Sometimes nature needs a helping hand. Your doctor would be able to recommend the most suitable method of assisted conception after running some tests. The approach recommended is dependent on several factors, namely the age of the female partner, the duration and cause of infertility and the preference of the couple. The following is an overview of the current treatment available for treating infertility.
Ovulation Induction
This is the most basic of all infertility treatment. For women who do not ovulate regularly, fertility tablets (sometimes injections) are given to stimulate the ovaries to produce eggs. The doctor then scans the ovaries to try to pinpoint the best time for intercourse. Alternatively, the woman may wish to time the intercourse by performing self-urine LH test.
Laparoscopic Keyhole Surgery
This is a surgery where tiny “keyhole” cuts are made on the tummy and special laparoscopic instruments are inserted. The aim of the surgery is to diagnose the cause of infertility (diagnostic laparoscopy) as well as to treat infertility (therapeutic laparoscopy). Surgery may be advised if you have blockage or adhesions of the Fallopian tubes, endometriosis, ovarian cysts and certain uterine fibroids. In general, the chance of falling pregnant is doubled after this surgery.
Intrauterine insemination (IUI)
IUI is often used when the woman is not ovulating regularly and has at least one open Fallopian tube or the husband has sperms that have low quality. This treatment is also useful for couples who cannot have intercourse adequately due to erectile dysfunction or vagisnismus (painful intercourse). The semen is washed and treated. A small plastic tube is inserted into the woman’s womb and the processed semen is inseminated close to the eggs, at the time she is most fertile. This usually takes place in conjunction with stimulation of the ovaries with medications.
In-vitro fertilization (IVF)
IVF is usually considered if the woman has damaged Fallopian tubes which are not amenable to surgical correction, or the husband has borderline low sperm count or quality, or when there are antibodies in the sperm. IVF is also sometimes considered if the couple has unexplained infertility. The woman undergoes a series of injections to stimulate the ovaries and when the eggs are matured they are collected. This is done using ultrasound and a fine hollow needle. Once the woman is sedated, a small probe is placed into the vagina to guide the needle to the ovaries, and the eggs are sucked up. The eggs are then mixed with the sperms in a flat, glass petri dish and kept in culture in the incubator for at least two days. The fertilized eggs (embryos) are then transferred back into the womb using a fine plastic tube.
Intracytoplasmic Sperm Injection (ICSI)
ICSI is used if the male partner has extremely low sperm count or quality. It is also useful for couples who have had IVF cycles where very little or no fertilization occurred. Eggs are collected as for IVF. Mature eggs are chosen and each one is held on a tiny pipette while a single sperm is injected directly into the centre of the egg using microinjection equipment. Fertilization occurs in about 70% of the time and the fertilized eggs are subsequently transferred back into the womb.
In-vitro Maturation (IVM)
In-vitro maturation (IVM) involves retrieving immature eggs from an unstimulated or partly stimulated ovary, and maturing these eggs in the incubator. Subsequently, these matured eggs are fertilized using ICSI. This is an attractive alternative to conventional IVF as it minimizes the discomfort and risks of ovarian stimulation as well as there is a significant reduction in costs. IVM is particularly useful in women who have polycystic ovaries, as the risk of Ovarian Hyper-stimulation Syndrome (OHSS) is high.
Preimplantation Genetic Diagnosis (PGD)
Following IVF, one or two cells are removed from a fertilized egg (embryo) using very specialized techniques. These cells are then tested for specific genetic disorders such as thalassemia and/or the correct numbers of chromosomes to exclude conditions such as Down Syndrome. Only healthy embryos are then transferred back into the womb. Despite earlier reports, PGD has not been shown to improve pregnancy rates.
Laser Assisted Hatching (LAH)
For a pregnancy to result from IVF or ICSI, the embryo must successfully implant into the uterus following the embryo transfer. Using a precision laser, an opening is made in the zona pellucida (the shell surrounding the fertilized egg) to weaken the wall of the embryo. The opening made by laser hatching helps the embryo hatch from zona pellucida and implant correctly. This procedure is recommended for women undergoing Frozen Embryo Replacement (FET) and women with recurrent IVF failure.
Sperm or Egg Banking
For certain individuals, there is a need to preserve their sperm or eggs for use at a later stage. This may include men or women who may need to undergo surgery to remove their reproductive organs due to a cancerous condition, or undergo chemotherapy which may render them sterile. It is now possible to freeze adequate amounts of sperms and eggs in cryobank for future use. There are also women who want to freeze their eggs before they reach the end of their reproductive life as they have not found the right life partners yet.
Dr Wong Pak Seng, Obstetrics and Gynaecologist, Sunway Medical Centre
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