Treatment of infertility

The selection of the best treatment for infertility depends on its cause. If the cause is mechanical like obstruction in the men’s ducts, the preferred solution is to go for microsurgery to repair the problem. Similarly, if the reason for the problem is due to scarred tubes in women, again surgical intervention may be preferred. There are a significant number of instances where the cause is undetermined: In other words, both partners seem to be doing OK; but they are not successful in producing kids. In instances such as these the stress may be one of the main causes of the problem. Many of the alternative solutions provided here are useful in this case. As we have discussed many causes for infertility can be caused by hormonal problems, chemical pollution, wearing tight clothes etc. In all these instances simple techniques provided in common sense remedies or in the alternative therapies are of great benefit. They also work synergistically with the conventional technique to boost the success rate. For example, reducing stress may improve the success when techniques such as artificial insemination, IUF etc. are employed. So, these work as truly integrative.

So, the first step in coming with an effective treatment is to determine the cause for the infertility. This is discussed in Investigating Fertility

Based on the determination of the cause and the partner who is responsible, the solutions are quite obvious in many cases. For example, it could be something as simple as the man's not wearing tight undershorts, or avoiding saunas and hot baths before sexual intercourse. On the other hand, it may require sophisticated manipulation of the woman's internal hormonal environment or even an operation. But sometimes the situation may not be correctable. Also, in a substantial number of cases no cause is ever discovered, even after a time- consuming and expensive evaluation. This news could be quite depressing and frustrating to a couple who desperately want a child. Here are some recently available options of which you should be aware.

Problems with Ovulation: Treatment with Clomiphene

For a woman who hasn't ovulated for a long time, clomiphene treatment is usually preferred. First, a menstrual period is induced with another drug medroxyprogesterone acetate. The woman then takes clomiphene for 5 days. Usually, she ovulates 5 to 10 days (average, 7 days) after clomiphene is stopped and has a period 14 to 16 days after ovulation.

If a woman doesn't have a period after treatment with clomiphene, she takes a pregnancy test. If she isn't pregnant, the treatment cycle is repeated with increasing doses of clomiphene until ovulation occurs or the maximum dose is reached. When the doctor determines the dose that induces ovulation, the woman takes that dose for at least six more treatment cycles. Most women who become pregnant do so by the sixth cycle in which ovulation occurs. Overall, about 75 to 80 percent of women treated with clomiphene ovulate, but only about 40 to 50 percent become pregnant. About 5 percent of pregnancies in women treated with clomiphene are multiple, primarily twins.

Prolonged use of clomiphene may increase the risk of ovarian cancer. So the treatment cycles should be limited.

Side effects of clomiphene include hot flashes, abdominal swelling, breast tenderness, nausea, vision problems, and headaches. About 5 percent of women treated with clomiphene develop ovarian hyperstimulation syndrome, in which the ovaries become greatly enlarged and a large amount of fluid shifts from the bloodstream to the abdominal cavity. To try to prevent this disorder, the doctor prescribes the lowest effective dose and withholds clomiphene if the ovaries enlarge.

 

Problems with Ovulation: Hormonal Therapy With Human Menopausal Gonadotropins

If the clomiphene treatment is not successful, hormonal therapy with human menopausal gonadotropins can be tried. These hormones are extracted from the urine of postmenopausal women. This hormone is very expensive and they have severe side effects. So, this is recommended only after the doctors are sure that ovulation problems, not problems with sperm or fallopian tubes, are the cause of infertility. Treatment cycles will be closely supervised by doctors experienced in using these hormones.

Human menopausal gonadotropins are injected into the muscle. It stimulates the ovarian follicles to mature. Woman's response to the hormones is carefully monitored and the doses are adjusted. After the follicles are mature, the woman is given an injection of a different hormone, human chorionic gonadotropin (HCG), to trigger ovulation. Although more than 95 percent of the women treated with these hormones ovulate, only 50 to 75 percent become pregnant. In women treated with human menopausal gonadotropins, 10 to 30 percent of pregnancies are multiple, primarily twins. Many doctors do not like to go for this approach because of the danger of multiple births.

Side effects: Increased risk of ovarian cancer, ovarian hyperstimulation syndrome. OHS develops in 10 to 20 percent of the women treated. It can be life threatening but usually can be avoided if the doctor closely monitors the treatment and withholds human chorionic gonadotropin when the woman's response becomes excessive.

Artificial Insemination With Sperm Provided By Male Partner

Artificial insemination with male partner’s sperm has a 50 percent chance of success and is your best bet if he is fertile but impotent. (He is making plenty of healthy sperm but can't muster the kind of erection needed to deliver them effectively so that fertilization can take place.). It's also the method of choice if the woman’s cervix, for one reason or another, does not allow sperm to gain entry to the uterus. In some cases, the sperm is "washed" to improve their ability to fertilize an egg. Semen is mixed and washed with a protein called Ham’s solution and then used in artificial insemination. In still another modification of this technique, a swim-up technique is used. The sperm is allowed to swim up the protein solution. The better, more mobile sperm is used in the artificial insemination.

Artificial Insemination With A Donor's Sperm

This may be an appropriate solution if the husband’s semen does not contain any healthy sperm. This also hast a 50 percent success rate. Reputable clinics specializing in this field screen the genetics of the contributors very carefully, and also examine the purchased sperm for evidence of infection and AIDS antibodies. Always check the credentials and reputation of the particular sperm bank you're planning to use; some of them are not good.

Embryo Transfer (ET) or In Vitro Fertilization (IVF)

This is a more expensive and complicated way to have your own baby. You go for this when the fallopian tubes of the woman (that lead from the ovary to the uterus) have been so scarred by infection that the egg cannot get through them to get to the uterus. In this technique, one of your eggs is removed from the woman’s ovary with a needle guided by ultrasound. It is then placed in a culture dish where it is fertilized with the man’s sperm. The egg is then transferred from the dish and implanted into the woman’s own uterus where it continues to grow for the usual 9 months. Embryo transfer has a 20 to 30 percent success rate, and can be attempted as often as necessary. The woman is normally given clomiphene (Clomid) or follicle-stimulating hormone (Pergonal) to stimulate the development of more eggs to improve the chances of a "hit" by the needle. This technique has now been used for almost 15 years, and has resulted in the birth of more than 25,000 babies in over forty different countries.