Female Infertility Treatment

Infertility treatment depends on the cause, your age, how long you’ve been infertile and personal preferences. Because infertility is a complex disorder, treatment involves significant financial, physical, psychological and time commitments.

Although some women need just one or two therapies to restore fertility, it’s possible that several different types of treatment may be needed.

Treatments can either attempt to restore fertility through medication or surgery, or help you get pregnant with sophisticated techniques.

1. Fertility restoration: Stimulating ovulation with fertility drugs

Fertility drugs regulate or stimulate ovulation. Fertility drugs are the main treatment for women who are infertile due to ovulation disorders.

Fertility drugs generally work like the natural hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation. They’re also used in women who ovulate to try to stimulate a better egg or an extra egg or eggs. Fertility drugs may include:

• Clomiphene citrate. Clomiphene (Clomid) is taken by mouth and stimulates ovulation by causing the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg.
• Gonadotropins. Instead of stimulating the pituitary gland to release more hormones, these injected treatments stimulate the ovary directly to produce multiple eggs. Gonadotropin medications include human menopausal gonadotropin or hMG(Menopur) and FSH (Gonal-F, Follistim AQ, Bravelle). Another gonadotropin, human chorionic gonadotropin (Ovidrel, Pregnyl), is used to mature the eggs and trigger their release at the time of ovulation. Concerns exist that there’s a higher risk of conceiving multiples and having a premature delivery with gonadotropin use.
• Metformin. Metformin (Glucophage, others) is used when insulin resistance is a known or suspected cause of infertility, usually in women with a diagnosis of PCOS. Metformin helps improve insulin resistance, which can improve the likelihood of ovulation.
• Letrozole. Letrozole (Femara) belongs to a class of drugs known as aromatase inhibitors and works in a similar fashion to clomiphene. Letrozole may induce ovulation. However, the effect this medication has on early pregnancy isn’t yet known, so it isn’t used for ovulation induction as frequently as others.
• Bromocriptine. Bromocriptine (Cycloset), a dopamine agonist, may be used when ovulation problems are caused by excess production of prolactin (hyperprolactinemia) by the pituitary gland.

Risks of fertility drugs

Using fertility drugs carries some risks, such as:

• Pregnancy with multiples. Oral medications carry a fairly low risk of multiples (less than 10 percent) and mostly a risk of twins. Your chances increase up to 30 percent with injectable medications. Injectable fertility medications also carry the major risk of triplets or more (higher order multiple pregnancy).Generally, the more fetuses you’re carrying, the greater the risk of premature labor, low birth weight and later developmental problems. Sometimes adjusting medications can lower the risk of multiples, if too many follicles develop.
• Ovarian hyperstimulation syndrome (OHSS). Injecting fertility drugs to induce ovulation can cause OHSS, which causes swollen and painful ovaries. Signs and symptoms usually go away without treatment, and include mild abdominal pain, bloating, nausea, vomiting and diarrhea.If you become pregnant, however, your symptoms might last several weeks. Rarely, it’s possible to develop a more-severe form of OHSS that can also cause rapid weight gain, enlarged painful ovaries, fluid in the abdomen and shortness of breath.
• Long-term risks of ovarian tumors. Most studies of women using fertility drugs suggest that there are few if any long-term risks. However, a few studies suggest that women taking fertility drugs for 12 or more months without a successful pregnancy may be at increased risk of borderline ovarian tumors later in life.Women who never have pregnancies have an increased risk of ovarian tumors, so it may be related to the underlying problem rather than the treatment. Since success rates are typically higher in the first few treatment cycles, re-evaluating medication use every few months and concentrating on the treatments that have the most success appear to be appropriate.

2. Fertility restoration: Surgery

Several surgical procedures can correct problems or otherwise improve female fertility. However, surgical treatments for fertility are rare these days due to the success of other treatments. They include:

• Laparoscopic or hysteroscopic surgery. These surgeries can remove or correct abnormalities to help improve your chances of getting pregnant. Surgery might involve correcting an abnormal uterine shape, removing endometrial polyps and some types of fibroids that misshape the uterine cavity, or removing pelvic or uterine adhesions.
• Polycystic Ovary Syndrome (PCOS):An operation on the ovaries may be suitable for some women with PCOS. The procedure is sometimes called ovarian drilling or ovarian diathermy. Again keyhole surgery is used. The tiny cysts in the ovaries can be removed or destroyed with the help of a heat source (diathermy). It may be done if other treatments for PCOS haven’t worked.
• Endometriosis: This is a condition that occurs when cells from the lining of the womb (uterus) grow in other areas of the body. Surgery may help in improving fertility in women with endometriosis.
• Tubal surgeries. If your fallopian tubes are blocked or filled with fluid (hydrosalpinx), your doctor may recommend laparoscopic surgery to remove adhesions, dilate a tube or create a new tubal opening. This surgery is rare, as pregnancy rates are usually better with IVF. For hydrosalpinx, removal of your tubes (salpingectomy) or blocking the tubes close to the uterus can improve your chances of pregnancy with IVF.

