Treatment option for infertility

What is assisted reproductive technology (ART)?
Assisted reproductive technology (ART) is a term that describes several different methods used to help infertile couples. ART involves removing eggs from a woman's body, mixing them with sperm in the laboratory and putting the embryos back into a woman's body.

The U.S. Centers for Disease Prevention (CDC) collects success rates on ART for some fertility clinics. According to the 2003 CDC report on ART, the average percentage of ART cycles that led to a healthy baby were as follows:
37.3% in women under the age of 35
30.2% in women aged 35-37
20.2% in women aged 37-40
11.0% in women aged 41-42

IVF
In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman's fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man's sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman's uterus.

# Who are the best couples for I.V.F. treatment ?
1-Couples with unexplained failure of conception
2-Patients with blocked tubes (the sperm cannot reach the oocytes to fertilize them)
3-Patients with poor semen analysis.
4-Patients with severe polycystic ovarian syndrome and dysfunctional ovulation
5-Patients with endometriosis
6-Patients with anti-sperm antibodies (both male and female)

There are basically five steps in the IVF and embryo transfer process which include the following:
1.Monitor and stimulate the development of healthy egg(s) in the ovaries.
2.Collect the eggs.
3.Secure the sperm.
4.Combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilization and early embryo growth.
5.Transfer embryos into the uterus.

GIFT & ZIFT
Gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT) are two procedures related to IVF.
GIFT is similar to IVF, but the gametes (egg and sperm) are transferred to the fallopian tubes rather than the uterus, and fertilization takes place in the tubes rather than in the laboratory. GIFT also involves a laparoscopic surgical procedure to transfer the sperm and egg into the tubes. GIFT accounts for approximately 2% of assisted reproductive technology (ART) procedures in the United States.
ZIFT differs from GIFT in that the fertilization process still takes place in the laboratory versus the fallopian tubes. It is similar to GIFT in that the fertilized egg is transferred into fallopian tubes, and it involves a laparoscopic surgical procedure. ZIFT accounts for less than 1.5% of assisted reproductive technology (ART) procedures in the United States.

IUI
Intrauterine insemination (IUI) is a procedure in which sperm are placed in a woman's uterus through artificial means. IUI is most often recommended for couples with unexplained infertility or male factor infertility — such as a low sperm count or poor sperm motility. For many couples, intrauterine insemination is a more affordable and less invasive alternative to in vitro fertilization (IVF). However, IUI is not effective for infertility associated with blocked or damaged fallopian tubes.
Intrauterine insemination involves injecting sperm directly into your uterus at the time of ovulation. This can be done using either your partner's sperm or a donor's sperm. Before the procedure, the sperm are "washed" and prepared for injection. Your doctor uses a soft tube (catheter) to deposit the sperm through your cervix and into your uterus at the time of ovulation. Fertility drugs that stimulate ovulation may be used in conjunction with intrauterine insemination. Success rates for IUI depend on many factors, including your age and the duration and cause of infertility.

Why is ‘sperm washing’ necessary
Sperm must be washed in order to be used with IUI. Raw semen cannot be inserted directly into a woman’s uterus. This is because semen contains chemicals called prostaglandins. Prostaglandins cause muscular contractions and are responsible for cramps during menstruation and pregnancy. If raw semen is inserted directly into your uterus, rather than going through the cervix first, it could cause severe pain and cramping. It could also cause your uterus to collapse, causing severe complications.
Sperm is also washed in order to increase your chances of becoming pregnant. Sperm washing can remove dead sperm and those sperm with poor motility. This leaves behind sperm that can swim faster and that are more likely to fertilize your egg. Sperm washing can also get rid of the white blood cells, mucous and seminal fluid surrounding the sperm, which can also interfere with fertility.

Male Infertility Treatment

Assisted reproductive technologies such as in vitro fertilization (IVF), GIFT, ZIFT, and intracytoplasmic sperm injection (ICSI) can be used when either the man or the woman is infertile. When male factor infertility is solely responsible for a couple’s inability to conceive (usually due to low sperm count or poor sperm quality) there are several techniques and male infertility treatment options designed to collect and process sperm to improve the chances of fertilization with the egg.

Sperm Retrieval Procedures
One of the most common causes of male infertility is low sperm count. Treatment for low sperm count usually involves some type of sperm retrieval procedure. These less invasive treatment options are designed to obtain sperm from a man who would otherwise have trouble producing it.

Percutaneous Epididymal Sperm Aspiration (PESA)
Percutaneous Epididymal Sperm Aspiration (PESA) is a male infertility and low sperm count treatment option to pursue if there is no sperm in the semen. During this minimally invasive sperm retrieval procedure, a needle is inserted through the scrotum and into the epididymis and the sperm cells are removed.
This virtually pain-free treatment commonly lasts between 10 and 20 minutes and requires only a local anesthetic.

Testicular Sperm Extraction (TESE)
TESE is another male infertility treatment reserved for men who have a blockage which prevents sperm from entering their epididymis. In this method, small amounts of testicular tissue are removed via a needle inserted into the testis. The tissue is processed and the sperm is eventually extracted.
This male infertility treatment involves a general anesthetic. Side effects include pain and soreness, which will usually diminish within a few days.

