The situations where surgical infertility treatments may be an option include:
Commonly known as fertility drugs, ovulation induction medications can be taken either orally or through injections to stimulate a woman’s ovaries to release multiple mature eggs. This improves chances for fertilization and ultimately pregnancy.
Success rates vary depending on the method of ovulation induction used to treat the infertility, though in general they are high. Risks include increased chances of multiple births and ovarian cysts, both of which are reduced by closely monitoring patients
Intrauterine insemination (IUI) is also commonly known as artificial insemination. This procedure involves placing a sperm sample that has been prepared (or “washed”) directly into a woman’s uterus near the time of ovulation. It is often coupled with ovulation induction, especially in couples who have infertility due to male factors, such as low semen volume, low sperm concentration or decreased sperm motility. It can also be used to treat infertility due to cervical mucus problems.
The main purpose of “washing” a semen sample is to separate the seminal fluid from the sperm cells. Seminal fluid contains prostaglandins, which can cause severe cramping in the uterus. Depending on the quality of the semen specimen, the sperm wash can also filter out cellular debris, round cells (including white blood cells), and dead sperm so that the final preparation that is used for the IUI contains a high concentration of sperm that have a good-to-fast-forward progression.
By processing the semen and placing the sperm directly into the uterus, IUI increases the number of sperm that move through the reproductive tract to the fallopian tubes – where fertilization usually occurs. This relatively simple procedure takes just a few minutes and is performed in our office without any sedation. In certain cases, back-to-back inseminations may be performed over the course of two consecutive days to further increase the amount of sperm in the reproductive tract during this key time in the reproductive cycle. This may enhance to the chance of achieving pregnancy, particularly in the case of donor sperm insemination procedures where no additional sperm reaches the fallopian tubes through sexual intercourse.
IVF means fertilisation outside of the body. In vitro literally means in glass (that is, in a laboratory dish or test tube). 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 into 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. You may also be asked to consider donating any spare embryos to be used for research, or to be donated to other infertile couples.
Your chance of success with IVFmay be higher if:
It is recommended that when IVF is used:
This technique involves an individual sperm being injected directly into an egg. (It is injected into the outer part of the egg – the cytoplasm.) 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.
If needed, a sperm can also be obtained by a small operation to the testis. This may be done when sperm cannot be produced in the usual way. For example, if the male partner has a blocked vas deferens, or has had a vasectomy.
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.