What are the infertility treatment?

Introduction

Infertility can be a challenging issue for couples trying to conceive, but there are several infertility treatment options available depending on the underlying cause.

Infertility treatments

There are lots of ways to help people with all kinds of fertility issues. Sometimes only one person needs treatment, other times both partners will use a combination of treatments. Fertility treatments often include medications that help with hormones and ovulation, sometimes combined with minor surgical procedures.

Intrauterine Insemination (IUI)

Intrauterine insemination (IUI) is a fertility treatment that gives sperm a better chance at fertilizing an egg. This treatment can improve pregnancy chances for some couples and individuals

It involves placing sperm directly into a woman’s uterus around the time of ovulation to facilitate fertilization. It is often recommended for couples facing certain fertility challenges and is considered less invasive and less expensive than other forms of assisted reproductive technology like In Vitro Fertilization (IVF).

IUI is a type of artificial insemination. Artificial insemination means that doctors insert sperm inside the uterus to achieve pregnancy.

How IUI Works

• Before the IUI procedure, the woman undergoes a series of tests to check for any potential issues that could affect the success of the treatment, such as blocked fallopian tubes or hormonal imbalances. The male partner may also undergo a semen analysis to assess sperm quality and count.
• The timing of the IUI is crucial. Ovulation can be monitored through various methods, including blood tests, ultrasound, or home ovulation predictor kits. Sometimes, fertility medications are used to stimulate the ovaries and control the timing of ovulation to ensure that an egg is ready for fertilization.
• On the day of the procedure, a sperm sample is collected from the male partner or a donor. The sample is then “washed” in a laboratory to concentrate the healthiest and most motile sperm, removing any seminal fluid and other impurities that could cause discomfort or reduce the chances of fertilization.
• The actual IUI procedure is relatively quick and straightforward. A speculum is inserted into the vagina to allow access to the cervix. Then, using a thin, flexible catheter, the prepared sperm is carefully inserted into the uterus. This process takes a few minutes and is usually painless, though some women may experience mild cramping.
• After the procedure, the woman may be advised to rest briefly before resuming normal activities. There is no required downtime, and many women return to their routine immediately after IUI.
• After IUI, there is a two-week waiting period before a pregnancy test can be taken. During this time, the woman may be prescribed progesterone supplements to help support the uterine lining and improve the chances of implantation.

Risks and Considerations

Multiple Pregnancies: When fertility medications are used to stimulate ovulation, there is an increased risk of multiple pregnancies (twins, triplets, etc.), which can pose health risks to both the mother and the babies.

Infection: There is a minimal risk of infection from the IUI procedure, but it is rare.

Ovarian Hyperstimulation Syndrome (OHSS): In rare cases, fertility medications can cause the ovaries to become swollen and painful.

In Vitro Fertilization (IVF)

In Vitro Fertilization (IVF) is an assisted reproductive technology (ART) that involves retrieving eggs from a woman’s ovaries, fertilizing them with sperm in a laboratory, and then transferring the resulting embryos into the woman’s uterus. IVF is one of the most effective infertility treatments and is often recommended when other methods of conception have been unsuccessful.

IVF is the joining of a woman’s egg and a man’s sperm in a laboratory dish. In vitro means outside the body. Fertilization means the sperm has attached to and entered the egg.