Microepididymal Sperm Aspiration (MESA)
MESA is a sperm retrieval treatment employing microsurgery techniques to collect sperm near blocked portions of the epididymis. Microepididymal sperm aspiration requires a tiny incision in the scrotum. Fluid is then recovered from the epididymal tube and analyzed for sperm content.
This type of male infertility treatment is performed under general anesthetic. Pain and discomfort are common after the procedure, but can be relieved with prescribed pain medication.

Sperm Preparation Methods
Sperm preparation methods are designed to enhance sperm function and increase the chances of conception. Each of the methods below ensures the sperm are ready to be used as part of fertility treatment with IVF, artificial insemination, and other assisted reproductive technologies.

Swim-Up Technique
The swim-up technique is widely used in fertility clinics. It is based on the fact that sperm need to swim up to reach the uterus and only the healthiest and most active sperm can do that. This preparation method involves placing a culture medium on top of semen in a tube. The healthy, active sperm swim up into the culture medium, leaving behind seminal fluid and debris such as white blood cells, dead sperm, and bacteria. As the sperm swim up to and reach this culture, they are collected and used in a fertilization treatment.

Cryopreservation
Cryopreservation of semen involves collecting and freezing sperm for later use. During this male infertility treatment, sperm is collected and mixed with a freezing medium that allows the sperm to survive the freezing process.
Some men who wish to undergo a vasectomy opt for cyropreservation treatment beforehand to ensure they have active sperm to use in the future, if need be.
Surgical Infertility Solutions for Men
In addition to the male infertility treatment methods used for assisted reproductive technology, there are a several surgical infertility solutions available to treat specific anatomical problems:

Vasoepididymostomy
Vasoepididymostomy is a surgical procedure designed to treat an epididymal obstruction, such as scarring or cysts, which can block the sperm from traveling into the vas deferens.
This male infertility treatment is a difficult microsurgical procedure, requiring a skillful and experienced surgeon.

Varicocelectomy
Varicocelectomy is the most common procedure performed for male infertility. This treatment is essentially a surgical procedure to repair varicoceles (varicose veins of the testicles). The additional blood from varicoceles can raise the temperature of the testes and impair sperm production, causing low sperm count. Treatment to repair this condition requires that veins are cut to eliminate blood flow to the varicocele, improving fertility and increasing the chances of conception.

Female Infertility Treatment

Natural Treatments
Female infertility treatment commonly involves assisted reproductive technologies such as IVF, GIFT, ZIFT, and ICSI to improve the chances of conception, but there are also a variety of structural causes of female factor infertility that have surgical solutions, including endometriosis treatment. Reproductive surgery and diagnostic procedures (particularly diagnostic hysteroscopy) can correct tubal obstruction, endometriosis, uterine fibroids, and scarring from pelvic inflammatory disease.

Endometriosis and Infertility – Treatment Options
Endometriosis is one of the most common causes of female factor infertility, affecting nearly 5 million women in the United States each year. Endometriosis is a chronic disease that causes tissue to build up outside of a woman’s uterus. The tissue can attach to the ovaries, uterine wall, and fallopian tubes causing severe abdominal pain. Endometriosis can also result in significant scarring of the reproductive organs, which sometimes contributes to female infertility. Endometriosis treatment includes several non-surgical and surgical options.
Hormonal medications can be used to halt or slow the progression of endometriosis. A common prescription used for endometriosis treatment is Gn-RH agonists, which control estrogen production – a contributing factor in the growth of endometrial tissue. Other prescription options can be discussed with your doctor or fertility specialist.
There are other effective, but more invasive female infertility and endometriosis treatment options. Read below to learn more.

Other Reproductive Surgery
Reproductive and female infertility treatment options often involve surgical procedures, including:

Laparotomy Microsurgery
This female infertility treatment involves the use of a microscope to perform reproductive surgery. Laparotomy microsurgery can be used for endometriosis treatment or to remove scar tissue and reconstruct fallopian tubes. This procedure is more invasive than most, but it is an excellent option for many women facing fertility problems.

Laparoscopy
This procedure entails the use of a laparoscope to perform surgery. The laparoscope is inserted through a small incision in order to view the pelvic organs. Operating through additional small incisions, scar tissue can be removed and damaged fallopian tubes can be repaired. This procedure is commonly used for female infertility and endometriosis treatment.

Diagnostic Hysteroscopy
Diagnostic hysteroscopy is an important tool used to diagnose female infertility. This treatment involves the use of a fiber optic scope to inspect the uterus for abnormal uterine conditions such as fibroids, polyps, and scarring. Diagnostic hysteroscopy is performed by stretching the cervical canal and using the scope to view the internal structure of the uterus.
Diagnostic hysteroscopy is commonly performed on an outpatient basis and recovery time is typically between two and three days.

Falloposcopy
This female infertility treatment is used to inspect the fallopian tubes for abnormalities such as tube obstruction, scarring, and damage to the inner lining. The falloscopy procedure entails the use of a fiber optic scope to inspect the fallopian tubes and correct any of the above conditions. It will also allow your physician to determine and recommend other female infertility treatment if the damage is too severe.

Contributed by Lawrence Oh