INFERTILITY TREATMENTS

 
 

 

Ovulation Induction (OI)

 

OI is also called ovarian stimulation and involves, most commonly, taking a drug called clomiphene citrate (the brand name is Clomid or Serophene) in tablet form.  The drug stimulates the production of various hormones that are responsible for ovulation.  Regular ultrasound scanning of the ovaries during the cycle is essential to ensure that not too many eggs are produced, which could lead to ovarian hyperstimulation syndrome.  Because of the associated risks of long-term use, the clomiphene should not be given for more than three months at a time.  It can be given for a total of six months, but there should be a one-month break after the first three months. 

 

Clomiphene is taken from day 2 to day 5 of your cycle.  The drug binds to oestrogen receptor sites in the brain, making the body think that oestrogen secretion is too low.  This causes the hypothalamus to produce more GnRH (gonadotrophin-releasing hormone).  GnRH tells the pituitary gland to release more LH and FSH.  This results in an egg starting to mature in a follicle, ready for ovulation.  HCG (human chorionic gonadotrophin) injections may also be given to boost final maturation of follicles.  HCG is usually given 36 to 40 hours before final maturation of follicles.

 

OI is suitable for women whose periods are irregular, as a result of a diagnosed hormonal imbalance, and those who are under the age of 35, are most likely to benefit.  OI can help women with polycystic ovarian syndrome, those whose production of LH is faulty and prevents the ovarin follicles from maturing properly or those who are producing insufficient amounts of progesterone after ovulation in the luteal phase which inhibits the implantation of a fertilized egg in the womb.

 

Ovarian hyperstimulation syndrome (OHSS) occurs in about 15% of women who are treated with OI or IVF where too many eggs are produced.  Women need to be followed closely and have regular ultrasound checks to check the number and development of follicles in each ovary.  Occasionally, the abdomen and thorax become engorged with fluid, and in vary rare cases OHSS can lead to thrombosis, heart attack or stroke.  Symptoms to watch out for include :

 

  • nausea and vomiting

  • severe abdominal pain

  • difficulty breathing

  • feeling faint

 

 

 

Intrauterine induction (IUI)

 

IUI is a procedure in which good-quality active sperm are placed directly into the uterus – and therefore close to an egg.  This is done around the time of ovulation, which is determined either by an ultrasound scan or using an ovulation predictor kit. 

 

IUI gives the sperm a helping hand by enabling them to avoid the first hurdle, having to make their way through the cervical mucous and into the uterus.  Natural fertilization still takes place in the fallopian tubes.  With IUI alone, there is a 6-8% rate of conception per cycle.  Used in conjunction with clomiphene, this goes up to 10-12%.

 

Your partner will have to produce a sperm sample which will be washed and sorted to make sure that only the healthiest sperm are used.  These are then placed into the uterus using a catheter that has been inserted via the cervix.  Treatment only takes a few minutes and generally causes little or no pain.  IUI takes place as close as possible to ovulation as possible. 

 

 

 

In-Vitro Fertilization (IVF) 

 

In-vitro fertilization (IVF) involves retrieving multiple mature eggs just before ovulation and fertilizing them in a Petri dish in laboratory conditions.  The resulting embryos are then graded and the best – though a maximum of tow – are then transferred, via a catheter inserted through the cervix, to the uterus, where it is hoped they will implant.

 

IVF is not suitable for everyone but can help :

women whose fallopian tubes have become blocked;

women with a hormonal imbalance who have not responded to other forms of treatment;

couples with unexplained infertility;

men with low sperm counts or poor-quality sperm;

couples who carry the gene for certain specific genetic disorders such as cystic fibrosis;

couples who require a donor egg to become pregnant, either because the woman is no longer producing eggs or because her eggs are not able to mature properly. 

 

Success rate of IVF varies considerably :

  • Women under 35 years                  28.2%

  • Women aged 35-37 years              23.6%

  • Women aged 38-39 years              18.3%

  • Women aged 40-42 years              10.6%

  • Women aged 43-44 years              3 %

  • Women aged 45 years and over      1 %

 

If IVF is the best option, find a fertility clinic that you think will give you the best chance of success, given your particular situation.  Information in this regard within South Africa is available on this website.

 

 

 

Intra-Cytoplasmic Sperm Injection (ICSI)

 

ICSI is a type of IVF that carries a high fertilization rate and a high live birth rate.  The procedure is particularly successful in overcoming male infertility issues arising from problems with sperm, as only a single healthy sperm needs to be isolated and then ijected directly into an egg.  ICSI is not an infallible technique : the egg may not be successfully fertilized because it is too immature, too ripe, or of poor quality generally : the sperm that fertilizes the egg may be defective;  and not all eggs that are fertilized will go on to divide.  However, the success rate of fertilization with ICSI is high.

 

ICSI will be considered when :

 

  • a man’s sperm count is very low;

  • the sperm are abnormal or have poor motility;

  • there is a blockage in the tubes carrying sperm from the testes to the penis;

  • previous IVF attempts have failed;

  • it is difficult for the eggs to be fertilized using standard IVF.

ICSI can be used as long as a man can produce a single sperm.  Even if no sperm are present in the ejaculate, or if, because of illness or injury, there is no ejaculate, it is possible to retrieve sperm directly from the testes or the tubes leading from the testes.  A sperm does not need to be mature or motile, because it is injected directly into the egg.

 

{West Z, “Plan to get pregnant”, 2008, 146-149,155)

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