Treatment of Infertility

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Ovulation induction and follicle tracking:

 Hormonal tablets or injections are given to the woman to induce ovulation. The response to the medication (growth of follicles in the ovaries) is monitored by hormonal tests and serial ultrasound scans. 

Intrauterine insemination (IUI):

 is a treatment modality where a prepared sample of stronger sperm is inserted into the uterus using a fine plastic catheter, close to the time of ovulation. Additionally, the woman is in some cases, given medication to help her ovulate. 

IUI is useful if:

  • You are having difficulty with intercourse
  • Unexplained infertility of relatively short duration
  • Minor problems with the semen samples
  • Mild endometriosis (a condition in which cells that normally line the womb are found elsewhere in the body)
  • You are using a donor sperm

In vitro Fertilization:

 is a technique where a woman’s eggs are removed from her ovaries and fertilized with the man’s prepared sperm sample in the lab. The woman is given medication to stimulate the ovary to produce several eggs. These are removed by trans-vaginal ultrasound guidance under anesthesia requiring a few hours of hospitalization. The eggs and sperm are then allowed to fertilize overnight in a petri dish in the lab and develop in the incubators for 2-6 days. The best embryos are then put back into the uterus to achieve pregnancy. Additional good quality embryos, if available, are frozen for future use. 

IVF is indicated when:

  • The female partner has blocked or damaged fallopian tubes and the egg and sperm may not be able to meet or the fertilised egg may not be able to make its way into the womb. 
  • The female partner has problems with ovulation (release of an egg) each month
  • The female partner has endometriosis 
  • Unexplained infertility where no cause has been found for not being able to conceive, especially when couples have been trying to get pregnant for more than two years. 
  • Failed IUI

Intracytoplasmic sperm injection (ICSI):

involves injecting a single sperm into each egg, in the lab to try and achieve fertilization. The earlier part of the treatment including ovarian stimulation and egg retrieval is the same as in IVF.

ICSI is useful when:

  • The sperm sample contains decreased numbers of sperm, reduced movement or there is a higher number of abnormal sperm. 
  • The male partner has no sperm in his ejaculate but sperm can be obtained from the testicles, by surgery
  • The male partner produces high levels of antibodies against his own sperm which affects the ability of the sperm to bind to the egg
  • Couples have already had IVF treatment but had unexplained failed fertilization of all the eggs or low fertilization
  • The male partner has retrograde ejaculation, where the sperm passes backwards into the bladder and is found in urine

Blastocyst transfer:

 a blastocyst is an advanced stage of an embryo that has developed 5-6 days after fertilization in the alb. In IVF and ICSI embryo may be transferred into the uterus between two to six days after fertilization. A blastocyst transfer is done in selected cases for better embryo selection. 

Embryo freezing and frozen embryo transfer:

 Embryo freezing is carried out when excess and good quality embryos are available. The frozen embryos can be thawed and used for embryo transfer in subsequent cycles without the need for ovarian stimulation and its associated complications. 

Micro-surgical sperm aspiration

 (PESA-percutaneous epidydimal sperm aspiration, TESE-testicular sperm extraction, mese-microsurgical epidydimal sperm extraction). These are surgical procedures carried out by the andrologist on the male partner, if he is azoospermic, to aspirate or extract sperm to carry out ICSI to achieve a pregnancy. Azoospermia is a condition where no sperms are present in the fluid a man ejaculates. A man might have azoospermia because of a blockage in the connecting passages from the testicles-called obstructive azoospermia or very few sperms or no sperm produced in the testicles called non-obstructive azoospermia.

Other treatments

Assisted hatching (AH): is a procedure to assist the embryos escape from its shell, so that it can implant into the woman’s uterus. It is recommended in special cases like poor quality of eggs/ embryos or repeated IVF failures

Cryopreservation of semen, eggs and embryos: This is a process where wither eggs, sperm or embryos are frozen for future use, using a specialized process in the lab

Pre-implantation genetic screening, pre-implantation genetic diagnosis (PGS, PGD): is a specialized treatment for couples who carry an inherited genetic defect that could cause serious health risks for their children, such as cystic fibrosis, sickle cell disease or thallesemia. This involves taking cells from the embryo and assessing their chromosomes or genes by very specialized procedures to select embryos, without specific condition, prior to embryo transfer

Donor program for semen, eggs and embryos: In some couples, a pregnancy cannot be achieved or there is a very low likelihood of a pregnancy with their own eggs and sperm. In such cases, the options of donor sperm, egg or embryo can be considered. 

Surrogacy or gestational surrogacy: this is an arrangement where a woman called the surrogate mother, carries and delivers a child for another couple. In gestational surrogacy, an embryo is implanted into the surrogate mother’s uterus to achieve a pregnancy. The surrogate mother is not genetically related to the baby. In traditional surrogacy, the surrogate woman can give her egg and the baby grows in her uterus and she is therefore related genetically to the baby

Fertility preservation: eggs and sperm can be frozen for future use, if men or women are diagnosed with cancer and are due to undergo treatment that could damage their fertility. Women may also choose to freeze their eggs to delay having a child. 

Treatment of immunological problems related to infertility: dysfunction of the immune system could contribute to infertility and pregnancy loss. Indeed, many pregnancies/ IVF cycles fail because of chromosomal abnormalities in the embryo. These defects occur randomly and are not always the cause of recurrent pregnancy losses and repeat IVF failure, especially in younger patients. 

Surgical management of female subfertility: includes laparoscopic ovarian drilling, adhesiolysis, salpingectomy for hydrosapinx or ectopic pregnancy, laparoscopic or open myomectomy, laparoscopic cystectomy, hysteroscopic tubal cannulation, hysteroscopic polypectomy, hysteroscopic fibroid resection etc.,

Surgical management of male subfertility: surgical sperm retrieval techniques, varicocelectomy, repair of obstructed vas deference etc. 

Treatment for sexual intercourse problems: medication or counselling can help improve fertility in conditions such as vaginismus, erectile dysfunction or premature ejaculation