3.Reproductive assistance

• Intrauterine insemination (IUI)
• In vitro fertilization (IVF)
• Intracytoplasmic sperm injection (ICSI)
• Surrogacy
• Gamete intrafallopian transfer (GIFT)
• Zygote Intrafallopian Transfer (ZIFT)
• Preimplantation genetic diagnosis

Intrauterine Insemination (IUI):

Intrauterine insemination (IUI) is a fertility treatment that involves placing sperm inside a woman’s uterus to facilitate fertilization. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization. IUI provides the sperm an advantage by giving it a head start, but still requires a sperm to reach and fertilize the egg on its own

Specially processed sperm is inserted into the uterus, directly through a thin, flexible catheter during IUI, the most common fertility method. If you opt for this method, your doctor might recommend that you start on fertility drugs as well, to increase the chances of fertilization. This method is used for cases in which men have slow-moving or lower quality sperm or a low sperm count. Also for women who have produced antibodies to their partner’s sperm or whose cervical mucus is too scant, acidic, or thick to transport the sperm to the egg.

In Vitro Fertilization (IVF):

IVF is used in a range of circumstances to assist with conception but is often the only means of achieving pregnancy for women whose fallopian tubes are blocked. In IVF, the woman’s eggs are collected, along with sperm from the male partner or donor. The egg and sperm are left in a culture dish in the laboratory to allow the egg to be fertilised. If fertilisation occurs and an embryo develops, the embryo is then placed into the woman’s uterus in a procedure called an embryo transfer. Sometimes multiple embryos may develop, and they can be frozen for use in later transfer procedures.

Intracytoplasmic Sperm Injection (ICSI):

In ICSI, an embryologist selects a healthy-looking, single sperm from the male’s semen and injects it directly into the egg with a microscopic needle. After the development of an embryo, it’s transferred into the uterus through IVF. This method is used for couples in which the man has a very low sperm count or poor sperm quality.
Donor Eggs: Eggs are extracted from the ovaries of another woman (usually younger) and fertilized by infusing with a sperm extracted from the recipient’s partner. Resulting embryos are then transferred into the recipient’s uterus. This method is used when the ovaries of a woman are damaged or prematurely failing, or for women who have undergone chemotherapy and/or radiation; older women with poor egg quality; as well as women with genetic disorders who do not want to pass it along.

Surrogacy:

The surrogate carries a baby for another woman. Artificial insemination is used to get a surrogate pregnant, using the man’s sperm or through IVF with the couple’s embryo. Donor eggs and sperm may also be used. This method is used for women who can’t carry a baby because of disease, hysterectomy, or infertility. In rare instances, both partners are infertile.

Gamete Intrafallopian Transfer (GIFT):

Eggs from the woman are collected, fused with sperm from the man in a petri dish, and then placed directly into the fallopian tubes, where fertilization can occur. This method is used for couples in which the woman has at least one functioning fallopian tube and/or the man has a low sperm count or sperm with poor motility, and couples who are suffering from unexplained fertility or who consider IVF anti-moral or anti-religious

Zygote Intrafallopian Transfer (ZIFT):

Like IVF, but in this case, the embryo is inserted into the fallopian tube, not the uterus. This method is used for couples who have unexplained infertility or those in which the man has a low sperm count, the woman has at least one tube open, and/or there are ovulation problems.

Preimplantation genetic diagnosis:

Preimplantation genetic diagnosis (PGD) is used to reduce the risk or avoid transmission of a genetic disease or chromosomal abnormality. PGD can be used by couples who have, or have a family history of, a genetic disease or chromosomal abnormality that they risk passing on to their children. PGD is also used for couples who have had repeated miscarriages or repeated IVF failure and also for women of advanced maternal age (generally over 36-38 years of age).

In PGD, embryos are generated through the process of IVF or ICSI and then one or two cells are removed from the embryo and are screened for a genetic condition. Embryos unaffected by a particular genetic condition may then be selected for transfer to the woman’s uterus.

What is preimplantation genetic diagnosis?

Assisted reproductive treatment clinics in Victoria perform PGD to reduce the risk of, or to avoid a range of conditions.

Sex selection can be performed in Victoria only to reduce the risk of transmission of a genetic disease or abnormality to a child. Sex selection may be performed to reduce the risk of transmission of a disorder linked to an X chromosome (such as Muscular Dystrophy or Haemophilia) or for a condition that occurs more frequently in one sex but where the genetic cause is unknown (e.g. autism).

Aneuploidy is a term used to describe an abnormality in chromosome number (fewer or more of a specific chromosome). Aneuploidy screening is performed in cases of advanced maternal age, repeated IVF failure, recurrent miscarriage and previous aneuploidy pregnancy.

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