    1. The sperms injected into the uterine cavity of the female can either be the concentrated form of good quality sperms from the male partner or from a donor.
    1. The procedure of insemination usually takes up to 5-10 minutes in the clinic and should not generally cause any discomfort or pain to the female.
    1. The success rate of this procedure is 38.1% when the blockage is closest to the uterus and 11.7% when the blockage is closer to the ovaries.
    1. Pregnancy through IUI has occur in every first three or four cycles of IUI.
  2. In vitro fertilization (IVF) – Eggs harvested from the ovaries of the female are combined with the sperms from the male in a laboratory dish and the embryos thus formed are implanted into the uterus.
    1. IVF can help with conception in cases where either one of the two partners have been diagnosed with conditions like endometriosis, low sperm counts, problems with the uterus or fallopian tubes, problems with ovulation, immune problems that harm sperm or eggs, inability of the sperms to penetrate or survive in the cervical mucus, poor quality of eggs, genetic problems in mother or father and unexplained fertility problems.
    1. IVF is never used as a first step for artificial conception. It is only used when fertility drugs and IUI have proven unsuccessful.
    1. In IVF, the procedure begins with the injection of drugs which increase the production of mature eggs in the ovary. Before these eggs emerge from the follicles, they are harvested in the clinic following which they are immediately mixed in the lab with the partner’s or donor’s sperms (donated on the same day). The fertilized eggs are then monitored in the lab for 3-5 days until advanced blastocyst stage is reached and then it is implanted into the womb of the mother or surrogate.
    1. The success rate of IVF in women under 35 is 50% whereas for women aged 42 or older, the success rate is 3.9%. (Success rate is in terms of live births)
  3. Intracytoplasmic sperm injection (ICSI) – A single sperm is directly injected into a single egg in the laboratory and the resulting embryo is implanted into the uterus.
    1. This procedure is undergone in cases where either the outer layer of the egg is too thick for the sperm to penetrate or when the sperm is too weak to swim to the egg and fertilize it.
    1. This is one of the most common procedure prescribed to couples suffering from severe case of male factor infertility.
    1. The success rate of fertilization be ICSI is 50-80%; this implies that even injection of a sperm directly into the egg cannot guarantee fertilization.

The major drawback concerned with all the assisted reproductive techniques (ARTs) is that they are heavy on the pocket and a single round of any of these procedures cannot guarantee the conception of a baby, causing financial, physical and mental stress to expectant parents.

  • Drugs-medicines – Fertility drugs are usually the first line of action for treating infertility along with assisted reproductive techniques before moving on to surgical interventions. Some common drugs used for fertility treatment include –
    • Clomiphene citrate is a drug which has been used for over 40 years for treating infertility in women. This drug stimulates the hypothalamus and pituitary gland present in the brain to release the Gonadotropin-releasing hormone (GnRH), Follicle stimulating hormone (FSH) and Luteinizing hormone (LH) which trigger the ovaries to mature and release the egg.
      • This drug has a success rate of 60-80% in stimulating ovulation and 50% of the ovulating women are able to get pregnant.
      • This drug has very mild side effects including hot flashes, blurred vision, nausea, bloating and headache. Sometimes, it can cause changes in the cervical mucus and may stop sperms from getting into the uterus.
      • The chances of multiple births are increased.
    • Hormone injections – these are used when treatment with clomiphene citrate doesn’t work. Some common hormone injections include –
      • Human chorionic gonadotrophin (hCG) – Triggers the ovaries to release eggs when used along with other fertility drugs. Examples, Novarel, Ovidrel, Pregnyl and Profasi.
      • Follicle stimulating hormone (FSH) – Triggers the growth of eggs in the ovaries. Examples, Bravelle, Fertinex, Folistim and Gonal-F.
      • Gonadotropin-releasing hormone (Gn-RH) – Triggers the release of Follicle stimulating hormone (FSH) and Luteinizing hormone (LH) from the pituitary gland. Examples, Factrel and Lutrepulse.

Similar to clomiphene citrate, hormone injections have a high success rate and around 50% of the women who start ovulating are able to get pregnant.

Usage of hormonal drugs have mild side effects which include ovarian hyperstimulation (Ovaries grow and become tender), infection, blood blisters, swelling, or bruising at the injection site.

The chances of multiple births are increased.

  • Other fertility drugsGanirelix acetate – It is an injection-based drug which can prevent early ovulation in women who are undergoing fertility procedures. Side effects of this drug include stomach pain, headache, and possible loss of pregnancy.Cabergoline and Bromocriptine – These are pill-based drugs which help in lowering certain hormone levels and reduce the size of pituitary tumors that may be the cause for ovulation troubles. Side effects of this drug include dizziness and upset stomach.

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