How IVF Works

• The IVF process begins with ovarian stimulation. The woman takes fertility medications (typically for about 10-14 days) to stimulate the ovaries to produce multiple eggs, rather than the single egg that develops each month.
• Regular monitoring blood tests and ultrasounds are conducted to track the development of the follicles, which contain the eggs.
• Once the follicles have matured, a procedure called egg retrieval (or egg aspiration) is scheduled. This procedure is usually performed under mild sedation.
• Using an ultrasound-guided needle, the eggs are collected from the ovaries through the vaginal wall. The procedure usually takes about 20-30 minutes, and recovery is relatively quick.
• On the day of egg retrieval, a sperm sample is collected from the male partner or a sperm donor. The sperm is then prepared in the lab by separating the healthiest, motile sperm from the rest of the sample.
• The eggs and sperm are combined in a laboratory dish to allow fertilization. There are two main methods of fertilization in IVF: Conventional Fertilization: The eggs and sperm are placed together in a dish and allowed to fertilize naturally. Intracytoplasmic Sperm Injection (ICSI): A single sperm is injected into an egg. ICSI is often used when there are issues with sperm quality or quantity.
• After fertilization, the embryos are cultured in the lab for several days (usually 3 to 5 days). During this time, they are monitored for development and growth. Embryos that reach the blastocyst stage (5 days old) have a higher chance of implantation and are often preferred for transfer.
• The healthiest embryo(s) are selected for transfer into the woman’s uterus. The number of embryos transferred depends on several factors, including the woman’s age and the quality of the embryos. The transfer is done using a thin catheter inserted through the cervix into the uterus. The procedure is typically quick and painless, similar to a Pap smear.
• After the embryo transfer, the woman may be prescribed progesterone supplements to support the uterine lining and help with embryo implantation.
• About 10-14 days after the embryo transfer, a blood test to determine if pregnancy has been achieved.

Risks and Considerations

Multiple Pregnancies: Transferring more than one embryo increases the risk of multiple pregnancies (twins, triplets, etc.), which carries higher health risks.

Ovarian Hyperstimulation Syndrome (OHSS): A condition where the ovaries become swollen and painful, usually due to fertility medications.

Ectopic Pregnancy: Rarely, an embryo can implant outside the uterus, usually in a fallopian tube, which requires medical intervention.

Emotional and Financial Stress: IVF can be emotionally challenging and financially costly, especially if multiple cycles are needed.

Intracytoplasmic Sperm Injection (ICSI)

Intracytoplasmic Sperm Injection (ICSI) is a specialized form of In Vitro Fertilization (IVF) that involves the injection of a single sperm into an egg to achieve fertilization. ICSI is primarily used to address male infertility issues, particularly when sperm quality or quantity is insufficient for conventional IVF methods.

How ICSI Works

• As with traditional IVF, the ICSI process begins with the woman undergoing ovarian stimulation. Fertility medications are used to stimulate the ovaries to produce multiple eggs. The development of the eggs is monitored through ultrasounds and blood tests.
• Once the eggs have matured, they are retrieved from the ovaries using a minor surgical procedure called egg retrieval or aspiration. This procedure is typically done under sedation or anesthesia and involves using a thin needle to collect the eggs from the ovaries via the vaginal wall.
• A sperm sample is collected from the male partner or a sperm donor on the day of egg retrieval. In cases where sperm cannot be obtained through ejaculation, it may be surgically extracted directly from the testicles (a procedure known as testicular sperm extraction or TESE). The sperm is then processed in the lab to isolate the healthiest, most motile sperm.
• In the lab, a single healthy sperm is selected and injected directly into the cytoplasm (the interior) of a mature egg using a fine needle called a micropipette.
• This method bypasses the natural barriers to fertilization, such as the egg’s outer layer (zona pellucida), and ensures that fertilization occurs even when sperm quality is poor.
• After the ICSI procedure, the fertilized eggs (now embryos) are cultured in the lab for several days (typically 3 to 5 days) to allow them to develop. The embryos are monitored during this time, and the best-quality embryos are selected for transfer.
• The selected embryo(s) are then transferred into the woman’s uterus using a thin catheter. This step is similar to the embryo transfer in conventional IVF. The number of embryos transferred depends on factors such as the woman’s age, the quality of the embryos, and the clinic’s protocol.
• After the embryo transfer, the woman may receive progesterone supplements to support the uterine lining and aid in implantation.
• About 10 to 14 days after the embryo transfer, a blood test is conducted to check for pregnancy

Risks and Considerations

Risks to the Egg: The ICSI procedure involves manipulating the egg, which carries a small risk of damage to the egg during the injection process.

Genetic Concerns: There is a slightly higher risk of certain genetic and chromosomal abnormalities with ICSI, especially in cases of severe male infertility. Preimplantation genetic testing (PGT) can be considered to screen for these issues.

Multiple Pregnancies: As with traditional IVF, there is a risk of multiple pregnancies if more than one embryo is transferred.

OHSS (Ovarian Hyperstimulation Syndrome): The use of fertility medications can sometimes lead to OHSS, a condition where the ovaries become swollen and painful.