Women who are unable to form eggs on their own , can be helped to do so with some medications. These medications help women to form one of more eggs (controlled ovarian hyper-stimulation) and release the egg ,so as to aid in fertilisation.
OVULATION INDUCTION (OI)
NORMAL CYCLE : Every cycle one egg matures and is released at the time of ovulation.
There are some patients who have inadequate egg production (ovulation) as the cause of infertility.
The treatment for these patients is ovulation induction using one or more of several drugs that are available for this purpose. The follicular growth and the endometrial thickness are then monitored by ultrasonography. Once the leading follicle reaches 18-20mm a final injection (called the trigger is given)
Some of the common drugs used are :
Clomiphene citrate : very commonly used. Usually given for 5 days, from the 2nd or the 3rd day of menstruation.The starting dose is 50 mg given once daily from the 2nd or 3rd day of menstruation. This medicine helps in forming in eggs/follicles in the ovaries. More than one follicle is usually formed, the aim is different for the number of follicles depending on whether IUI Or IVF is planned.
Letrozole is another choice of drug. The starting dose is usually 2.5 to 5 mg per day.
GnRH agonist such as leuprolide or busarlin OR a GnRH antagonist such as cetrorelix or ganirelix .
SO, the aim is to develop one or two follicles in the ovaries using one of the above mentioned drugs .
The process of ovulation induction should be all the following
B: INTRA UTERINE INSEMINATION
What is IUI?.
Intra Uterine Insemination
This is one of the simplest procedures done infertility treatment. It is a simple procedure done without any anesthesia, where the husbands washed sperms are placed inside the woman’s uterus so that more number of good motile sperms are able to reach the Fallopian tubes ( and so the ovaries) via the uterine cavity .
Iui is done when the woman is ovulating ( her egg is mature and ready to rupture /ovulate or has just ovulated ) .
IUI is usually done for couples with unexplained infertility, mild male factor infertility, problems with the cervical mucus (to name a few common indications).
The woman is usually put on some medications: either oral or injectables and with the help of sonography the size of the follicle ( containing the egg) is measured and IUI procedure is suitably timed .
IUI is relatively cost-effective, as compared to IVF but here in IUI the chances of conception are relatively lower as compared to Ivf ( in vitro fertilization)
In IUI, we try to form a fewer number of eggs in the woman’s ovaries with the help of oral or injectable medicines. In IVF we need to stimulate the ovary to produce more number of eggs .
Please get in touch with us for further discussion on fertility treatment, if you or someone you know, is struggling to start a family. Do not worry, there’s always some ray of hope. We must however not waste time!
C: IVF TREATMENT – What is IVF and who needs it ?
IVF is a more advanced form of fertility treatment needed for couples in whom the other forms of treatments have failed (Like ovulation induction, IUI)
Some common indications of IVF are as follows:
- Both Fallopian tubes are absent, blocked or hopelessly diseased.
- The husband has a reduced sperm count (Oligozoospermia).
- Sperms antibodies.
- Unexplained Infertility (refer to couples in whom no obvious pathology is found but who can not conceive).
- Ovarian factor, no oocytes.
Some investigations are needed prior to starting an IVF cycle for a couple :
1) For the female partner /wife
- CBC, Blood group , Rubella Ig G, Chlamydia Ig A.
- HIV, HBs Ag, Anti HCV, VDRL.
- Blood sugar, bleeding time, clothing time.
- Thyroid profile (T3,T4, TSH), Prolactin.
- Serum LH/FSH.
- Serum AMH.
- Ultrasonography of the pelvis : uterus and ovaries on 3rd /4th day of the cycle (Antral follicle count is also assessed. Any uterine anomaly and ovarian mass/cyst is also excluded.)
- Hysteroscopy may be done in the cycle before doing IVF.
2) For the male partner /husband
- Blood group.
- Semen analysis.
- Semen culture and antibiotic sensitivity test.
- Sperm Survival test and semen harvesting.
- HBs Ag, HIV, anti HCV Antibodies, VDRL (valid only for 3 months.)
In IVF / test tube baby several eggs are formed in a woman’s ovaries by giving her injectable hormonal medications starting from the beginning of her present cycle or from the 21st day of the preceding cycle. These oocytes/eggs are then retrieved under anaesthesia and fertilised with the husbands sperm outside the body in an ivf lab using ivf media. The embryos which are formed as a result of fertilisation are graded and are then transferred into the womb / uterine cavity of the lady, either in the same cycle or in another cycle (frozen cycle transfer).
The lady is advised to rest for 3/4 hours after the ovum pick up / egg retrieval which is done under Anesthesia.
Thereafter medications are given for luteal support and a pregnancy test is advised 2 weeks later
D: IVF – ICSI
Stands for: Intra cytoplasmic sperm injection – This technique is done in the IVF lab by the embryologist wherein a sperm is injected into the cytoplasm of the egg, to increase the possibility of fertilisation further.
This technique is used in couples with unexplained infertility, having Immunological factor, repeated failed IVF, to name a few common indications.
E: IMSI – What is IMSI?
Intracytoplasmic morphologically selected sperm injection (IMSI).
Through IMSI technique it is possible to enlarge sperm head, up to 6000 magnification which enables the embryologist to select best speeds, so as to have better quality embryos which not only implant but grow well too. IMSI has shown to reduce the incidence of abortions.
Other fertility treatment procedures such as assisted hatching, vitrification are also done. Further information about these is made available to the couple when they attend the counselling session.
A medical visa is needed by any overseas couple who wishes to undergo any fertility treatment / procedure (IUI, IVF) in India.