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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.
To summarize, the IVF procedure consists
of:
(A) Controlled Ovarian stimulation with drugs (GNRH Analogues and
Gonadotropins) to produce many eggs.
(B) Monitoring of follicles and egg development with the aid of vaginal
sonography and serial Estradiol hormone estimation.
(C) Administration of HCG injection, (Human Chorionic
Gonadotropins)
when the
two leading follicles are 18mm in diameter.
(D) Oocyte or egg retrieval under short general anesthesia, 35 to
37 hours after
HCG injection.
(E) Identification and isolation of eggs in the laboratory.
(F) Sperm collection and processing in the lab.
(G) Fertilization of the egg with the sperm.
(H) Embryo formation 2 to 5 days after fertilization.
(I) Embryo transfer of good quality embryos back to the womb, after
2(four cell
embryo), 3 (six-eight cell embryo) or 5 (Blastocyst
stage) days after egg
removal.
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