Fertility Treatments

Are you trying to conceive but unsure if it is okay to keep trying or thinking of delaying the decision of starting a family but want to confirm if this could backfire? If the answer to either of these questions is yes, then it would be advisable to see a Fertility Expert. The Doctor would ask you questions on your medical and family history (to identify any pre-existing reason which would impact fertility), and do basic blood tests and an Ultrasound scan of the female partner. In case you would like a detailed investigation the inside of the womb cavity can be checked for any polyps or fibroids indenting or growing into the cavity. In addition the fallopian tubes can be checked to see if they are open. The male partner should also accompany as semen test is an integral part of fertility screening. In case all tests are in the normal range, the couple can safely plan their pregnancy. In case a problem is diagnosed, timely advise would improve outcome of treatment.

Women who have irregular periods do not ovulate (release of egg from ovary). If other tests are normal, the simplest treatment would be to correct the underlying lack of ovulation. This is done through medications (tablets and/or injections) in conjunction with ultrasound monitoring. The tablets are typically given from the second day of the cycle for five days. In case the response to tablets is inadequate or absent, injections may be started from the seventh day of cycle till the follicle (which houses the egg) is ready for ovulation. Some patients may be given injections directly from the second day of cycle till the follicle is ready for ovulation. At this stage an (hCG) injection is given to cause ovulation.   Ultrasound monitoring is mandatory to help ensure ovulation of no more than 2-3 eggs so that the pregnancy that results is either a singleton or a twin pregnancy.

Intrauterine insemination is the process of inserting active sperms (obtained through processing of fresh semen) at or around the time of ovulation into the uterus. This is best done in conjunction with mild ovarian stimulation for better success rates. It is often offered to couples experiencing delay in conception. It is also indicated in couples unable to cohabit. IUI with donor sperm is offered to single women wanting to conceive and in couples where husband’s sperms are absent. It is unsuitable in couples where infertility is either due to obstructed fallopian tubes or if the sperm number or motility is low.

In vitro fertilisation or test tube baby is the technique of creating embryos in the laboratory from eggs and sperms. In many cases embryos are created by injection of a single sperm into each egg, this technique is called Intra Cytoplasmic Sperm Injection or ICSI. The embryos thus formed are cultured/grown for three to five days. The best embryos are then transferred into the uterus with the anticipation that they will grow into a pregnancy.

An IVF cycle consists of the following steps:

• Stimulation of ovaries with daily injections

• Egg collection

• Creation of embryos (IVF/ICSI)

• Culture of embryos

• Embryo Transfer

Embryos may also be preserved so that they can be transferred in a subsequent cycle for best success rates. Surplus embryos can be kept preserved for second attempt or a second pregnancy.

Success rates with IVF/ICSI mainly depend on the age of the female partner. The chances start decreasing after the age of 35 years.

Sperm freezing is a well-known technique used for preserving sperm for later use. This is especially useful in cancer patients before undergoing chemotherapy/radiotherapy to preserve fertility. In addition, sperm freezing technique has practical uses where availability of husband at the time of fertility treatment is difficult.

Embryo freezing has come a long way since the advent of the technique of Vitrification. Embryo survive and give success rates comparable to fresh embryos with this technique. Embryo cryopreservation can be used to enable pregnancy later (in married cancer patients), to delay fertility, to enable genetic testing of embryos prior to transfer and to store surplus embryos for later use. The success rates of Frozen embryo transfer in a subsequent natural cycle are better than fresh transfer in the same cycle, hence choosing this option will give better success rates.

Egg freezing involves stimulation of the ovaries (exactly like in IVF) followed by egg collection. The mature eggs thus collected are preserved using Vitrification technique. It is an acceptable method of preserving fertility for women with cancer prior to undergoing cancer treatment, women at risk of damage to ovaries or those wishing to delay childbearing for social or personal reasons.

Adverse impact of conditions such as swollen tubes, fibroids, endometriosis, polyps, septum, etc on the success of fertility treatments can be decreased by corrective keyhole surgery through Hysteroscopy and/or Laparoscopy.

Conditions such as fibroids (non-cancerous growths in the uterus), blocked fallopian tubes, endometriosis have a negative influence on success rates of fertility treatments. In many conditions, keyhole surgery can be done to get the best chances of success from fertility treatments. For example, in case of a fibroid greater than 1 cm growing into the cavity of uterus, removal of the fibroid will improve the chances of pregnancy from IVF treatment. Similarly, in case of blocked and swollen tubes, laparoscopy can eliminate the impact of the disease on the success rate of IVF.