Infertility is when a couple is not able to become pregnant after 1 year of regular and unprotected sexual intercourse. The main symptom of infertility is not being able to get pregnant, and there may be no other symptoms.
Some causes of infertility can’t be prevented. When the reasons can’t be controlled, then infertility treatment can be done. According to the causes, infertility treatment is selected. It ranges from medications to the implantation of an embryo into the womb by Assisted Reproductive Technology (ART).
For men, the problems affected fertility includes hormonal imbalance and erectile dysfunction. These can be handled with medicines. Other issues like blockage of tubes which carry sperms can be repaired with surgery.
In women, most medicines used for infertility treatment, stimulates ovaries to produce more eggs to increase the chances of pregnancy. If there is any blockage in the fallopian tubes, then surgery can be done. Surgery also can be done in conditions like endometriosis, polyp, fibroids, etc.
Assisted Reproductive Technology (ART):
Assisted reproductive technologies are used in couples which are still suffering from infertility even after many of the infertility treatments.
1. Intra-Uterine Insemination (IUI)
- Preparing the semen sample:
The male partner has to provide a semen sample. The sample will be washed to separate highly active, normal sperm among the lower quality sperms.
- Monitoring for ovulation:
For this, the woman can use an at-home urine ovulation predictor kit which detects the LH surge or an imaging method that helps to visualize the ovaries and growth of ovum. She will be given with HCG injection for ovulation with one or more eggs.
This infertility treatment is commonly done in 1 to 2 days after ovulation.
- The patient should lie on her back, and a speculum is inserted into the vagina. A vial containing a sample of healthy sperm is attached to the end of a long flexible catheter. Then inserted the catheter through the vagina and the sperm is pushed into the uterus, then the catheter is removed.
2. In Vitro Fertilization (IVF)
- Ovulation induction
If the patient uses her ovum for the procedure, then she has to take measures to induce ovulation. Medications for ovarian stimulation, oozyte maturation, to prevent premature ovulation, and to prepare the lining of the uterus.
- Egg retrieval
The patient is sedated for the procedure. An ultrasound probe is inserted into the vagina to identify the follicles. Then a thin needle is inserted for the retrieval of eggs with the help of a suction device. Mature eggs are placed in nutritive liquid and incubated.
- Sperm retrieval
The male partner should provide a semen sample by masturbation on the morning of egg retrieval. Testicular aspiration also can be used for sperm retrieval. Sperms are separated from the semen fluid.
Fertilization for infertility treatment can be done with two different methods.
- Conventional insemination: Healthy sperm and mature egg are mixed and incubated overnight.
- Intra cytoplasmic sperm injection (ICSI): An effective infertility treatment in which healthy sperm is injected directly into the mature ovum.
- Embryo transfer
The procedure is done with mild sedatives. Then a long, thin tube is inserted into the uterus through the vagina. A syringe containing one or more embryos suspended in a fluid is attached to the catheter. Then using this catheter, the embryo is placed into the uterus.
3. Intra Cytoplasmic Sperm Injection (ICSI)
ICSI, an infertility treatment, used as a part of in vitro fertilization. In this method, the healthy sperm is directly injected to the cytoplasm of the egg.
- Fertility drugs are used to stimulate ovulation. The male partner is advised to produce a sperm sample himself. Sperm extraction method also can be used.
- The retrieved sperms are frozen.
- Egg retrieval is done by a needle attached with an ultrasound probe.
- Isolated healthy sperm is selected and it is injected to the ovum. After one day, after fertilization, the embryo is formed. Then the procedure follows the same steps as in IVF.
- ICSI is the commonly used infertility treatment for couples who are dealing with male factor infertility.
Surrogacy is an arrangement, supported by a legal agreement, where a woman is agreeing to become pregnant for a person or a couple. There are two types of surrogacy.
1) Traditional surrogacy
Here the ovum of surrogate and sperm from a donor or the intended father is used. Insemination of the surrogate is done by natural or artificial insemination. If the sperm of the donor is used, then there will not be any genetic relationship between the baby and the intended parents.
2) Gestational surrogacy:
The embryo created by in vitro fertilization is implanted in the surrogate. The child will be genetically unrelated to the surrogate mother.
It is a provision of a man, of his sperm for artificial insemination to his wife or a woman who is not his sexual partner.
Sperm donation requires basic screening for infectious diseases and certain risk factors.
– Physical examination
– Semen testing
– Genetic testing
– Family medical history
– Psychological evaluation
– Personal and sexual history
The sperm is collected from the donor. The sample is frozen and keeps in quarantine for 6 months. After 6 months the donor is examined for infectious diseases like HIV. If the tests are negative, the frozen sample is evaluated for quality. If it has standard quality, then it is used for infertility treatment.
Egg donation is a process by which a woman who is young and healthy donate eggs to another person for assisted reproduction so that the recipient can have a baby.
- Egg donor application and screening
- Egg donor matching: A tentative donor egg match is made when a recipient decides to continue with a specific donor.
- Suppression and ovarian stimulation for the egg donor: The donor should take a daily injection to suppress her normal cycle to synchronize with the recipient’s cycle. Then gonadotropin injection is taken to stimulate the ovary to produce eggs.
- Endometrial lining development of the donor-recipient: During egg retrieval from the donor, the recipient should take estrogen and progesterone to prepare the endometrium for implantation.
- Triggering ovulation and egg retrieval for the egg donor: When ultrasound imaging shows the ovum is matured, then hCG injection is given to the donor for ovulation.
- Fertilization and embryo transfer.
- Post-Retrieval checkup for the donor.
Embryo donation is otherwise called as embryo adoption, because the fertilized ovum, which is almost ready to become a baby is donated to a recipient.
– Locate the donor embryos: You can sign up through an agency, clinic or by personally.
– Get the doctor’s approval: A fertility doctor can look at all the medical factors related to the embryo which has to be donated. Then he will approve to continue the process.
– Sign a contract
– Arrange transportation of the embryo
– Start taking medicines: Before embryo transfer, you have to taking medicines which contain estrogen and progesterone, to prepare the body and uterus to accept the embryo.
– Frozen embryo transfer: The embryo is transferred to the uterus which is ready for implanting the embryo.