Treatments

Assisted Reproductive Technology (ART) is the term used for infertility treatments. These treatments are designed to increase the number of eggs or sperms and to bring them together, thus improving the likelihood of pregnancy.

Infertility treatment can range from practical lifestyle changes to extended medical procedures – depending on the nature of the problem. As a first step, it may just be a few simple measures, like awareness of fertile period and psycho social interventions (Quit Smoking / Alcohol, Relaxation Therapy).

Fertility treatments can be grouped into three categories:

Medicines to improve fertility – used alone or along with other methods

Surgical treatments – used when a cause of the infertility can be treated by a surgical intervention

Assisted conception – includes procedures such as intrauterine insemination (IUI), in vitro fertilisation (IVF), gamete intrafallopian transfer (GIFT), and intracytoplasmic sperm injection (ICSI).

Each of these is discussed briefly below.

Medicines that may improve fertility

Medicines are mainly given to stimulate ovulation.

Hormones called gonadotropins control ovulation. These are made in the pituitary gland. A gonadotropin is a hormone that stimulates the activity of the gonads (the ovaries in women and the testes in men). The main gonadotropins made by the pituitary gland are called follicle-stimulating hormone (FSH) and luteinising hormone (LH).

Clomifene is a medication used to help with fertility It is taken as a tablet. It works by blocking a feedback mechanism to the pituitary gland. This results in the pituitary making and releasing more gonadotropin hormones than normal. The extra amount of gonadotropin hormones may stimulate the ovaries to ovulate.

Injectable medications that contain gonadotrophins are another type of treatment. They are used when clomifene does not work, or prior to IUI and IVF, to cause ovulation.

Surgical treatments

• Fallopian tube problems – surgery may help some women with infertility caused by Fallopian tube problems. Some women who have had a tubal tie (sterilisation) in the past for contraception may be able to have their fertility restored by tubal surgery.
• Endometriosis – laparascopic surgery may help to improve fertility in women with endometriosis.
• Polycystic Ovary Syndrome – an operation on the ovaries may be suitable for some women with PCOS. The procedure is sometimes called ovarian drilling or ovarian diathermy. Using keyhole surgery, a heat source (diathermy) is usually used to destroy some of the tiny cysts (follicles) that develop in the ovaries. It is usually done if other treatments for PCOS haven’t worked.
• Fibroids – for women with fibroids, surgery (to remove the fibroid) may be considered if there is no other explanation for the infertility.
• Male infertility – when sperm are blocked by an abnormality in the epididymis (a coiled tube inside the scrotum that is used to store sperm) in the testis, surgery may help. Varicoceles (like varicose veins of the testes) that occur in men who have an abnormal sperm count may be repaired.

Assisted Conception

• IUI (Intra Uterine Insemination): This is the method by which processed semen is placed directly in the uterus with the help of a catheter.
• IVF (Invitro Fertilization): IVF means fertilization of an ovum outside the body and consequently, the transfer of the fertilized ovum (embryo) into the uterus of the woman.
• ICSI (Intra Cytoplasmic Sperm Injection): ICSI is the technological breakthrough in the field of IVF which is used to overcome the inability of sperm to fertilize an egg (which may be either due to sub-optimal sperm parameters, oocyte defects or other reasons). In this technique, a single sperm is directly injected into the cytoplasm of an egg in order to achieve fertilization.
• TESA (Testicular Sperm Aspiration): Apollo Hospitals carries out on an average 8-10 TESA every month.
• Embryo Freezing Excess (Surplus): Embryos can be Cryo-preserved at ultra low temperatures for many years. These frozen embryos can be used subsequently, without the need for ovarian stimulation and egg retrieval.Assisted Hatching: The procedure is based on the fact that an alteration in zona pellucida (outer covering of egg) either by drilling a hole through it or by thinning it, will promote hatching or implantation of embryos that are otherwise unable to escape intact from the zona pellucida.
• Semen/Sperm freezing: Semen/Sperm can be stored frozen at ultra low temperatures for a longer duration which could be helpful in a variety of circumstances – semen freezing prior to chemotherapy, inability of the male partner to be present or to deliver the semen on the day of procedure, testicular biopsy/sperm freezing to avoid repeated biopsies, donor semen, etc.