Fertility
If you have been trying to start a family without success
you are not alone. The World Health Organization estimates that
approximately 8-10% couples experience some for of infertility. But
don't panic. There's a lot that can be done to help you. To
understand what causes infertility you need to know a bit about
fertility, the ability to make babies.
Fertility Facts
It takes one sperm and one egg to create a baby. If you
and your partner have been trying to conceive a child for one year
and it hasn't happened yet, technically you are experiencing
infertility.
In order for pregnancy to occur, an egg has to be released from the
ovary and unite with a sperm. Normally this union, called
fertilization, occurs within the fallopian tube, which joins the
uterus (womb) to the ovary. However, in IVF the union occurs in a
laboratory after eggs and sperm have been collected. Embryos are
then transferred to the uterus to continue growth.
When it doesn't happen, what are the possible causes?
Conception is a problem of the couple and is definitely not
just a woman's problem. Both male and female should be healthy and
fertile for a pregnancy to occur. Factors such as smoking, excess
exercise, stress, alcohol, poor nutrition, body weight and use of
contraceptive can have an impact on the ability to get pregnant.
Besides, there are biological factors in males and females that
affect fertility.
The most common MALE factors:
+ Complete absence of sperms.
+ Low and very low sperm count.
+ Poor movement of sperms.
+ Defective production of sperms.
+ Infections.
The most common FEMALE factors:
+ Defective or no ovulation.
+ Tubal blocks.
+ Previous infections.
+ Hormonal defects.
+ Uterine abnormalities.
What are the basic tests for MALE and FEMALE infertility?
Semen analysis in males and ovulation study by ultrasound and a
uterine tube test (HSG) and other tests in case of females.
What are the methods adopted to help couple achieve pregnancy?
+ Normal sexual activity timed during ovulation. If a
woman has regular periods, it is best to have sexual activity on
10th., 12th, 14th, 16th, or 18th. day, with the day the period
begins being counted as the 1st. day for this purpose. Please
consult your doctor if your periods are irregular.
+ Depending on test results, different treatments can
be suggested. Eighty five to ninety percent of infertility cases are
treated with drugs and surgery.
+ Assisted Reproduction Technology (ART)
(a) IUI (Intra Uterine Insemination) which
involves inserting a processed sperm
sample into the womb to coincide with
ovulation to increase the chances fo
conception taking place?
(b) Test Tube baby procedure (IVF - ET)
(C) ICSI - ET is used to treat couples who previously
had failure in conceiving
due to the extremely low sperm count of the
male partner.
Ideal IVF Candidates
Both fallopian tubes are absent or blocked due to surgery or
tubal pregnancy) or infection (STD, or Tuberculosis)
Endometriosis
Reduced sperm count or motility (IVF can be normally performed
for counts which are more than 5 million per ml. For counts less
than 5 million per ml. ICSI is a better option.) Patients where
all other treatments such as ovulation induction with intra
uterine insemination have proven unsuccessful.
Patients with unexplained infertility where all the
investigations performed on the couple are normal, but who still
do not conceive with routine treatments. Patients who have
failed to become pregnant in- spite of all routine treatments of
infertility.
Patients who want to become pregnant by the procedure of embryo
and egg donation. In our unit, the success rates of IVF are in
the region of 20 to 30%, which are comparable to the leading
units in the world.
IVF Procedure
There are five major steps in the IVF and embryo transfer
sequence:
1 . Monitor the development of ripening egg(s) in the
ovaries
2 . Collection of eggs
3 . Obtaining the sperm
4 . Putting the eggs and sperm together in the
laboratory, and providing correct
conditions for fertilization and early embryo growth
5 . Transferring the embryos into the uterus
To control the timing of egg ripening and to increase the
chance of collecting substantial number of eggs, fertility drugs
are prescribed according to each individual case. Before
determining the egg retrieval schedule, we perform an ultrasound
of the ovaries to check the development of eggs and a
blood/urine test to measure hormone levels.
The Egg Retrieval Process
The retrieval procedure to obtain the eggs is performed
trans-vaginally using a hollow needle guided by the ultrasound
image (this is completely comfortable under adequate sedation
and local anesthesia). Eggs are gently removed from the ovaries
using the needle. This is called "follicular aspiration." Its
timing is crucial because the egg will not develop properly if
it is collected too early; if too late, the egg also may develop
poorly or may have already been released from the ovary and
lost.
The eggs are immediately identified by our embryologists in our
special IVF laboratory. They are placed with the sperm in
incubators to allow fertilization to take place. The eggs are
examined carefully at intervals to ensure that fertilization and
cell division have taken place; the fertilized eggs are now
called embryos.
Embryos are usually placed in the wife's uterus 2 or 3 days
after egg retrieval. A speculum is inserted into the vagina to
expose the neck of the womb (cervix). The embryos are suspended
in a tiny drop of fluid and then very gently introduced through
a catheter into the womb, often under ultrasound guidance. The
transfer is followed by a resting period, blood tests and
possibly ultrasound examinations to verify if pregnancy has been
established.
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