Fertility may have challenged us, but we are stronger for it.
If a couple has tried to conceive for a year, with no success, it is probably because one of them is infertile. This could be a result of external conditions such as trauma to the reproductive organs or prolonged exposure to certain harsh chemicals. It could also be a medical condition. In these modern times there is no need to blindly pin the blame on the woman, because research has proven that men and women face the same odds at being infertile. There are specific tests to identify the cause for infertility and better still, there are various medical procedures to get pregnant in spite of infertility.
IDENTIFYING THE PROBLEM
The first step is to consult IVF Specialist and get tested. The doctor will first get a thorough medical history and do a physical examination for both partners which is then followed by gender-specific tests.
Tests for Men:
The semen sample collected by Masturbation and handed over to the lab for testing. The test tells about
- Volume of Semen
- Number of sperms in an ejaculate
- Sperm Motility
- Sperm Morphology (Shape)
- PH level of semen
- Pus cells (if any)
These values along with a few other markers, will help the doctor to understand about semen parameters.
Tests for Women:
- Ovulation Testing is done which reveals whether the woman is ovulating or not.
- Ovarian Reserve testing determines the number of eggs in ovary.
- Hysterosalpingography is done to assess the inner part of uterus and whether fallopian tubes are blocked or open. It is done by injecting an X – ray contrast dye into the uterine cavity.
- The hormones secreted by the Pituitary Gland affect ovulation. Hence these levels are also tested. Hormone testing is also done for female partner.
- Hysteroscopy may be required to check for uterine cause of infertility.
- Laparoscopy might be required to get a better view of the uterus, fallopian tubes and ovaries.
FERTILITY TREATMENT FOR MEN:
- Discontinuing harmful habits such as alcohol consumption and smoking helps in improving sperm quality
- Certain medications are given to improve motility of sperms.
- Surgery may be required in certain cases. For instance, if the issue at hand is varicoceles, widening of the veins in the scrotum will increase quantity of sperms. Surgery is also the option in case of a sperm blockage, to restore fertility.
- Erectile Dysfunction can be treated with oral medication, Alprostadil self-injection or Alprostadil urethral suppository. All of these helps to induce and sustain an erection.
FERTILITY TREATMENT FOR WOMEN:
- For women diagnosed with PCOS or Polycystic Ovarian Syndrome, the main cause of infertility is irregular or delayed ovulation. Oral Medications such as Clomiphene citrate and Letrozole are taken to stimulate growth of eggs & hence ovulation.
- Metformin is also a drug given to women with PCOS or insulin resistance to lower testosterone levels and promote ovulation.
- For women who do not ovulate because of problems with their pituitary gland, human menopausal gonadotropin or hMG is injected into the body to stimulate development of mature eggs. Follicle-stimulating hormone or FSH is an injectable medication similar to hMG.
- Bromocriptine and Cabergoline are medications recommended for women with ovulation problems caused by high levels of prolactin.
- Thyroxine is also recommended in cases of Subclinical hypothyroidism & hypothyroidism.
ASSISTED REPRODUCTIVE TECHNOLOGY
- Intra Uterine Insemination (IUI): Couples with unexplained infertility and slightly compromised sperm parameters will benefit from IUI procedure where the highly motile morphologically normal sperms are harvested from the semen sample via Density Gradient Separation Technique. This separated active enriched sperms are inseminated into the uterus while she is ovulating.
- In Vitro Fertilization (IVF): IVF is the most beneficial innovation and advanced technique in infertility for couples with Blockage of both tubes, Erectile dysfunction, Endometriosis, Ovulatory dysfunction and unexplained infertility. In IVF, eggs from the mother’s ovary are retrieved and fertilized by the sperm outside the womb. The fertilized eggs are allowed to grow for 3 to 5 days before transferring them back to the uterus.
- IntraCytoplasmic Sperm Injection (ICSI): ICSI is one of the recent and most successful techniques in the infertility treatment covering wide number of infertility causing parameters like Azoospermia, low sperm count, lack of motility, abnormal sperms, previous IVF failure, and unexplained infertility. It is a specialised and more advanced technique in the field of ART. In this process, each egg is prepared by removing its outer coat of cells and the sperm is injected into cytoplasm of each egg. Upon fertilization, the embryo is grown in the lab for 2 to 5 days before transferring it into the uterus.
- IntraCytoplasmic Morphologically Selected Sperm Injection (IMSI): This is a real-time laboratory technique involving injecting a morphologically selected sperm into the egg. This is done using an inverted microscope that is able to provide a much greater magnifying power (around 6000 times) than those that are normally used in reproductive laboratories. With this microscope, the Embryologist can see the internal morphology of the sperms and discard those with abnormalities. Being able to select a sperm without morphological alterations is believed to increase the chances of successful implantation of embryo and decrease the likelihood of a miscarriage.
- Blastocyst Culture: This is a highly developed embryo cultured in the laboratory under favourable conditions that has divided many times to a point where it is nearly ready to implant on the walls of the uterus. Blastocyst transfer is not an option for all IVF/ ICSI patients. This procedure is most successful with patients who are younger and have a large number of eggs available during retrieval. In general pregnancy rates are higher in those whose embryos grow to the blastocyst stage. Conversely, pregnancy rates are lower in those whose embryos do not develop into blastocyst stage.
- Assisted Hatching: In some conditions it is necessary to make a small hole in the shell of the embryo with a laser or chemical to aid in the IVF process, which is known as Assisted hatching. This is most commonly recommended for women who have had failed IVF cycles, poor embryo development, are age 38 or older or have thickened embryo shells.
- Gestational Surrogacy: Here the baby is carried by a woman (surrogate) who is not the biological mother of the embryo placed in her uterus. In gestational surrogacy, the pregnancy results from the transfer of an embryo created by In Vitro Fertilization (IVF), in a manner so the resulting child is genetically unrelated to the surrogate. Gestational surrogates are also referred to as gestational carriers. Surrogates are commonly used for women with recurrent miscarriages, untreatable problems of the uterus, uterine or endometrial scarring, prior hysterectomy or conditions where pregnancy becomes a threat to the life of the mother.
Advancement in medicine has definitely made it possible to give hope even to infertile couples. It is best to identify symptoms as the earliest and begin treatment right away to increase your chances of having a baby. Only the best fertility clinics offer these treatments, so be sure to choose wisely.