The desire to have a child is natural, and most women plan on experiencing pregnancy and childbirth at a certain point in their adult lives. Although conceiving a child may seem like the easiest thing in the world, it is actually not the case for many couples. the consequence of the infertility can effect on you, your emotions, your sexuality and your relationships. It also outlines a number of ways in which you and your partner can cope with the problem of infertility. Background on infertility is generally defined as the inability to conceive after one year of trying to become pregnant. Most couples assume that they are fertile and expect to conceive soon after they stop using birth control. However, almost 10 percent of all women of childbearing age are infertile, and about one quarter will experience at least one period of infertility sometime during their lives.
Causes of infertility:
Most couples that have difficulties achieving pregnancy are not sterile, but are usually infertile or subfertile (having a reduced chance of conceiving spontaneously in the normal way). The most common known causes of infertility are spermatozoal defects, ovulatory disorders and tubal disease. But the biggest group is due to “unexplained infertility”. This is when a couple fails to conceive after about 18 months of regular intercourse, and no cause is found.
Among couples who seek medical help, infertility is exclusively a problem in the female in about 40% of cases, and exclusively in the male in about 30% of cases. In the balance of cases, infertility results from problems in both partners or the cause of the infertility cannot be explained. Today’s treatments offer a good rate of success, and approximately three out of four women will get pregnant as a result of treatment.
Today there is plenty of latest procedures and treatment available to assist couples in achieving pregnancy. The treatment recommended for you will depend on your particular diagnosis and your decision on which direction your treatment will take. Our hospitals offers you a quality selection of the following procedures and treatments:
In Vitro Fertilisation-Embryo Transfer (IVF) or EGG donation
IVF-ET is probably the most commonly used of the Assisted Reproductive Technologies (ART). It is often known as the “test tube baby” procedure and has helped infertile couples conceive and bear children for well over two decades. In order for a pregnancy to occur, an egg must be released from the ovary and unite with a sperm. This union, called fertilisation, normally occurs within the fallopian tube. During the process of IVF, however, this union takes place in a laboratory after both eggs and sperm have been collected. The fertilised eggs are then transferred to the uterus to continue growth.
Cases in which IVF may be recommended
process at a glance There are several major steps to the in vitro fertilisation (IVF) process. All of these are done on an outpatient basis:
- Downregulation of the pituitary, depending on which IVF protocol is used
- Stimulation and monitoring of the follicles
- Collection of the eggs
- Collection and preparation of the sperm sample
- Incubation of the egg(s) and sperm together in the laboratory, to allow for fertilisation and early embryo development
- Transfer of the embryo(s) into the uterus
- A two-week wait for a pregnancy test
Intra-Uterine Insemination (IUI)
This procedure, also known as “artificial insemination”, involves placing washed sperm into the uterus with a small catheter through the cervix. Sperm can be from the partner or from frozen donor sperm, depending upon your needs. IUI is often performed if you have had failed attempts at timed intercourse or if there is a determination of abnormal cervical mucous/sperm interaction, poor mucous, or hostile mucous which renders the sperm unviable. In the latter case, sperm are injected past the cervical barrier to enable them to move into the fallopian tube and reach the egg. Variations in the procedure include taking medications to produce multiple follicles and the release of more than one egg in order to achieve fertilisation.
Medication is given which temporarily switches off the messages going from the brain to the ovaries telling them to produce an egg on a monthly basis.
In addition, down regulation prevents premature release of the egg. Thus, down regulation primarily serves to ensure correct timing of ovulation prior to egg collection. To ensure that the medication has worked, a blood sample is taken to check the level of oestradiol (one of the oestrogen hormones) and sometimes by performing an ultrasound scan of the ovaries and womb (uterus).
