INFERTILITY TREATMENT AND THEIR INDICATIONS:
Ovulation induction alone: Anovulation
Intrauterine insemination alone: Coital problems, immunological factors, cervical factors, borderline male factors
Ovulation induction and intrauterine insemination: Unexplained infertility, minimal-to-mild endometriosis, borderline insemination male factors
Gamete intrafallopian transfer: Unexplained infertility, minimal-to-mild endometriosis
In vitro fertilization: Tubal infertility, moderate-to-severe endometriosis, male-factor infertility, failure of other treatments
Intracytoplasmic sperm injection: Severe male-factor infertility, previous fertilisation failure
Oocyte donation: Primary or secondary ovarian failure, familial genetic disorders, repeated ART failure
Ovulation induction is a hormonal therapy to stimulate egg development and release, or ovulation. These drugs were designed to induce ovulation in women who did not ovulate on their own eg, women with irregular menstrual cycles. The goal was to produce a single, healthy egg. These are used by the Best Ivf Hospital in Chennai.
The second use of ovulation induction was to increase the number of eggs reaching maturity in a single cycle, to increase chances for conception. These agents carry an increased risk of multiple gestation, ovarian hyper stimulation. Recently evidence suggest that there may be an advantage to treating even ovulatory women with fertility medications. These women with “unexplained infertility” may have subtle defects in ovulation, and medications may induce two to three eggs to mature, rather only one.
This treatment therefore improves the quality and quantity of the ovulation, thus enhancing pregnancy rates. In ovulatory women, ovulation induction is always combined with intrauterine insemination. Ovulation induction should progress only after a complete and thorough evaluation. All underlying hormonal disorders, e.g. thyroid disorder, abnormal prolactin, should be treated prior to resorting to ovulation induction with fertility drugs.
INTRA UTERINE INSEMINATION:
Intrauterine insemination (IUI), also known as artificial insemination, is a procedure that is used to treat some cases of infertility. During IUI, specially washed and concentrated semen is placed directly into the uterus around the time a woman is ovulating. It can increase the chances of conception. When 3-4 cycles of failed IUI, we would recommend HSG.
Intrauterine insemination which involves careful monitoring before the actual procedure:
Preparing the semen sample. Your partner provides a semen sample, which is thawed and prepared. Because non sperm elements in semen can cause reactions in the woman’s body that interfere with fertilization, the sample will be washed in a way that separates the highly active, normal sperm from lower quality sperm and other elements. The chances of achieving pregnancy increases by using a small, highly concentrated sample of healthy sperm. Monitoring for ovulation. The timing of IUI is monitored with signs of impending ovulation when your body produces a surge or release of luteinizing hormone (LH) and visualize your ovaries and egg growth (transvaginal ultrasound) can be done. You also may be given an injection of human chorionic gonadotropin (HCG) to make you ovulate one or more eggs at the right time. Determining optimal timing. Most IUIs are done a day or two before and after detecting ovulation.
IUI Improves the Chances of Conception:
Decrease the Travel Time of the Sperm: An IUI decreases the travel time for the sperm to reach the egg.
Increase Amount of Sperm to Female Reproductive System: An IUI helps larger numbers of sperm reach into the female reproductive tract.
Synchronizes the Sperm and the Egg: An IUI will help to synchronize the timing of the sperm and the egg when done at the right time.
While lying on an exam table, you’ll put your legs into stirrups and a speculum will be inserted into your vagina,
Attaches a vial containing a sample of healthy sperm to the end of a long, thin, flexible tube (catheter)
Inserts the catheter into your vagina, through your cervical opening and into your uterus
Pushes the sperm sample through the tube into your uterus
Removes the catheter, followed by the speculum
After insemination, you’ll be asked to lie on your back for about 20-30 minutes. You may experience some light spotting for a day or two after the procedure.
When combined with ovulation induction or superovulation, IUI can treat many causes of infertility including:
Ovarian dysfunction: the irregular release of eggs from the ovaries
Endometriosis: painful inflammation of uterine tissue that has migrated outside of the uterus
Cervical factor infertility: the partial or complete blockage of the cervical canal, which prevents sperm from getting into the uterus
Polycystic ovarian syndrome: a common hormonal disorder found in women
Unexplained infertility: diagnosed when all other testing is normal. In these cases, IUI combined with ovulation induction or superovulation can as much as double the chance of pregnancy.
Hysterosalpingogram (HSG): Hysterosalpingogram (HSG) is a fluoroscopic x-ray procedure to evaluate the patency of the fallopian tubes and the shape of the uterine cavity.
Saline infusion sonography. Similar procedure can be done with introduction of saline into uterine cavity and visualization through ultrasound. The flow of saline is noted.
Laparoscopy and chromopertubation: This is done under general anesthesia and a laparoscope connected to a camera can visualize the tubes. A dye is passed through the uterus and its spill is noted from the tubal opening.
HSG is performed:
HSG is an outpatient procedure that can be completed in less than half an hour. HSG is performed in the follicular phase of the menstrual cycle (before ovulation), after menstruation has stopped. A thin catheter is inserted into the cervix and uterus to allow injection of radio-opaque contrast media (a dye that helps show the outline of the fallopian tubes under x-ray). As the dye moves through the uterine cavity, HSG provides a series of fluoroscopic images to demonstrate filling of the uterine cavity and fallopian tubes.
