Infertility Treatments

Infertility affects nearly 10 to 15 % of all married couples planning to start their families. The incidence is increasing. Delay in marriage and childbirth, changing life-style and many such factors have contributed to this increase. New techniques have been now available to counter this menace.

It comprises of:

Intra-uterine-insemination (IUI)

What it means?

IUI means injecting sperms inside the uterine cavity.

Who are suitable candidates?

Unexplained infertility, mild male factor infertility, sexual dysfunction, mild endometriosis, with ovulation induction donor insemination.

Who should not get IUI?

Women with blocked tubes, severe endometriosis, more than six failed cycles of IUI, severe male factor infertility.

What are its main steps?

Steps:
  Giving appropriate medicines to the female partner to stimulate ovaries to produce one to four follicles
  Preparing semen sample from male partner to obtain an enriched and clean sample containing active spermatozoa
  Injecting this sperm preparation inside the uterus at the time of ovulation as decided by follicular sonography

Intrauterine insemination with donor sperm (IUI-D)

What it means?

IUI-D means injecting sperms taken from sperm bank inside the uterine cavity.

Who are suitable candidates?

Male partner with nil sperm count, with genetic diseases, very low counts not willing for ICSI, HIV or other serious medical illnesses.

Who should not get IUI-D?

Women with blocked tubes, severe endometriosis, more than six failed cycles of IUI.

What are its main steps?

Steps:
  Giving appropriate medicines to the female partner to stimulate ovaries to produce one to four follicles Natural cycles can also be used.
  Taking sperm from sperm bank. Matched for Blood group, height, color of skin, hair and eyes. These samples are screened for thalassemia trait and common infections e.g. HIV, hepatitis etc. and quarantined for window period.
  Injecting this sperm preparation inside the uterus at the time of ovulation as decided by follicular sonography.

Advantages:

Simple and cost-effective technique in well selected cases with only minor side effects. Overall success rate remains between 10 to 20 % per treatment cycle.

Disadvantage:

The sperm belong to a donor.

Legal status:

  Allowed by Indian Council of Medical Research guidelines, when done with the consent of both partners. The child thus born has all legal rights and obligations.
  Donation from known donor is not allowed.

Ovulation induction in PCOS

What it means?

PCOS or polycystic ovarian syndrome is a common endocrine disorder characterised by irregular menstrual cycles, infertility and other features like excessive hair growth on body and obesity. It is diagnosed by ultrasound and hormonal tests like LH, FSH and AMH.
Who are suitable candidates?

Patients diagnosed with PCOS, who are not able to conceive after trying for at least 6 months.

What are its main steps?

  Ovulation induction is done with the help of medicines such as clomiphene and injectable drugs like HMG and FSH.
  Various protocols can be followed. Efficacy of the treatment is assessed by serial ultrasound.

Advantages:

Cost effective treatment with good success rate.

Disadvantages:

Occasionally the procedure for ovulation induction may get prolonged.
More chances of multiple pregnancy.

Ovulation induction in hypo-hypo

What it means?

Hypo hypo or hypogonadotrophic hypogonadism is a hormonal disorder in which there is defective production of the hormones FSH and LH from the pituitary resulting in absence of menstrual cycle (amenorrhea) in the female. Therefore, ovulation induction is required for pregnancy.

Who are suitable candidates?

Patients with amenorrhoea diagnosed with hypo hypo after hormonal tests FSH and LH.

What are its main steps?

  Complete workup of the female and male partner is required before starting treatment to rule out any other problem and look for cause of hypo hypo.
  Ovulation induction is done with the help of injectable drugs like HMG. Efficacy of ovulation induction is assessed by serial ultrasound.

Advantages:

Very high success rate:

Disadvantages:

Complications like OHSS and multiple pregnancy can occur.

Gonadotrophin treatment of male hypo-hypo

What it means?

Hypo hypo or hypogonadotrophic hypogonadism is a hormonal disorder in which there is defective production of the hormones FSH and LH from the pituitary resulting in defective sperm production in the male. If the disorder occurs at an early age, puberty may be delayed.

Who are suitable candidates?

Patients presenting with delayed puberty or infertility, diagnosed with hypo hypo after hormonal tests FSH and LH.

What are its main steps?

  Complete workup of the female and male partner is required before starting treatment to rule out any other problem and look for cause of hypo hypo.
  Injectable drugs HCG and HMG are given on alternate days or twice a week for 3 to 6 months. Efficacy of treatment is assessed by repeating semen analysis.

Advantages:

Good success rate.

Disadvantages:

There is wide variation in response to treatment among the patients. Procedures like IUI and IVF may still be required, but success rate is high.
Treatment is costly and prolonged over 3 to 6 months.

Treatment of sexual dysfunction

What it means?

Sexual dysfunction means the inability to perform intercourse due to various reasons. The problem may be in female in the form of pain during intercourse or in males in the form of erectile dysfunction. It may occur due to psychological or physical reasons.

Who are suitable candidates?

Couples unable to perform intercourse.

What are its main steps?

Physical factors are to be ruled out such as;

  • Females – endometriosis, trauma, scarring
  • Males – diabetes mellitus, neurological dysfunction, etc.

Most common cause is still psychological for both partners and proper counselling is required for treatment. Medicines are helpful in some situations.

Advantages:

Highly effective treatment if done properly.

Disadvantages:

Psychological counselling require prolonged sessions.