Ovarian stimulation and follicles monitoring
Gonadotropins are given to stimulate the ovaries into producing the follicles, which contain the eggs. HMG contains equal parts of FSH (Follicle Stimulating Hormone) and LH ( Lutenizing Hormone). Both hormones are natural parts of the follicle stimulating process. Treatment with hMG lasts 1 to 2 weeks and involves a once-daily subcutaneous injection. Your doctor or nurse will teach you how to give the injections yourself. The length of treatment will depend on how your ovaries respond; ovary response will be monitored with the use of ultrasound. Once ultrasound shows that the lead follicle has matured in size, hCG (human Chorionic Gonadotropin) will be injected to trigger the release of the egg
Egg retrieval and embryo observation
Thirty-six hours after the trigger shot, retrieval of the eggs is undertaken. The procedure itself is performed at the hospital/clinic most often by a transvaginal route. A needle, guided by ultrasound imaging, is inserted through the vaginal wall into the ovaries, where the follicles containing the eggs are punctured and withdrawn. The released eggs are transferred to the lab where their developmental stage is assessed. Anesthesia is usually not used for this simple procedure. The procedure takes about 10-15 minutes, and you can return home a few hours after it. A sperm specimen is then washed and prepared for insemination. Each egg is placed in a dish and a defined number of sperm cells is added. Each dish is placed in an incubator. The embryos are then observed for a few days for normal fertilisation under a microscope.
If fertilisation is successful, the embryos can then be transferred to the uterus. The transfer technique is accomplished by placing 1-4 embryos inside a narrow plastic tube (transfer catheter) which is then inserted into the uterus through the cervix. The process lasts only a few minutes. You may then rest for a couple of hours, and return home where you often are advised to take it easy for 1 or 2 days.
Luteal phase support
In some cases, supplemental progesterone is occasionally used to improve the secretion of progesterone and estrogen during the luteal phase. It is administered in different ways to support the luteal phase. Luteal support is administered to improve chances of implantation.
Intra-Cytoplasmic Sperm Injection (ICSI)
ICSI is a type of assisted microsurgical fertilisation that involves the injection of a single sperm directly into an egg. Over the last few years, various methods of assisted microsurgical fertilisation (micromanipulation procedures) have been developed for use when the male partner exhibits poor sperm motility and/or low sperm count. ICSI allows a much higher fertilisation rate for these patients with “normal” fertilisation in over 50% of the eggs. Eggs for ICSI are obtained in exactly the same way as those for IVF. Following egg retrieval, the cells surrounding each egg are carefully removed. The eggs are then examined under a microscope and only those that are judged as mature are suitable for injection. Typically, 70% of the eggs that are obtained are suitable for ICSI. The sperm are washed and prepared. The egg and the sperm are then placed on a special microscope that has micromanipulators attached to it. One micromanipulator holds the egg in place, while the other is used to inject the sperm into the egg. The remainder of the procedure is similar to standard IVF with regard to incubation of the eggs and transfer of the resulting embryos.
Gamete Intra-Fallopian Transfer (GIFT)
This form of assisted reproduction technique involves the same first and second step as in vitro fertilisation, namely superovulation and monitoring follicular and endometrial growth. The eggs are retrieved (normally transvaginally with local anaesthesia), again by ultrasoundguided-aspiration of the follicles on the ovaries. A previously washed and prepared sperm specimen is obtained. The eggs and sperm are then placed together in a catheter. Normally two eggs in each tube are transferred. In step four, a laparoscopy is performed on the patient and a small camera is placed just under the navel into the pelvic area. The fallopian tube is then grasped using special instruments and the catheter containing the eggs and sperm are threaded into the fallopian tube (see ill. 3). The eggs and sperm are then injected into the fallopian tube. The idea is to bypass physical barriers to normal egg and sperm transport due to adhesions, endometriosis, and immunological problems. Although the process places the egg and sperm in close proximity that enhances the chance of collision, it does not guarantee fertilisation. Eggs in excess can be taken back to the lab for IVF and possible embryo freezing for future use. This may help to determine if normal fertilisation can take place. In cases of questionable sperm motility or fusion, achieving fertilisation in the lab may be preferable.