TREATMENT OPTIONS

Discovering that you have an infertility problem can be very stressful. You become faced with many difficult decisions to make. There are usually five options available to choose:

Accepting child-free living (stay childless)

The decision regarding the management of your infertility is yours and yours  alone. But it should be noted that the provision of fertility treatments varies greatly from country to country and even in the same country from clinic to clinic. Before you agree to a fertility treatment, we recommend that you consider the following questions:

What is the cause of your infertility?
Why and how the treatment will be given?
What are the alternatives?
What is your chance of achieving a pregnancy and a live birth without treatment and how much will the proposed treatment improve your chances of success?
How much will the treatment cost?
What are the possible risks and complications?
How long will you have to undergo treatment in order to give it a reasonable chance to work

Ovulation Induction

Some women have irregular menstrual cycles and don’t produce an egg each month. This is called anovulation and is usually due to the woman having polycystic ovary syndrome (PCOS). Other causes include stress, weight loss or weight gain, or excessive production of a hormone called prolactin which stimulates milk production in the breasts.

Anovulation is the commonest cause of infertility and the easiest to treat. The treatment is call ovulation induction and the aim is to restore ovulation in the most natural way possible.  It involves the woman taking fertility drugs, either in the form of tablets or injections, to help the ovary produce and release a single egg each month.

Injections are only used if there is no response to the milder tablet drugs. The response to the medication is monitored with a series of ultrasound scans in the first half of the cycle (follicle tracking) and a hormone blood test for progesterone 7 days after ovulation.

IUI

Intrauterine insemination (IUI) is the simplest form of assisted conception and involves the injection of prepared sperm into the uterine (womb) cavity. The procedure is similar to having a smear test except a fine catheter is passed through your cervix, to enable the passage of sperm directly into the womb. The procedure is timed to correspond with ovulation and optimise chance of conception.

In general IUI is appropriate in the following cases:

• Unexplained infertility
•  Mild degree of abnormality in the sperm
• Antisperm antibodies
•  Difficulties having intercourse

PROCEDURE
Insemination is timed to when the egg is released into the fallopian tube, either following the administration of HCG  or urine detection of natural ovulation. On the morning of insemination your partner will need to produce a fresh sperm sample which is washed and prepared in the laboratory. He will need to attend the clinic at least 2  hours before your insemination is scheduled to occur.

The prepared sample is then mixed with a small amount of culture fluid and drawn into a syringe. During the insemination the clinician or nurse performing the procedure will gently insert a speculum into your vagina to visualise the cervix. Cervical secretions are first removed and then a fine plastic catheter is passed gently through your cervix into the uterus. The syringe is attached and sperm injected slowly.

This may be slightly uncomfortable, a mild period pain sensation but otherwise is relatively quick and painless. There is no need to take time off work or limit usual daily activities following IUI but you should plan for 2 to 4 visits to the ACUduring your treatment cycle for scans and the insemination itself.

If you do not have a period 2 weeks after insemination, a pregnancy test should be done. This can be a standard home pregnancy test or you may choose to come to the clinic for a blood test. If the test result is positive we can arrange for you to come in for an early pregnancy scan 3 weeks later (you will be 7 weeks pregnant at this stage). 

Following insemination you may be commenced on progesterone pessaries (Cyclogest) to take each night for 14
days.

IVF
In Vitro Fertilisation (IVF) is a treatment in which fertilisation of eggs by sperm takes place outside the body in a dish in the laboratory. The fertilised eggs are allowed to grow in the laboratory for 2 or 3 days before being replaced in the woman’s uterus (womb). It is the treatment of choice for women with blocked, damaged or absent fallopian tubes but is also used when there are moderate sperm abnormalities or the infertility is unexplained
An ovary has a pool of immature eggs.

In a woman’s natural cycle, it is usual to produce one egg each month, which is released from the developing follicle (fluid filled sacs) two weeks before the next period starts. In IVF cycles the aim is to achieve the growth and development of several follicles in order to maximise the chance of collecting several eggs.

Injections of follicle stimulating hormone (FSH) are taken from the start of the cycle to stimulate growth. and when the follicles are mature the eggs are collected. These are then put together with the sperm in the laboratory to allow fertilisation to take place. The fertilised eggs are allowed to grow in the laboratory for 2 or 3 days before being replaced in the woman’s womb (uterus)

The main reasons for advising IVF in a couple are:

•  Damaged or blocked fallopian tubes, which stop the sperm from reaching the egg
•  Suboptimal sperm quantity or quality, which reduces the chance of fertilisation
•  Antisperm antibodies present in sperm
•  Anovulation (failure of the ovary to release an egg) resistant to conventional ovulation induction techniques
• Unexplained infertility

ICSI is a special form of IVF in which individual sperm are injected into the egg under microscopic vision. This is the treatment advised for couples where the sperm quantity or quality is very
poor.  

The IVF cycle  
The IVF cycle consists of five stages:
1.  Stimulation of the ovary with fertility drugs to enhance egg production (superovulation)  
2.  Collection of mature eggs from the ovary (egg retrieval)
3.  Preparation of motile sperm from the male
4.  Mixing of eggs and sperm in the laboratory to allow fertilisation to occur
5.  Selection of the one or two (occasionally three in some circumstances) best embryos and transferring these to the uterus (embryo transfer)

ICSI

Intracytoplasmic injection (ICSI) is a special form of IVF in which individual sperm are injected into the egg under microscopic vision. This is the treatment advised for couples where the sperm quantity or quality is very poor or when IVF has resulted in failed fertilisation. It is also used when the sperm has been collected through surgical sperm retrieval. Who needs ICSI?

ICSI is appropriate:

•  When sperm is too poor for IVF such as; low count, poor movement (motility or progression) or high
percentage of abnormal forms (morphology)
•  When there are high levels of antisperm antibodies (e.g. following vasectomy reversal)
•  When there has been previous failed or poor fertilisation during IVF
•  When the sperm has been microsurgically recovered from the epididymis or testes

Men who have very few sperm (oligospermia), no sperm (azoospermia) or high numbers of abnormal sperm would
previously have had little or no chance of fathering their own genetic offspring. ICSI offers such men and their
partners real hope of having their own genetic child.