Investigating infertility

Infertility id defined as inability of a couple to conceive naturally after a year of regular unprotected sexual intercourse.

The most common causes of infertility are male factors as sperm abnormalities, female factor as ovulation dysfunction and tubal pathology combined male and female factors and unexplained infertility .

The basics steps of infertility investigation are:

• Detailed medical history and physical examination
• Ovarian function ovulation
• Evaluation of Fallopian tube function
• Evaluation of anatomy (transvaginal ultrasound, diagnostic hysteroscopy)
• Sperm Analysis                   

After all the physical examination and other investigation tests, your  doctor will be able to tell you the exact infertility problem you or your partner is suffering from. Once the infertility problem is diagnosed, your doctor can suggest the best treatment. In 20% percent of the cases, the cause of infertility cannot be ascertained and it is known as unexplained infertility.

Infertility can be treated with medicine, surgery, artificial insemination or assisted reproductive technology. Many times these treatments are combined.

IVF Treatment

In vitro fertilization, or IVF, is a complex series of procedures that is used to treat infertility problems in people who are struggling to conceive. It is the most effective form of assisted reproduction.

Every woman and couple have a different situation and it is necessary to undertake a detailed medical history, utilise or perform diagnostic tests and take into account your preferences before designing the right fertility treatment for you.

The most common indications for in vitro fertilisation  include:

• Damaged or blocked fallopian tubes
• Ovulation problems
• Premature ovarian failure (loss of normal function of your ovaries before the age of 40)
• Severe Endometriosis (presence of endometrial tissue outside the uterus)
• Presence of uterine fibroids  (benign tumours in the wall of the uterus)
• Male factor infertility, including low sperm count and low sperm motility
• Presence of a genetic disorder
• Unexplained infertility

What is the IVF Process?

In vitro fertilization, or IVF, is the act of fertilizing an egg with a sperm cell outside of the body, in the laboratory. IVF is a complicated process that contains many different steps and procedures, each designed to increase the likelihood of a successful pregnancy.

Here’s what a couple goes through during the IVF process:

Step 1: Egg Stimulation

The ovaries are first stimulated using an injection with hormones to produce many eggs at once. The injections can be administered by the patient at home, and starts from Day 2  or 3 of the menstrual cycle. It takes 10-12 days from the first injection to the time the eggs are retrieved.

Step 2: Assess Egg Maturation

 The gynaecologist performs a simple ultrasound scan to check on the maturity of the stimulated eggs after some days of stimulation

Step 3: Egg Retrieval

Once a mature egg is observed, it will be extracted from the woman in a day surgery procedure within the IVF centre. This procedure is done under light  anaesthesia. From the first injection to the retrieval of eggs, the duration is approximately between 10- 12 days. Don’t forget that every women reacts differently !

Step 4: Fertilisation with Sperm

The collected eggs and sperm are fertilised in an IVF laboratory by an embryologist on the day of the egg retrieval. Eggs that have been successfully fertilised are known as embryos. These embryos are then grown for 3 to 5 days, during which the abnormal or unhealthy ones are weeded out. An embryoscope may be used to create a time-lapse video over these 5 days to monitor the development of the embryos in the IVF laboratory.

Step 5: Transfer of Embryos

The embryo will be transferred back into the woman’s womb in a simple procedure that is done in the IVF centre. This transfer process will take around 10-20 min and does not require anaesthesia.

Step 6: Pregnancy Test

2 weeks after the transfer of the embryo into the woman’s womb, a pregnancy test (blood test) will be done to check if the woman has successfully conceived.

Natural Cycle IVF Treatment

One of the more recent “come backs” in treatment for infertility is Natural Cycle  IVF. This method does away with the injections of ovary-stimulating hormones used in standard IVF and instead relies solely on the natural development of the egg.

Natural Cycle IVF is suitable for woman who wish to limit the amount of medication they take during a fertility treatment, older women who do not produce many egg follicles during a previous traditional cycle of ovarian stimulation when high doses of medication would not yield any more eggs, women at high risk of OHSS (including PCOS sufferers).

We will need to monitor your cycle using ultrasounds and blood tests to find out when you are likely to ovulate.

We may also need to use an antagonist to prevent premature ovulation to ensure that we don’t have to cancel the retrieval procedure. 

An egg collection is performed and the egg is then fertilised with your partner’s sperm in a  laboratory the same way as in a traditional IVF treatment.

Modified Natural Cycle IVF

Modified Natural Cycle IVF is simply an IVF protocol where lower doses of fertility drugs are used to stimulate the ovaries compared to conventional IVF.

This protocol is designed for patients with extremely low ovarian reserve, which means a very low number of eggs in the ovary to begin with. It is an option where standard doses of drugs would not yield any more eggs than with the modified natural regime.

Intracytoplasmic Sperm Injection - ICSI 

Many of the infertility cases may be attributed to the male partner. There are several possible causes:

• A low sperm concentration
• Low sperm motility
• Sperm which are not able to fertilise eggs because they are not functional due to some abnormality in their structure
• Combinations of some of these factors

In vitro fertilisation (IVF) has proven to be very effective for treating male infertility .This happens because the motile sperm can be collected and concentrated from the husbands semen and placed in direct contact with the egg in a culture environment in the laboratory.

There are cases of male factor infertility which cannot be addressed even through in vitro fertilisation, in these cases we make ICSI.

Intracytoplasmic sperm injection is performed as part of the IVF treatment process. Following egg retrieval and sperm collection (via self-collection or testicular biopsy), the sperm are microscopically assessed for motility, size and shape. Based on this assessment, one sperm is selected for intracytoplasmic sperm injection.

The selected sperm is gently injected into the centre of a mature egg (we will assess the egg first to ensure it is mature). If fertilisation is successful, the resultant embryo is then grown and transferred into your uterus (this procedure is referred to as ‘embryo transfer’).