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ADVANCES IN INFERTILITY TREATMENT

Friday, November 1, 2019

The incidence of infertility is increasing worldwide. Couples experiencing fertility problems should ideally be treated by a specialist team as this is likely to improve the effectiveness and efficiency of treatment and this is definitely known to improve patient satisfaction.

The common treatment options in the female are ovulation induction, laparoscopic surgery for mild tubal disease and endometriosis and Assisted Reproductive Technologies such as IUI (Intra Uterine Insemination) and IVF (test tube baby). The main treatment options for male infertility are assisted reproduction treatment in the form of IUI, IVF and ICSI (Intra Cytoplasmic Sperm Injection) depending on the severity of the problem.

IVF is commonly referred to as "test tube baby" treatment. IVF stands for “In Vitro Fertilization”. The procedure involves removing a number of mature eggs from the ovary, fertilizing them outside the body with the husband's sperm in the laboratory and transferring the resultant embryos (fertilized eggs) back into the patient's uterus.

 The indications for IVF are blocked fallopian tubes, unexplained infertility-where routine tests do not indicate any abnormality in the couple, severe abnormalities in the sperm parameters –very low sperm count/ motility, endometriosis-moderate/severe and advanced female age.

Intracytoplasmic Sperm injection (ICSI) is different from IVF in that ICSI involves injecting a single sperm inside the mature egg mechanically by specialized equipment called micromanipulator. This starts off the process of fertilization, which involves fusion of genetic material from the male and female gametes to form a pre-embryo or zygote. This technique has revolutionized the management of male infertility as men with severely low sperm counts and even men with azoospermia (no sperm in the semen) are also able to achieve their own genetic child using this technique.

In men with azoospermia, spermatozoa can be withdrawn from the seminiferous tubules situated within the testis itself using a fine needle and the sperm thus obtained used for ICSI. This procedure is known as Testicular Aspiration (TESA) or Testicular Extraction (TESE).

Couples with genetic problems can now undergo a technique called PGD (Pre Implantation Genetic Diagnosis) whereby a disease free embryo (fertilized egg) can be selected and put back into the woman’s uterus thereby giving these couples a chance of having a baby who is free of the genetic condition. The main advantage is that it avoids the need for termination of an affected fetus.

Assisted Hatching is a process whereby using laser, the outer shell of the egg (zona) is thinned to improve the success rates in those couples with repeated IVF failures. Prolonged culture of embryos to blastocyst stage (day 5 embryo) is also offered in certain clinics to improve the success rates either primarily or in those couples with repeated IVF failures. Another advance in fertility treatment is the use of cryopreservation technique. The surplus embryos resulting from a fresh IVF cycle could be frozen using techniques such as vitrification or slow freezing so that they could be used by the couple later if the fresh cycle fails in achieving a pregnancy or to get a second child. The freezing technique is also used to freeze gametes (egg/sperm) in those who need to undergo chemotherapy for cancer as a means to preserve fertility.

 Another advance in the field of fertility is the use of donor gametes-egg/sperm. Use of donor eggs are suggested to women with premature ovarian failure –where there are no eggs in the ovary either due to premature menopause (due to genetic or other reasons) or if the patient has undergone previous cancer treatment such as chemotherapy which can cause damage to the ovaries.

Surrogacy is an arrangement in which a woman carries and delivers a child for another couple or person. Using this form of arrangement, women with genetically absent uterus, women in whom the uterus has been surgically removed and those with repeated IVF failures are able to obtain their own genetic child.

The other recent advances include the introduction of long acting hormone injections which is effective for a week as opposed to the need for having daily hormone injections administered which has very much simplified the IVF process. Recently, improvements in assisted reproductive techniques and treatment options available for infertility have greatly increased the chance of treatment success in sub fertile couples and this has led to more than three out of four couples presenting for fertility treatment being successful in achieving a pregnancy over a period of time.

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