After careful investigation your Doctor will discuss with you what treatment options there are. Sometimes the cause for a couple’s infertility can be found and treated, after which normal fertility will be restored. For example when fallopian tubes are blocked surgery might be possible to re open them. Some cases of ovarian failure can be treated with medicines.
Even when no cause for infertility is found there are ways to help you increase your chances of getting pregnant. Assisted reproductive techniques (ARTs) involve manipulation of sperm and ova or embryos in vitro with the goal of producing a pregnancy. Examples of ART are intrauterine insemination (IUI), in vitro fertilization (IVF).
Ovulation Induction (OVI)
OVI is a hormonal treatment with which the menstrual cycle is regulated. Follicle growth will be monitored and ovulation detected with ovulation test (LH tests) or induced by an injection of pregnyl. This way we will know exactly when the ovulation will take place.
Ovulation induction involves taking medication to induce ovulation by encouraging eggs to develop in the ovaries and be released, increasing the chance of conception through timed intercourse or artificial insemination.
Ovulation Induction, The Process
Assessment Your fertility doctor will assess your ovulation cycle with blood tests to measure hormone levels at specific stages of your cycle; and an ultrasound to see the development of follicles in the ovaries and thickness and appearance of the uterus lining.
Stimulation Your ovaries are stimulated with medications to promote the growth of follicles containing eggs. Your doctor will discuss with you the most appropriate medication or combination of medications for your situation.
Monitoring Your cycle is monitored very closely with ultrasounds and/or blood tests to check the number and size of follicles developing, this is essential to reduce the risk of a multiple pregnancy.
Timed intercourse or Intra Uterine Insemination (IUI) Follicle growth will be monitored and ovulation detected with ovulation test (LH tests) or induced by an injection of pregnyl. Near the time of ovulation your specialist will advise the most appropriate day to have sexual intercourse to maximise your chance of pregnancy or perform an intrauterine insemination where prepared sperm is inserted into the uterus.
Intra Uterine Insemination (IUI)
IUI is short for Intra Uterine Insemination. IUI is a procedure in which after ovarian stimulation sperm that is processed in the laboratory is placed directly high in the uterus.
IUI with homologous semen should be preferred as the first choice treatment to more invasive and expensive techniques of assisted reproduction in case of infertility of unknown cause or due to cervical or mild male factor.
Many variables may influence success rates after IUI treatment. Some factors such as female age, duration of infertility etc cannot be influenced. However overall live birth could be estimated at approximately 15% per treatment cycle. Subsequently IUI has a good patient compliancy (low drop out rate), a low risk of OHHS (ovarian hyper stimulation syndrome) and a low number of multiple pregnancies.
In Vitro Fertilisation (IVF)
IVF or in vitro fertilization, is a technique that involves fertilization of an egg cell outside of the body after which an embryo is transferred into the womb.
During IVF treatment, fertility drugs are prescribed to stimulate egg production. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. Stimulation will be monitored by transvaginal ultrasound hormone levels in the blood. Then eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity to remove the eggs. A sample of sperm is prepared for combining with the eggs after which the sperm and eggs are mixed together and stored in a laboratory dish to encourage fertilization.
In some cases where there is a lower probability of fertilization, intracytoplasmic sperm injection (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.
The embryos are usually transferred into the woman’s uterus three to five days following egg retrieval and fertilization. A catheter or small tube is inserted into the uterus to transfer the embryos. If the procedure is successful, implantation typically occurs around six to ten days following egg retrieval.
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It is helpful when beginning fertility treatment to develop a long-term plan with your doctor so that you will have an idea of how long to pursue a particular treatment before moving on to more aggressive therapy or stopping treatment. Each couple has a unique set of circumstances, and the chances of treatment success vary widely.