How do fertility treatments work?
The four main broad reasons for infertility are:
- ovulation defects
- tubal factor infertility
- male factor infertility
- unexplained nature infertility
There can also be other groups of patients in whom fertility treatments or interventions may be required, for example, patients with recurrent miscarriages.
So fertility treatments, going on to look at the ovulation defects and can be managed easily by performing ovulation induction. Ovulation induction involves the use of pills such as a Clomid or Clomiphene or using gonadotropin injections to help induce the ovulation. This is then monitored and based on the results, you’re advised.
Either further injections are given to facilitate the ovulation or we wait for the natural ovulation to happen and then you are advised to timed intercourse.
That is how in most cases the ovulation problems can be addressed. In some cases, you may be advised to take progesterone supplements to help with providing additional progesterone support if the embryo implants.
Tubal factor infertility
Tubal factor infertility can be dealt with largely by performing IVF. IVF is usually indicated in patients with moderate to severe tubal disease. Where it has led to the blockage of the fallopian tubes or total damage of both fallopian tubes or it has led to the removal of both fallopian tubes or what we call a Salpingo-oophorectomy.
By performing an IVF the initial processes of conception such as fertilisation and the early embryo development which happen in the fallopian tube. By performing an IVF, we are undertaking these procedures outside the body and then replacing the embryo at the time when it would naturally be within the womb cavity between. So that’s how IVF can circumvent the tubal factor infertility.
Male factor infertility
In cases of male infertility when performing treatments like intracytoplasmic sperm insemination (ICSI) the patients have to go through a process which is very similar to the IVF process. However in IVF when we inseminate the eggs we leave the eggs, and the sperm in the petri dish and the fertilisation happens naturally.
Whereas with ICSI the embryologist assesses the sperms under the microscope and picks up a healthier pairing sperm and injects it into the egg.
So what we are performing is, we are injecting the sperm into the egg, but the injected sperm and egg still have to go through many changes in the next 20 to 24 hours to create the early embryo. So that is how sometimes we can deal with a male factor infertility.
In cases of men where there is a total absence of sperms in the ejaculate then we may suggest performing procedures such as a surgical sperm recovery (SSR). By performing this process, we retrieve the sperms and these sperms, are then frozen and used for an ICSI treatment at a later date.
Unexplained nature infertility
When patients might have unexplained infertility, that means we have not identified any reason for infertility; we would suggest performing an IVF along with ICSI.
In patients with recurrent miscarriages, we probably would suggest performing pre-implantation genetic screening of the embryos (PGS) what is also known as comprehensive chromosome screening (CCS). Because the majority of the early miscarriages are genetic nature and therefore by selecting a genetically normal embryo and replacing back, we may be able to help some patients.
So these are in summary the different ways how fertility treatment works, but it depends on the cause of infertility.
In some patients we can perform artificial insemination, it is also commonly known as intrauterine insemination (IUI). Generally, intrauterine insemination (IUI) will be recommended for patients who have problems such as vaginismus, or there is a history of erectile dysfunction. These are the cases in which we may suggest IUI.
However in patients with unexplained infertility insemination nowadays is not a recommended procedure even the National Institute of Clinical Excellence (NICE) suggest that couples experience unexplained infertility of more than two years should consider moving on to IVF.