Nowadays the most cases of infertility (both female, male and combined) could be treated - nearly 90% of all infertility cases are overcome through modern treatment. Often several procedures and surgical modern medical techniques are used for infertility diagnosis and/or treatment.
Infertility treatment methods and approaches could be very different depending on main infertility factors – multiple test results, age of both the man and woman, how long the couple has been trying to get pregnant, the overall health of the partners and preference of the partners. Modern surgical procedures and/or simple techniques became a part of standard infertility treatment protocols in most infertility clinics.
During infertility treatments the following surgical procedures and techniques can be used:
 Ovarian Drilling – for treating damaged ovaries - mainly for women with polycystic ovary syndrome (PCOS) ;
Artificial Intrauterine Inseminations (IUI) – for increasing the chances for egg fertilization by the sperm;
Surgery – for repairing damaged reproductive organs (for women and men);
Assisted Reproductive Techniques (ART) - for imitation of natural fertilization in vitro (in tubes);
Egg donation and/or sperm donation and/or surrogacy – using healthy eggs and/or sperm from healthy donors OR using surrogacy.
Pre-implantation genetic diagnosis (PGD) - for identifying embryos with chromosome abnormalities.
INFERTILITY TREATMENT - Ovarian Drilling
Ovarian drilling is a surgical procedure/technique dedicated to the treatment of infertile women with Polycystic Ovary Syndrome (PCOS). Sometimes ovarian drilling can be used in non-married girls who suffer from severe PCOS symptoms like oligomenorrhea and/or hirsutism. Ovarian drilling consists of performing micro-perforations in ovaries in order to induce ovulation. As Polycyctic Ovary Syndrome (PCOS) is characterized by ovulation disorders and represents the most common cause of infertility, mainly ovarian drilling is recommended to infertile women with PCOS.
Ovarian drilling is a procedure in which a laser fibre or electrosurgical needle punctures the ovary 4 to 10 times. In most cases the ovarian drilling is done during laparoscopy – it results in a dramatic lowering of male hormones within days.
Studies have shown that up to 80% of patients will benefit from such treatment. Many women who fail to ovulate with ovulation induction drugs (Clomiphene or Metformin) will respond when these medications are used after ovarian drilling. Side effects are rare, but may result in adhesion formation or ovarian failure if there are complications during the procedure.
OVARIAN DRILLING advantages include:
- Improved endocrine hormonal status – reduced androgens;
- Spontaneous ovulation;
- Increased response to ovulation induction (Clomiphene Citrate, Seraphene, Clomid);
- Reduction in gonadotropin doses for ovulation induction and hence reduction in cost of further stimulated cycles;
- Improvement in pregnancy rates;
- Reduction in multiple pregnancy rates;
- Reduction in first trimester abortions;
- Reduction in ovarian hyperstimulation.
INFERTILITY TREATMENT - IUI
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In most cases artificial intrauterine insemination (IUI) is recommended if 1) infertility cannot be explained (so called "unexplained infertility");
2) the man has a low sperm count, or decreased sperm mobility;
3) the man is impotent (erectile dysfunction, an inability to maintain an erection), or premature ejaculation;
4) the woman has mild endometriosis;
5) women have problems with their cervical mucus.
During IUI the sperm is passed through a tube that enters the cervix and extends into the womb. This procedure is performed to coincide with ovulation in order to increase the chance of conception. The woman may also be given a low dose of ovary stimulating hormones in order to increase the likelihood of conception.
Side effects could include temporary cramps after or during IUI, which are similar to period cramps.
IUIs can be performed either with the partner's sperm or with donor sperm.
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INFERTILITY TREATMENT – Surgery & Procedures
Hysteroscopy
The hysteroscopy is an outpatient procedure in which the narrow fiberoptic telescope is inserted into your uterus through your cervix, to look for and sometimes remove adhesions inside your uterus or some polyps. Samples of endometrium also could be taken for future laboratory tests.
In general the surgery is recommended if 1) woman's fallopian tubes are blocked; 2) man's sperm ducts are blocked and it's interfering with sperm production or movement.
Fallopian tube surgery
If fallopian tubes are blocked or scarred because of untreated or badly treated pelvic inflammatory disease (PID), you may need to have surgery to repair the tubes. Surgery can be used to break up the scar tissue in your fallopian tubes, making it easier for eggs to pass along them. Possible complications from tubal surgery include an ectopic pregnancy.
