What treatments are available to cure infertility?
The ultimate goal of infertility treatment is a healthy pregnancy and the birth of one healthy infant. There are various treatments for infertility, depending what the problem is. Identifying the cause of your infertility is important as it may affect the choice of treatment. If the cause is known, the treatment can be tailored to the problem. A fertility treatment plan, involving both the man and woman, may include changes in nutrition, lifestyle, and environmental factors.
Drug therapies (such as bromocriptine or clomiphene citrate), hormone therapy (e.g., Perganol), surgical intervention, and assisted reproductive technologies may be used, depending on the problem and diagnosis. Assisted reproductive technologies (ART) include intra-uterine insemination (IUI), in vitro fertilization (IVF), gamete intra-fallopian transfer (GIFT), GIFT-ET (a combination of GIFT and IVF), zygote intrafallopian transfer (ZIFT), and intracytoplasmic sperm injection.
Drug treatments - if test results detect problems with ovulation, fertility drugs may be used. These drugs can be used to encourage and regulate ovulation. Because the drugs stimulate the ovaries a woman can produce and mature one or more ova in each cycle. In men, fertility drugs can help increase sperm production.
In Vitro Fertilization (IVF) - IVF is used to treat infertility blockages of the fallopian tubes, endometriosis, abnormal sperm, and some cases of unexplained infertility. If the fallopian tubes are damaged and can’t be repaired or there is a problem with sperm transportation, I.V.F may be recommended. This involves fertilization of the egg taking place outside the body (in a laboratory) followed by implantation into the woman’s uterus (womb). In vitro means 'in glass' and refers to the dish where fertilization takes place. The process of I.V.F. treatment is commonly known as a 'test tube baby'.
Artificial Insemination (AI) - Artificial insemination is used in cases where the male has a low sperm count or a high number of abnormal sperm, or the woman has sperm antibodies present in her cervical mucus. Sperm is treated in the laboratory to increase the chances of fertilisation. Large numbers of sperm are then inserted directly into the uterus for easy access to the fallopian tubes. Sometimes when couples are producing sperm and eggs, but have a problem bringing them together, (maybe due to the woman’s tubes being blocked or even a problem with intercourse) artificial insemination is sometimes used. In this situation, the sperm and eggs are physically placed together in the woman’s womb and then left for nature to run its course.
Surgery - if a woman's fallopian tubes are blocked she will be offered surgery to unblock them. If the surgery is a success the couple may then be able to go on and have a natural conception. If the man's sperm ducts are blocked and it's interfering with sperm production or movement, he will also be offered surgery.
Gamete Intra-Fallopian Transfer (GIFT) - This procedure is the same as that for IVF except that fertilisation takes place inside the body of the woman. The eggs and sperm (gametes) are collected and placed directly into the fallopian tubes for fertilisation to occur. GIFT is used in cases of endometriosis, cervical disorders, and some types of male infertility. It is suitable only for women with no abnormalities in the fallopian tubes.
Zygote Intra-Fallopian Transfer (ZIFT) - ZIFT involves the same procedure as IVF except that the very early embryo (zygote) is placed directly into the fallopian tube. This procedure is undertaken when there are abnormal sperm and/or problems with the ability of the sperm to fertilise the eggs.
Intracytoplasmic Sperm Injection (ICSI) - This is a technique in which a single sperm is inserted directly into the egg. Eggs are obtained the same way as for IVF and then fertilised by injecting a single sperm into them. The fertilised eggs can be transferred to the fallopian tubes of the woman or grown in the laboratory for a couple of days and then transferred to the uterus.
Epididymal and testicular sperm extraction - Sperm are removed from the epididymis or directly from the testis using a needle. Fertilisation is performed by ICSI. This treatment is used in cases of male infertility such as azoospermia and spermatic cord abnormalities. Usually enough sperm can be collected so that samples can be frozen for later use if required.
Freezing of sperm and embryos - If more embryos are produced through IVF than are needed for transfer into the womnan's uterus, the extra embryos can be frozen. The stored embryos can be used later if the patient does not become pregnant, or if the couple wishes to have more children through IVF at a later date. There is a limit to the number of years frozen embryos can be stored, and laws governing this may differ in each state. Similarly, sperm can be frozen for use in subsequent IVF cycles, or as 'insurance' against infertility due to procedures such as cancer therapies, vasectomy or prolonged absence from a partner (such as men in military service may experience). Sperm can also be frozen and kept in sperm donor banks.
Donor eggs, embryos and sperm - For women who have ovarian failure, men who do not produce sperm, or couples whose eggs fail to fertilise, the use of donor eggs, embryos or sperm may be an option. Older women may also wish to use donor eggs from younger women to overcome the problems of ageing. Depending on which state you live in, there are certain legal restrictions on the use of donor eggs, embryos and sperm.
Pre-implantation genetic diagnosis (PGD) - PGD is an embryo screening technique which can be used to identify embryos with chromosome abnormalities. A single cell is removed from an early-stage embryo and checked for genetic disorders using molecular techniques. Only the healthy embryos are transferred to the woman's body. Genetic disorders that can currently be detected in this way include cystic fibrosis, Duchenne muscular dystrophy, thalassemia, haemophilia A, muscular dystrophy, hydrocephalus, Huntington's disease, imbalances in the number of chromosomes (aneuploidy), and sex-linked disorders. Research is ongoing to develop reliable tests for other genetic disorders.
Problems with male sperm quality and count don't preclude pregnancy through IUI. But if the total healthy sperm count at the time of insemination is less than five million - a very low count - chances for pregnancy are diminished. If the total healthy sperm count is below one million, IVF or donor sperm insemination is usually performed.