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Infertility - Treatments

infertility treatments


Fertility treatments can be grouped into three categories:

  • Medicines to improve fertility - these are sometimes used alone, but can also be used in addition to assisted conception.
  • Surgical treatments - these may be used when a cause of the infertility is found that may be helped by an operation.
  • Assisted conception - this includes several techniques such as intrauterine insemination (IUI), in vitro fertilisation (IVF), gamete intrafallopian transfer (GIFT), and intracytoplasmic sperm injection (ICSI).

Each of these is discussed briefly below.

Medicines that may improve fertility

Medicines are mainly used to help with ovulation. Ovulation is when the ovary makes and releases an egg (ovum).

Ovulation is partly controlled by hormones called gonadotrophins. These are made in the pituitary gland (a gland just under the brain). The main gonadotrophins made by the pituitary gland are called follicle-stimulating hormone (FSH) and luteinising hormone (LH). These pass into the bloodstream and travel to the ovaries.

Clomifene is a medicine that has been used to help with fertility for many years. It is taken as a tablet. It works by blocking a feedback mechanism to the pituitary gland. This results in the pituitary making and releasing more gonadotrophin hormones than normal. The extra amount of gonadotrophin hormones may stimulate the ovaries to ovulate.

Medicines that contain gonadotrophins are another type of treatment. These need to be injected. They are used when clomifene does not work, or prior to IUI and IVF, to cause ovulation. Gonadotrophin medicines may also improve fertility in men with certain types of hormone problems that can affect sperm count.

Medicines that contain gonadotrophin-releasing hormone are sometimes used. These stimulate the pituitary to release gonadotrophins (which in turn stimulate the ovaries).

Metformin may be offered to women with polycystic ovary syndrome (PCOS) who have infertility but have not responded to clomifene. Some studies have suggested that metformin may help to improve fertility in some women with PCOS, usually in addition to clomifene.

Surgical treatments

Fallopian tube problems - surgery may help some women with infertility caused by Fallopian tube problems. For example, if your Fallopian tubes have been blocked or scarred from a previous disease, infection, or other problem. These days, most surgery to the Fallopian tubes is done by keyhole surgery.

Endometriosis - surgery may help to improve fertility in women with endometriosis.

Polycystic ovary syndrome - an operation on the ovaries may be suitable for some women with PCOS. The procedure is sometimes called ovarian drilling or ovarian diathermy. Using keyhole surgery, a heat source (diathermy) is used to destroy some of the follicles (tiny cysts) that develop in the ovaries.

Fibroids - for women with fibroids, surgery (to remove the fibroid) may be considered if there is no other explanation for the infertility.

Male infertility - when sperm are blocked by an abnormality in the epididymis in the testis, surgery may help. Varicoceles (like varicose veins of the testes) that occur in young men (aged under 25 years) may be repaired surgically.

Assisted conception

Intrauterine insemination (IUI)

This is the process by which sperm are placed in the woman's womb. It is done by using a fine plastic tube which is passed through the cervix into the uterus. Sperm are passed through the tube. It is a relatively straightforward procedure. It can be timed to coincide with ovulation (about half way through a monthly cycle) in women who are still ovulating. Fertility medicines may also be given beforehand, to maximize the chance of ovulation occurring.

Women who have this procedure need to have healthy Fallopian tubes to allow the egg to travel from the ovary into the womb. If successful, fertilisation takes place within the womb.The sperm used can be either from the male partner, or from a donor:

The male partner's sperm can be used when the cause of the infertility is unexplained and the sperm seem fine, or for cases where the female cervical mucus seems to block or kill the sperm. Sperm is obtained by the male partner masturbating just prior to the IUI procedure.

Donor sperm are obtained from a sperm bank of frozen sperm provided by donors. It may be considered as an option when: the male partner has no or very few sperm; has had a vasectomy, and reversal has failed or not been tried; has an infectious disease such as HIV; there is a high risk of transmitting a genetic disorder to a baby.

If IUI does not work, couples tend to move on to try other methods described below.

