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Infertility is defined as the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year.
Fertility treatment can be grouped into 3 categories:
1.Medicines to improve fertility
3.Assisted reproductive technique like
Indication: ART includes all fertility treatments in which both eggs and sperm are handled.The main indication for ART is infertility, which is defined as at least 12 months of unprotected intercourse without conception. The success rate of ART depends on different factors:
-Age of the partners
-Reason for infertility
-Type of ART
-If the egg is fresh or frozen
-If the embryo is fresh or frozen
Treatments: These include:
1.Intrauterine Insemination (IUI)
2.In Vitro Fertilization(IVF)
3.Third Party Assisted ART
c.Surrogates and Gestational Carriers
Intrauterine insemination (IUI) involves placement of a man's sperm into a woman's uterus using a long, narrow tube. During this procedure sometimes medications are given that stimulate ovulation in women; this combination can increase the chance of pregnancy in some cases.
In vitro fertilization (IVF) - Eggs and sperm are taken from the couple and are incubated together in a dish in a laboratory to produce an embryo. A health care provider places the embryo into the woman's uterus, where it may implant and result in a successful pregnancy.The steps of IVF are:
Stimulation of Egg Maturation Medications are given to the woman to stimulate the ovaries for making many mature eggs at one time. These medications are given by injection for 8 to 14 days. Doctor closely monitors the development of the eggs using transvaginal ultrasound and also blood is drawn frequently to assess estrogen production by the ovaries. When the eggs are mature as determined by the size of the ovarian follicles and the level of estrogen an hCG injection initiates the ovulation process.
Egg Retrieval The doctor takes out the eggs 34 to 36 hours after the injection. This procedure is done on out patient basis which normally takes about 30 minutes. Mild sedative and painkiller are given during the procedure.
Fertilization - A man provides a semen sample which is placed in a dish with the egg and left overnight in an incubator. Fertilization usually occurs on its own if the sperm are healthy. If that is not possible, a single sperm is injected into an egg using a needle. This process is called intracytoplasmic sperm injection (ICSI).
Fig 1: Illustration of ICSI Fig 2: Illustration of IVF
Embryo Transfer - Embryos that develop from IVF are placed into the uterus from 1 to 6 days after retrieval. The doctor inserts a long, thin tube through the vagina and into the uterus and injects the embryo into the uterus which should implant into the lining of the uterus 6 to 10 days after retrieval.(4)
Check out this link to know more on IVF:
Third party assisted ART: When couples do not achieve pregnancy from infertility treatments or traditional ART, they may choose to use a third party assisted ART method to have a child.
Sperm donation: This is helpful when a man does not produce sperm or produces very low numbers of sperm, or if he has a genetic disease.
Egg donation: Egg donation may be particularly helpful for women who:
- Have primary ovary insufficiency (POI)
- Have had chemotherapy or radiation therapy
- Have had surgical removal of the ovaries
- Were born without ovaries
- Are carriers of known genetic diseases
- Are infertile because of poor egg quality
Surrogates and Gestational Carriers: When the woman is unable to carry a pregnancy to term then surrogate or gestational carriers are chosen. A surrogate is a woman inseminated with sperm from the male partner of the couple. In contrast, a gestational carrier is implanted with an embryo that is not biologically related to her.
Which type of ART you require will be decided by your doctor after making a diagnosis of the cause of your infertility status.
Side effects/Risks: risk found due to assisted reproductive technique are:
The main risks are
Low birth weight.
Preterm birth- strongly associated with many health problems, such as visual impairment and cerebral palsy
It is important to recognize that the rate of birth defects in the general population is about 3% of all births for major malformations and 6% if minor defects are included. Recent studies have suggested that the rate of major birth defects in IVF conceived children maybe on the order of 4% to 5%. Contact your doctor to know more.
Miscarriages - The miscarriage rate is about the same of ART as the general population. Many times older females undergo ART and their miscarriage rates are naturally higher. Since pregnancy testing is done two weeks after embryo transfer, we often know about spontaneous miscarriages in the very early stages of pregnancy. These miscarriages would probably go unnoticed in the general population.
Ovarian hyperstimulation syndrome characterized by heartburn, gas, nausea or loss of appetite and sudden excess abdominal pain, nausea, vomiting (5) , (7)
Complications specific to IUI are: infection, spotting and multiple pregnancy. (8)
Do's and Don'ts after assisted reproductive technique surgery:
You will have to lie down for some time usually 15-20 minutes after the procedure. Also you will have to be in the hospital for a few hours becoming going home.
You may feel wet after the procedure. Do not worry; it is not due to leakage but due to handling of the mucus during the procedure.
Take the medications as prescribed. This forms a very important part for the success of ART.
Avoid vigorous exercise or aerobics as it can harm an implanting embryo and reduce the success the rate of ART(9)
Common things to expect at home (Do not worry):
You may have mild pain or cramping
Passing a small amount of clear or bloody fluid shortly after the procedure due to the swabbing of the cervix before the embryo transfer