I want to start off with a hypothetical story about a Jim and Sandy. They are successful business professionals living a happy and prosperous life with just one discrepancy. They wanted a child really badly but despite conscious attempts and unprotected intercourse for years, Sandy never conceived. It was pretty devastating for both of them but somehow they made peace with themselves thinking that they can never have a child of their own.
But was she really infertile?
Infertility is a fairly common issue and according to research statistics, more than 12 to 15% of all couples face some difficulty in getting pregnant naturally and almost 7% of all the couples are infertile and cannot conceive without some kind of medical intervention.
Thousands of couples make peace with themselves, just like Sandy and Jim thinking that there is no treatment for infertility. That is simply not true. Nowadays there are a wide range of treatments available to help couple conceive ranging from the simple to the complex. The rest of this article will discuss some of the popular treatment modalities and interventions available today for couples fighting infertility.
What are some available treatments of infertility for women?
According to statistics, the primary cause of infertility is a defect in female in 40% of the cases that can be managed by medical or interventional methods of treatment available today.
In many women who present to fertility clinics, the primary defect is a hormonal imbalance that can be corrected by medications like Clomiphene citrate (Clomid). Irregularities of female reproductive hormones prevent ovulation, which is the primary cause of infertility in such cases. Restoration of ovulation by Clomiphene citrate induction involves increasing the release of female reproductive hormones from the pituitary such as FSH (Follicular Stimulating Hormone) and LH (Luteinizing Hormone); thereby helping women achieve a healthy pregnancy.
Other popular medical treatments include:
- Metformin is another medication that is employed in women with known history of polycystic ovarian disease.
- Human menopausal gonadotropin is a hormonal aid used in women who are unable to conceive because of advancing age or hormonal problems. This directly stimulates the ovaries to produce hormones that are able to support a viable pregnancy by signaling the body to releasing the eggs and preparing the endometrium for implantation.
- Hormonal therapy in the form of supplementation with estrogen or progestin during pregnancy that helps women with history of recurrent miscarriages; whereas Luteinizing Hormone is helpful in women who never ovulate because of LH surge failure.
- Other popular medications include Bromocriptine, Human chorionic gonadotropin (hCG), Aromatase inhibitors and Gonadotropin-releasing hormone analogs.
Sometimes long standing pelvic infections lead to scarring of fallopian tubes that becomes a cause of infertility and even with induction, the risk of ectopic pregnancy increases tremendously. In all such cases, the ideal treatment is tubal surgery or laproscopy to remove scarred segments of genital tract. Although, chances of conception are still low after that but it invariably helps a lot of women.
Uterine polyps and fibroids are two other common ailments in many women that will interfere with the proper implantation of a fertilized egg into the lining of the uterus. Depending on the severity of the condition different surgical interventions may be suggested. Operative hysteroscopy is the preferred method of treatment for polyps, and smaller fibroids as it is quicker and safer than older methodologies.
What are some available treatments of infertility in men?
Defects of sperm motility and morphology or a low count may all affect the ability of a man to impregnate his female partner. Sometimes, healthy lifestyle changes, dietary modification, abstinence from alcohol, tobacco and drugs may help but in majority of the cases, other treatments must be employed to treat infertility in men. These include:
- Vitamin E therapy that helps in preventing oxidative damage to sperms and improves quality of semen.
- Selenium is one of the popular remedies that are employed in treatment of infertility due to poor quality sperms.
- Electric or vibratory stimulation is a technique used in males who are unable to ejaculate because of a spinal surgery, spinal injury or direct injury in the pelvic region that is interfering with the ejaculation. It is also helpful in males with history of pre-mature ejaculation.
What to do when nothing works?
In many cases, despite medicinal and interventional therapies, no fruitful results are seen. However, due to advancements in science and technology, there are a number of other interventions that can help infertile couples. Some of these treatments are:
Intra Uterine Insemination (IUI)
IUI is a procedure where processed sperm in injected directly into the uterus when the female partner is ovulating. The goal is to increase the number of viable sperm reaching the ovulated eggs. The procedure can help couples experiencing unexplained fertility, cervical issues, or other issues. This procedure is much less invasive and expensive than more complex treatments such as IVF and is often recommended to couples as a first line of treatment when there is not a solid reason to jump directly to more aggressive treatments.
In-vitro fertilization (IVF):
IVF or in-vitro fertilization is employed in women who are unable to conceive naturally because of a positive history of pelvic surgery, tubal pregnancy, pelvic inflammatory disease and other causes. The IVF procedure is made up of several key steps. First the stimulation phase, where the female partner takes medication to induce her ovaries to produce more mature eggs than she normally would. During this time she is carefully monitored to make sure the proper level of stimulation and that the eggs are properly mature for when they are retrieved. The doctor then surgically removes the mature eggs from the ovaries during the egg retrieval. These eggs are then fertilized in the embryology laboratory with the partner’s sperm (or donor sperm in some cases). The resulting embryos are carefully monitored and when the time is right(usually three or five days after the retrieval) are directly implanted back into the uterine cavity so they can develop normally.
In some cases, women are unable to produce healthy mature eggs at all despite stimulation or induction. In all such cases, IVF can be successful performed by using donor eggs.
Intracytoplasmic sperm injection:
Intracytoplasmic sperm injection is another well-known technique used in conjunction with IVF that is employed in cases where either male sperm count is deficient or most of the sperms are morphologically abnormal. In this procedure, a normal sperm is directly injected into each mature egg obtained through an IVF cycle.
Surgical sperm aspiration:
This procedure is employed in males who cannot ejaculate successfully due to inflammation or infection induced blockade of male reproductive tract. Surgical sperm aspiration can be performed by aspirating the sperm directly from testicles, vas deferens or epididymis.
How to make use of Assisted Fertilization Techniques?
Although, assisted fertilization techniques carry a ray of hope for infertile couples, the chances of having a successful IVF or ICSI can be low. Research studies conducted by medical researchers in Harvard Medical School in Boston and Beth Israel Deaconess Medical Center identified that out of 14,248 IVF performed from 2000 to 2005 only 3,126 were successful and resulted in live-birth of full-term babies. In order to optimize your chances of conception, it is very important to consider following things and speak to your fertility doctor about it.
- Maternal age: is a huge factor when determining your likely success rate. For example, the average couple under 35 can expect a success rate of around 60%, that rate drops to around 10% for the average couple over 42
- Pre-implantation Genetic Diagnosis: In some cases when one or both genetic parents have a known medical condition, it becomes important to determine the the genetic combination of the embryos by Pre-implantation Genetic Diagnosis before implantation in order to increase the chances of producing an offspring free of the genetic disorder. This will likely reduce your chances as there is no way of determining if or how many your embryos will meet the requirements.
Speak to your healthcare provider in detail about the possible techniques or procedures that may be helpful for you and maintain a healthy and stress-free lifestyle to avoid gestational problems.