The benefits of HSG:
HSG can reveal uterine or fallopian tube abnormalities that impair fertility. As tubal disease, such as adhesions or scar tissue, is responsible for approximately 20% of infertility cases, HSG should be completed early in the workup of infertility. Some studies have demonstrated increased pregnancy rates in patients who undergo a normal HSG. This may be simply because when the contrast medium is injected into the area by catheter, the flow of the dye sometimes dislodges whatever is blocking the fallopian tubes, e.g. endometriosis lesions. We advise patients who is about to begin fertility treatment with Clomid or HCG (gonadotropin) to have an HSG first, especially if she has a history of endometriosis or other tubal problems.
Will it have pain or other side effects from the HSG test?
Women may have mild to moderate cramping during the HSG procedure. It is rare to experience severe pain from HSG. A possible side effect is allergy to the dye, which contains iodine, so if you know you have an iodine allergy, make sure to tell your fertility doctor prior to having your HSG. Infection is a very rare side effects.
In vitro fertilization (IVF) The most common ART technique is ICSI. IVF in a Ivf Center in Chennai involves stimulating and retrieving multiple mature eggs from a woman, fertilizing them with a man’s sperm in a dish in a lab, and implanting the embryos in the uterus three to five days after fertilization. IVF is offered as a primary treatment for infertility in women over age 40. IVF can also be done if you have certain health conditions. For example:
- Infertility in males
- Damaged or absent Fallopian Tubes
- Unclear Infertility
- Ongoing Intrauterine Insemination Failure
- Pelvic and tubal Adhesions
- The reserves of ovarian are poor in nature
- Preimplantation Genetic Diagnosis (PGD)
- Premature menopause – Donor oocytes
- Uterine pathology needing surrogacy
Failed IUI: If intrauterine insemination (IUI) has been tried 3-4 times and has not been successful the success rates for subsequent IUI’s are not more than 7%. It is better to go for IVF which has a higher success rate.
Fallopian tube damage or blockage. Fallopian tube damage or blockage makes it difficult for an egg to be fertilized or for an embryo to travel to the uterus.
Ovulation disorders. If ovulation is infrequent or absent, fewer eggs are available for fertilization.
Premature ovarian failure. Premature ovarian failure is the loss of normal ovarian function before age 40. When AMH is falling it is better to give the best chance in the shortest period possible and that means IVF because if ovaries fail, they don’t produce normal amounts of the hormone estrogen or have eggs to release regularly.
Endometriosis. Endometriosis occurs when the uterine tissue implants and grows outside of the uterus often affecting the function of the ovaries, uterus and fallopian tubes.
Uterine fibroids. Fibroids are benign tumors in the wall of the uterus and are common in women in their 30s and 40s. Fibroids can interfere with implantation of the fertilized egg.
Previous tubal sterilization or removal. If you’ve had tubal ligation a type of sterilization in which your fallopian tubes are cut or blocked to permanently prevent pregnancy and want to conceive, IVF may be an alternative to tubal ligation reversal.
Impaired sperm production or function. In male factor infertility a total count of less than 10 million or a motility <40% will indicate IVF. If total motile count is the less than 1 million or morphology is less than 4 % IVF with intracytoplasmic sperm injection is indicated. Below-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg.
A genetic disorder. In a case of continuous abortions because of genetic causes and if a genetic disease one can opt for a PGD (preimplantation genetic diagnosis) where the embryo is biopsied with a single cell taken out and transfer of normal embryo in an IVF for pre implantation genetic diagnosis. It is a procedure that involves IVF. After the eggs are harvested and fertilized, they’re screened for certain genetic problems, although not all genetic problems can be found. Embryos that don’t contain identified problems can be transferred to the uterus.
Fertility preservation for cancer or other health conditions. If you are about to start cancer treatment, such as radiation or chemotherapy that could harm your fertility, IVF for fertility preservation may be an option. Women can have eggs harvested from their ovaries and frozen in an unfertilized state for later use or the eggs can be fertilized and frozen as embryos for future use.Women who don’t have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using another person to carry the pregnancy (gestational carrier). In this case, the woman’s eggs are fertilized with sperm, but the resulting embryos are placed in the gestational carrier’s uterus.
Unexplained infertility. Unexplained infertility means no cause of infertility has been found despite evaluation for common causes.
Other techniques sometimes used in an IVF cycle, such as:
Intracytoplasmic sperm injection (ICSI). A single healthy sperm is injected directly into a mature egg. ICSI is often used when there is poor semen quality or quantity. Most common used technique.
Assisted hatching. This technique assists the implantation of the embryo into the lining of the uterus by opening the outer covering of the embryo (hatching).
Donor eggs or sperm: When there are severe problems with either the eggs or sperm, you may choose to use eggs, sperm or embryos from a known or anonymous donor.
Gestational carrier. Women who don’t have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF in a Best Ivf Centre in Chennai using a gestational carrier. In this case, the couple’s embryo is placed in the uterus of the carrier for pregnancy.