Laparoscopic surgery
Very often the laparoscopic surgery is recommended for women who have endometriosis. It may also be used to remove submucosal fibroids.
In women with PCOS, laparoscopic ovarian drilling can be used if ovulation medication has not worked. This involves using either heat or a laser to destroy part of the ovary.
Correction of an epididymal blockage
The epididymis is a coil-like structure in the testicles that helps to store and transport sperm. Sometimes the epididymis becomes blocked, preventing sperm from being ejaculated normally. If this is causing infertility, surgery to correct the blockage can be performed.
INFERTILITY TREATMENT - ART
Modern medicine developed few types of Assisted Reproductive Technology (ART) including In Vitro Fertilization – IVF; Gamete Intra-fallopian Transfer – GIFT; Zygote Intra-fallopian Transfer – ZIFT; Tubal Embryo Transfer – TET and Intracytoplasmic sperm injection – ICSI.
In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman's Fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. A sperm sample is obtained from the father. Eggs are put in a dish in the lab along with the man's sperm for fertilization. Fertilization occurs in the laboratory when the sperm are mixed with the eggs. The fertilized eggs (zygotes) begin cell division. After 2-3 days, the zygotes are ready to be implanted into the mother's uterus. Some clinics are waiting a full 5-6 days to allow more cell division before implantation. To improve the chances that an embryo will develop into a baby, approximately 3 fertilized eggs are introduced into the uterus at one time. Often this leads to multiple births.
Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman's Fallopian tube. So fertilization occurs in the woman's body. A sperm sample is obtained from the father. Eggs are harvested from the mother. Then, both the sperm and the eggs are injected into the mother's fallopian tube in hopes that fertilization will occur naturally.
Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF. Fertilization occurs in the laboratory - sperm and eggs are united in the laboratory. Then the fertilized eggs (the very young embryo) are injected/transferred into the Fallopian tube instead of the uterus.
Tubal Embryo Transfer (TET).The main groups of patients selected for TET procedure are women who are keen to have gamete intra-Fallopian transfer (GIFT) but where there is doubt about the chance of fertilization, and women who encountered difficulties in previous embryo transfers through the cervix.
The TET procedure involves the transfer of embryos that are more advanced in development than those in ZIFT i.e. cleaved embryos. The aim is to achieve fertilization in-vitro (in the laboratory) and then replace the cleaved embryos in the Fallopian tube, the normal site for fertilization. It is suitable only for women who have at least one healthy Fallopian tube.
TET is carried out as a day-case procedure under a general anesthetic, using laparoscopy. You may experience some abdominal discomfort and pain for a few days after the procedure, but painkillers can relieve this.
Intracytoplasmic sperm injection (ICSI). This procedure is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or Fallopian tube.
During ART procedures sometimes donor eggs (eggs from another woman) could be used as well as donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who have ovarian problems and cannot produce eggs. Genetic diseases could be another indication for using donor eggs and/or donor sperm - donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple could also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.
If you or your partner has an infertility problem, you may be able to receive eggs or sperm from a donor to help you conceive. Treatment with donor eggs is usually carried out using IVF.
Donor eggs, embryos and sperm can be used for women who have ovarian failure, men who do not produce sperm, or couples whose eggs fail to fertilize or couples with genetic diseases. Older women may also wish to use donor eggs from younger women to overcome the problems of ageing.
Surrogacy is an arrangement in which a woman carries and delivers a child for another couple or person. This woman may be the child's genetic mother (called traditional surrogacy), or she may carry the pregnancy to delivery after having an embryo, to which she has no genetic relationship, transferred to her uterus (called gestational surrogacy). If the pregnant woman received compensation for carrying and delivering the child (besides medical and other reasonable expenses) the arrangement is called a commercial surrogacy, otherwise the arrangement is sometimes referred to as an altruistic surrogacy (Wikipedia).
INFERTILITY TREATMENT - Pre-implantation genetic diagnosis
Pre-implantation genetic diagnosis (PGD) is an embryo screening technique which can be used to identify embryos with chromosome abnormalities. A single cell is removed from an early-stage embryo and checked for genetic disorders using molecular techniques. Only the healthy embryos are transferred to the woman's body. Genetic disorders that can currently be detected in this way include cystic fibrosis, Duchenne muscular dystrophy, thalassemia, haemophilia A, muscular dystrophy, hydrocephalus, Huntington's disease, imbalances in the number of chromosomes (aneuploidy), and sex-linked disorders. Research is ongoing to develop reliable tests for other genetic disorders.
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