Infertility Treatment
Diagnosis
It is essential for the doctor to understand a couple’s sexual habits and make recommendations to improve chances of conceiving before a couple is tested for infertility. In some cases there is no specific reason ascertained for infertility this is also termed as unexplained infertility. Infertility diagnosis can be an expensive and uncomfortable process.
Tests for men:
In males, the testicles produce healthy sperm which is ejaculated into the vagina and travels to the egg and fertilises it. These are the main requisites of male fertility. Tests for male infertility aim to ascertain if any of these processes are damaged.
Apart from physical examination of the male genitals, male infertility testing includes the following:
- Hormone testing: Blood tests are done to determine if adequate testosterone and other male hormones are present.
- Transrectal or scrotal ultrasound: Imaging studies of the structures like ejaculatory duct or seminal vesicles are done to ascertain if these organs are performing poorly or if there are any blockages.
- Semen analysis: semen specimens are collected in a sterile container and sent for lab testing. This test is done to analyse the level of sperm production, sperm motility, sperm volume, concentrations and structure.
- Genetic testing: tests are done to ascertain any genetic disorders causing infertility.
- Testicular biopsy: In certain cases where the semen test depicts low number of sperm then, testicular biopsy is performed to identify disorders leading to infertility.
Tests for women:
Apart from general physical exam with a gynaecological exam, specific fertility tests include:
- Ovarian reserve testing: This test helps to identify the quantity of eggs available for ovulation. This test may involve imaging and blood tests.
- Ovulation/hormone testing: Blood tests are done at different times of a menstrual cycle to determine hormone levels in blood.
- Ultrasound: Imaging test of the pelvic area is done to determine issues affecting fertility. In some cases a sonohysterogram, is also done to see the details of the uterus that are not visible in a regular ultrasound.
- Hysterosalpingography: This testing is done to evaluate the condition of the fallopian tubes to ascertain if there are any blockages or any damages in the tubes.
In rare cases, tests may include:
- Laparoscopy: This is a minimally invasive procedure in which a thin tube with lighted camera is inserted from small incisions made in the navel area. With the help of this camera, fallopian tubes, ovaries and the uterus are examined to check for any endometriosis, scarring, any blockages and irregularities of the reproductive organs.
- Hysteroscopy: The doctor might recommend a hysteroscopy to examine any uterine abnormalities. In this procedure a thin device is inserted through the cervix into the uterine cavity.
According to the symptoms, the doctor will determine which tests are required to diagnose infertility issues.
Treatment:
Factors that determine infertility treatment are causes of infertility, duration, age of the couple, and personal choices. In some cases infertility cannot be treated. But if the couple is not able to conceive they can achieve pregnancy by assisted reproductive technology.
Treatment for men:
Infertility caused by lack of healthy sperm can be treated by the following:
- Surgery: In certain cases, a surgery can treat sperm blockage and restore fertility. Also in certain cases surgery can be done to treat varicocele, a condition in which there is enlargement of veins carrying blood to the testicles.
- Sperm retrieval: In this procedure sperm is obtained directly from the testicles. This process is done for men who have ejaculation issue or have no sperm in their semen.
- Changing lifestyle: Choosing an improved lifestyle and bringing changes in behaviours can enhance the chances of conceiving. Lifestyle changes like exercising regularly, quitting smoking and consumption of alcohol, increasing frequency of intercourse can help in treatment of infertility.
- Medications: The doctors may prescribe medications that improve the sperm count and the quality of the sperm. This improves chances of getting pregnant.
Treatment for women:
Types and nature of treatments required to improve fertility depends on the causes and duration of infertility in women.
- Intrauterine Insemination (IUI): This is a non-invasive procedure in which healthy sperm sample is placed into the uterus directly in co-ordination with the time when the ovary releases a mature egg. The sperm then directly travels to the fallopian tube to fertilise the egg thus omitting the long journey a sperm has to travel in natural conception.
- Surgery: Problems of the uterus like endometriosis, uterine septum, scar tissue, uterine fibroids, and pelvic adhesions can be treated with Hysteroscopic and laparoscopic surgery. Certain cases may also require open abdominal surgery depending on the severity of the problem.
- Stimulating ovulation/ medications: Women who face infertility due to ovulations disorders can get treated with the help of medications that regulate and induce ovulation.
Assisted reproductive technology:
Assisted reproductive technology (ART) is used to treat infertility. ART incorporates technology that handles both eggs as well as sperm. In vitro fertilization (IVF) is one of the most common ART process. It works my extracting eggs from the female body and fertilising them in the lab with a sperm to form embryos. These embryos are then implanted in the woman’s uterus. In most of the cases IVF is done using the couple’s eggs and sperm however in a few cases donor eggs and sperm are also used. Women who have uterus disorders and are unable to carry the baby in their womb can also opt for IVF using a gestational carrier (surrogate). In such cases, the couple’s embryos are implanted in the uterus of another woman or the carrier for pregnancy.
Another technique used in IVF is Intracytoplasmic sperm injection (ICSI). In this procedure a healthy sperm is directly injected into the mature egg. Assisted hatching technique is also used in IVF process. In this procedure the outer covering of the embryo is opened and then the embryo is implanted into the lining of the uterus.
Complications of treatment:
Infertility treatments have complications like multiple pregnancies. Complications like premature labor and delivery rise with the increase in number of foetuses. In ART procedures the chances of having multiples pregnancies is considerably high.
Some women suffer from Ovarian Hyperstimulation Syndrome (OHSS). A condition in which the ovaries over-respond to the fertility medications, due to which a large number of eggs are may be matured and are released at one time. This results in enlargement of the ovary and fluid build-up in the abdomen. This condition is characterised by abdominal pain, bloating, weight gain, shortness of breath.
Bleeding and infection are common risks involved in any invasive procedure performed to treat and diagnose infertility.
