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Fertility Treatment

Fertility -in nutshell

Fertility is usually taken for granted by many couples. But unfortunately, 1 in 7 couples suffer from Subfertility. This causes immense emotional, social, and financial burden to individual couples. Over the last few decades there are many developments in the field of Assisted reproductive Technology and many couples now could fulfill their dreams of having a child through fertility treatment.

To manage fertility issues, it is important to understand basic Anatomy, physiology and Embryology of female and male reproductive system and process of Ovulation, fertilization, implantation and growing of the fetus in-utero.

Your first appointment

Bring the following to your first visit:

  • abc
  • abc
  • abc
  • Your partner, family member or friend are welcome to attend.

To conceive its important to have: 

  • Healthy Oocyte
  • Healthy Sperm
  • Patent tubes and good endometrium

History: 

Important to take detailed history from both partners.

  • Age of female partner is crucial oocyte quality depends on woman’s age
  • Duration- Usually if healthy couple doesn’t conceive for one year- investigations should be started.
  • Menstrual cycles- regular menstrual cycles- usually means- regular ovulation. Irregular cycles are suggestive of anovulatory problems. Polycystic ovaries is a common problem.
  • Obesity – hampers quality of oocytes and sperm
  • Smoking, alcohol, recreation drugs have adverse effects on the gamete quality
  • Previous surgery- can lead to tubal damage in females and Vas obstruction in male.
  • Previous treatment- gives important information about ovarian response, oocyte quality and endometrial receptivity.

Investigations:

  • To know the oocyte quality- FSH, LH, Estrogen and Prolactin levels should be checked in first 5 days of menstrual cycle.
  • AMH test is a good predictive of oocyte reserve and can be done anytime during cycle.
  • Pelvic ultrasound- gives more details about Uterus, oocytes, antral count
  • Semen analysis- Count, motility, morphology is tested.
  • Tubal patency test- saline sonography, HSG or laparoscopy. This is an important test as option of IUI or IVF can be determined by tubal patency.
  • Laparoscopy, Hysteroscopy- can also be performed to diagnose pelvic pathology like endometriosis, adhesions, hydrosalpinx, fibroids etc.
  • Routine antenatal investigations should be carried out- this gives as a chance to correct any issues prenatally. FBC, Rubella immunity, HIV, Hep B, Hep C, VDRL are basic investigations to perform.

Treatment options:

 Along with providing support, education and counselling most of the treatment options fall in to one of these categories:

  1. Ovulation induction- when anovulation is diagnosed- OI in different forms can achieve pregnancy in most of the cases. Tubal patency must be checked prior to OI.
  2. General measures- reducing weight, stopping smoking, correcting any medical disorders like thyroid, diabetes will help in improving fertility.
  3. IUI- is a simple, cheap and effective in some cases. Cumulative success rates are good. Tubal patency must be confirmed before IUI. Semen analysis should have enough count and motility for IUI treatment. NICE Guidelines recommends 6 cycles of IUI before undertaking IVF treatment.
  1. IVF- This is broader terminology which includes IVF and ICSI.

Complex cases may need:

Fertility specialist will recommend these treatment options in complex cases.

  1. Oocyte donation
  2. Sperm donation
  3. Surrogacy