In vitro fertilisation (IVF)

In vitro fertilisation means fertilisation outside of the body. IVF is mainly used in couples whose infertility is caused by blocked Fallopian tubes, or unexplained infertility.
IVF involves taking fertility medicines to stimulate the ovaries to make more eggs than usual. When the eggs have formed, a small operation is needed to harvest them (egg retrieval). Each egg is mixed with sperm. This is obtained either by the male partner masturbating, or from a donor. The egg/sperm mixture is left for a few days in a laboratory dish. The aim is for sperm to fertilise the eggs to form embryos.

One or two embryos which have formed are then placed in the woman's womb using a fine plastic tube passed through the cervix. Any other embryos which have formed in the dish are either discarded or, if you wish, frozen for further attempts at IVF at a later date.

Your chance of success with IVF may be higher if:

  • The female partner is under the age of 39.
  • The female partner has been pregnant before.
  • The female partner has a body mass index (BMI) between 19 and 30 (they are a good weight).

Other things that may reduce the chance of success of IVF include:

  • Drinking too much alcohol or smoking.

It is recommended that couples should be given the chance of three complete cycles of IVF in order to have a realistic chance of conceiving.

Gamete intrafallopian transfer (GIFT)

A gamete is an egg or sperm. Eggs and sperm are collected in the same way as for IVF. The eggs are mixed with sperm. The mixture of eggs and sperm is then placed into one of the woman's Fallopian tubes. Therefore, unlike IVF, the sperm fertilises the egg naturally inside the woman's Fallopian tube or womb, and not outside the body in a laboratory dish. For this to work, the woman's Fallopian tube needs to be healthy.

Intracytoplasmic sperm injection (ICSI)

This technique involves an individual sperm being injected directly into an egg. (It is injected into the cytoplasm - the outer part of the egg.) This method bypasses any natural barriers that may have been preventing fertilisation. For example, some cases of infertility are due to the sperm of a male partner not being able to penetrate the outer part of the egg to fertilise the egg. ICSI can also be used when a male partner has a low sperm count as only one sperm is needed.

The egg containing the sperm is then placed in the womb in the same way as with IVF. ICSI is used for couples who have failed to achieve fertilisation through IVF, or where the quality or number of sperm is too low for normal IVF to be likely to succeed.

Egg donation

This involves stimulating the ovaries of a female donor with fertility medicines, and collecting the eggs which form. The eggs are mixed with and fertilised by sperm of the recipient's partner (similar to IVF). After 2-3 days, embryos are placed in the womb of the recipient via the cervix. This method is an option for: women who have ovarian failure and cannot produce eggs; who have had their ovaries removed; who have conditions where the ovaries do not work (for example, in Turner syndrome); where there is a high risk of transmitting a genetic disorder to the baby. It is also used in certain cases of IVF failure.

Embryo donation

Couples who have had successful IVF treatment may decide to donate any spare embryos to help other infertile couples.

Some people suggest that supplements including zinc, selenium, and vitamin E supplements, may be helpful for men who have abnormal sperm counts due to an unknown cause. However, the evidence to support them is weak.

Possible complications of infertility treatments

Multiple pregnancy

Pregnancy in the Fallopian tube:An ectopic pregnancy (a pregnancy that develops in the Fallopian tube) is a little more likely in women who are undergoing treatment for infertility.

Stress

Over-stimulation of the ovaries: There is a small risk that some of the medicines used to treat infertility, such as the gonadotrophin medicines, can over-stimulate the ovaries and can lead to a condition known as ovarian hyperstimulation syndrome.

Close monitoring using ultrasound is often used when women are given medicines to stimulate the production of eggs by the ovaries. The numbers and size of follicles (the sac containing an egg) can be measured.


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List of Health Topics related to Infertility

Infertility

What Is Infertility

Ways to Boost Your Fertility

Treatment Options

Surrogacy

Some IVF Facts

Smoking and Inferility

Semen Analysis

Risk factors of Infertility

Pelvic Exam

PCOS-Short and Sweet

IVF for Dummies

How to Select an IVF Fertility Clinic

Embryo Glue or Transfer Media

Donor Sperm

Donor Eggs

Diagnosis of Female Infertility

Diagnosing infertility

Complications of IVF Treatment

Causes of infertility

Blastocyst Culure and Transfer

Age and Fertility

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