Infertility Treatment for Women

Drugs

Fertility drugs help by inducing or regulating ovulation in women who are infertile due to ovarian dysfunction. These drugs include :

1. Clomiphene which is taken orally and helps to stimulate ovulation in women. It is particularly useful in cases of polycystic ovary syndrome (PCOS) and other ovulation disorders and works by acting on the pituitary gland.
2. Human menopausal gonadotropin (hMG) is given in as an injection and directly stimulates the ovaries in case of pituitary gland failure.
3. Follicle stimulating hormone (FSH) stimulates the ovaries to mature egg follicles.
4. Human chorionic gonadotropin HCG).
5. Metformin is used when insulin resistance is the cause of infertility.
6. Bromocriptine inhibits prolactin secretion and is helpful in cases of hyperprolactinemia causing infertility.

The main side effect of fertility drugs is the possibility of multiple pregnancies.

Surgery

Surgical intervention may be considered in the following cases :

1. Blockage in the fallopian tube.
2. Genetic defects in the reproductive system.
3. Endometriosis.
4. Uterine fibroid.
5. Ovarian cysts

Assisted reproductive technology (ART)

This form of treatment for infertility allows couples to have their own biological baby, and chances of success are more in a woman with a healthy uterus, with a good response to fertility drugs, who ovulates normally or uses eggs from a donor. Healthy sperm from the male partner or a donor is necessary. The various forms of ART include :

1. Artificial insemination where a concentrated amount of healthy sperm from the partner or a donor is introduced into the uterus by means of a catheter.
2. In vitro fertilization (IVF) where mature eggs are fertilized with sperm  in a laboratory dish, and is then implanted into the uterus three to five days after fertilization.
3. Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF but the embryo is transferred to the fallopian tube instead of the uterus.
4. Gamete intrafallopian transfer (GIFT) when eggs and sperms are transferred to the fallopian tube so that fertilization occurs inside the woman’s body.
5. Intracytoplasmic sperm injection (ICSI) is the method where a single sperm is injected into a mature egg to obtain fertilization and is especially helpful in men with low sperm count.
6. Embryo donation is where an embryo or egg from a donor is fertilized with sperm and implanted into the uterus.
7. Surrogacy is when a couple’s embryo or a donor embryo is carried by a surrogate mother.

Infertility Treatment for Men

Difficulty in conceiving may lie with the male partner and may require similar procedures as for women. The main approach to treating infertility in men includes :

• Treating sexual problems such as impotence or premature ejaculation by medicines or counseling.

• Hormone treatment, surgery, or assisted reproductive technology (ART) can help treat infertility in men, depending upon the cause.

Secondary infertility is the inability to conceive or carry a pregnancy to term after successfully conceiving one or more children. The causes of secondary infertility tend to be the same as those for primary infertility. Sterility is a term used loosely but indicates the total inability to conceive, in other words, you can never fall pregnant or impregnate a woman. The causes of sterility are the same as infertility.

Overall, women are more proactive about addressing the issue of infertility and will seek treatment when necessary. However, as a woman, the problem may not lie with you and it is also important to understand the causes of male infertility, so as to assist your partner accordingly.

Causes of Female Infertility

• Fallopian tube damage or blockage may prevent eggs from reaching the uterus or sperms from reaching the eggs. This may occur due to salpingitis (inflammation of the fallopian tube), the most common cause of which is chlamydia, a sexually transmitted disease, pelvic inflammatory disease, previous surgery for sterilization, and earlier ectopic pregnancy.
• Endometriosis is implantation and growth of uterine tissue outside the uterus, such as in the ovary, pelvic peritoneum or any other site, and is a common cause for infertility.
• Ovulation disorders is any condition, usually hormonal, which prevents release of mature eggs from the ovary (anovulation).
• Poor egg quality is usually related to age of the woman. After the age of 35 there are more chances of the ovum developing chromosomal abnormalities which disallows continuation of pregnancy.
• Polycystic ovary syndrome are multiple cysts in the ovary, which  cause a hormonal imbalance and irregular ovulation.
• Hyperprolactinemia refers to  high levels of prolactin, often an indication of a pituitary tumor, and this state affects ovulation, which may result in infertility.
• Premature ovarian failure or early menopause may occur before the age of 40, often due to unknown causes, but may also be associated with immune system disease, radiation, chemotherapy, or smoking.
• Hostile cervical mucus.
• Pelvic adhesions are bands of scar tissues that may form in the pelvis after pelvic infection or surgery, and may be the cause for infertility.
• Uterine fibroids are benign tumors in the uterus which may cause infertility by preventing implantation of the fertilized ovum in the uterine wall.
• Thyroid disorders such as hypothyroidism or hyperthyroidism.
• Cancer, especially of the reproductive system, and its treatment by radiation or chemotherapy.
• Medical conditions such as Cushing’s disease, sickle cell disease, diabetes, and kidney disease.
• Smoking and excessive caffeine consumption.
• Genetic defects.

Causes of Male Infertility

• Low sperm count or complete absence of sperm production by the testes (azoospermia).
• Impaired morphology (shape and structure) or motility of the sperm.
• Undescended testes
• Varicocele
• Testosterone (male hormone) deficiency
• Genetic defects
• Infections like sexually transmitted disease, such as chlamydia, or childhood diseases, such as mumps before puberty.
• Erectile dysfunction, premature ejaculation, or psychological problems.
• Absence of semen
• Blockage of ejaculatory ducts
• Hypospadius is a birth defect where the urinary opening is on the underside of the penis.
• Substance abuse, smoking, alcohol or drug dependency, and exposure to chemicals such as lead.

There are a number of infertility treatment options but the most suitable course of action will depend on the cause of infertility, coupled with the individual’s state of health and cost considerations.