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Reproductive Medicine (Infertility Treatment))

Infertility refers to the condition or state when a couple is unable concieve or make a baby.

Background Information

It can be Primary infertility when couples who have not become pregnant after at least 1 year of unprotected sex or Secondary infertility where the couple have been pregnant at least once, but never again.

The reproductive medicine and infertility treatment section of Globe Health Tours is dedicated to help out couples with infertility in the diagnosis of the underlying cause of infertility as well as in treating them. We also help couples choose affiliated and best treatments abroad including male and female infertility treatments, assissted reproduction, surrogate motherhood etc.

Read about Pre-conception Advice: How to Improve Your Chances of Conception in our FAQ section.

 

 

Infertility Tests for Women

There are many different tests and investigative procedures that can be arranged. These include blood tests, various types of scans, X-ray imaging and various types of surgical procedures. All are designed to give your doctors information which will be vital in trying to identify the cause of infertility and in choosing the best approach to assist in conception. It is important to understand that not all women will need all of these tests. Your doctor will discuss with you those that he/she feels are necessary.

1. BLOOD TESTS

Many different parameters can be measured by taking a few millilitres of blood. These include;

  • Haematology: full blood count, erythrocyte sedimentation rate and others,
  • Biochemistry: electrolytes and renal function tests, liver function tests, thyroid tests, glucose level and others,
  • Hormone Profiles: oestrogen, progesterone, follicle stimulating hormone, luteinising hormone, prolactin, testosterone and others,
  • Microbiology: rubella and hepatitis B immunity checks

These blood tests are most often done at your General Practice Surgery or equivalent.

2. URINE TEST

This may be required for chlamydia testing and is usually done by your General Practitioner or Practice Nurse.

3. VAGINAL SWABS

Swabs may be taken from the vagina or cervix to test for various sexually transmitted infections such as chlamydia, gonorrhoea and many others.

4. ULTRASOUND SCAN

This pelvic scan can visualise your ovaries and uterus and determine their shape and size. The scan can also reveal the presence of abnormalities such as cysts, fibroids or other growths. Pelvic ultrasound scans can either be done through the abdominal wall or from inside the vagina using a vaginal probe to reveal more detail.

5. FOLLICLE TRACKING

This is essentially the same ultrasound scan as described above. However, serial scans can be used to track the development of eggs in the ovary.

6. HYSTEROSALPINGOGRAM

This is a special type of X-ray and is sometimes called a HSG or "tubogram". A radio-opaque dye is injected through the cervix into the uterus. The dye travels through the uterus and up into the fallopian tubes. A series of X-rays are then taken. The dye can then clearly be seen on the X-ray image, outlining the inside of the uterus and tubes. Any deformities of the uterus and tubes or any tubal blockages can also be clearly visualised as the path of the dye may be obstructed by any blockages in the tubes.

7. HYSTEROSCOPY

In this procedure, a thin tube containing a light and camera is inserted via the vagina, through the cervix and into the uterus. This enables the doctor to visualise and inspect the inside of the womb. Abnormalities that may be found include fibroids, polyps or other abnormal structures within the womb. At the same time, an endometrial biopsy can also be taken (a sample of the womb lining is collected and sent to a lab for detailed analysis).

8. LAPAROSCOPY

A thin tube called a laparoscope is inserted through a small incision in the abdomen. The scope contains a light and a camera to enable the doctor to visualise and inspect the pelvic organs. This procedure is usually done under a general anaesthetic. Sometimes, a dye is injected into the fallopian tubes via the cervix at the same time. The flow of dye can then be seen with the laparoscope. Any tubal obstructions can then be detected and localised.

9. HYSTEROSALPINGO-CONTRAST-SONOGRAPHY (HYCOSY)

As with laparoscopy, dye is injected into the fallopian tubes and ultrasound scans are used to detected the dye and localise any blockages of the tubes. This test gives similar but more detailed results compared with laparoscopy but is not suitable for every woman.

10. ENDOMETRIAL BIOPSY

A small catheter is inserted through the vagina and cervix, into the inside of the uterus. A sample of the womb lining (endometrium) is removed and sent to a lab for analysis. This test can be mildly uncomfortable. Therefore, pain killers may be offered before the test. Biopsies can also be taken with hysteroscopy.

Infertility Tests for Men

When dealing with infertility, doctors will tend to deal with couples. This obviously includes the male partner. In fact, male infertility is a substantial problem even though many patients see infertility as a predominantly female problem. Tests for men look mostly at sperm production and the exclusion of sexually transmitted infections.

This is done in the following ways.

1. URINE TEST

A sample of urine may be collected and sent to the lab for chlamydia screening.

2. SEMEN ANALYSIS

This forms the mainstay of male infertility testing. A semen sample is usually produced by masturbation. This is done close to or at the clinic or testing facility as rapid testing of a fresh sample is the only way to ensure accurate results. The semen sample is then processed and results obtained for several different parameters. These include;

  • Sperm counts: a semen sample may contain normal numbers of sperm, a reduced number (oligozoospermia) or there may a complete absence of sperm (azoospermia).
  • Sperm motility: this looks at how the sperm are moving or swimming. In some cases, adequate numbers of sperm may be present but they may have reduced motility.
  • Sperm morphology: this looks at how sperm cells look. If they look abnormal in shape and appearance, they may not be able to travel to the egg or fertilise it.

If an abnormality is found, the doctor may then ask for further tests such as blood tests or ultrasound scans to determine the cause.

3. SPERM ANTIBODY TEST

This looks for proteins in the semen that may prevent successful fertilisation of the egg by sperm.

4. SPERM INVASION TEST

This looks at whether sperm are able to swim through the cervix and remain active thereafter.

Infertility: An Overview of Treatment

There are many different methods and techniques that doctors and clinics can employ to improve your chances of conception. These are summarised below. For a more detailed analysis of each of these treatments, please click onto the appropriate page.

1. DRUG TREATMENTS

Drugs used by women:

  • Ovulation Induction Drugs
  • Pituitary Stimulating Drugs
  • Ovary Stimulators
  • Cycle Suppressant Drugs
  • Drugs That Maintain Pregnancy
  • Other Drugs.
  • Drugs used by men.

Please read "Drugs Used in Infertility Treatment" for further details.

2.SURGERY

Surgical procedures for women;

  • To Unblock Fallopian Tubes
  • Reversal of Sterilisation

Surgical Procedures for men;

  • Vasectomy Reversal
  • Varicocele Surgery
  • Percutaneous Epididymal Sperm Aspiration (PESA)
  • Testicular Sperm Extraction (TESE)
  • Microsurgical Sperm Aspiration (MESA)

Please read "Surgical Treatments in Infertility" for further details.

3. ARTIFICIAL INSEMINATION

  • Intrauterine Insemination (IUI) which places sperm into the uterus (womb),
  • Intracervical Insemination which places the sperm into the neck of the womb (the cervix),
  • Intrafallopian Insemination which places sperm into the fallopian tubes,
  • Intraperitoneal Insemination which places sperm near the opening of the fallopian tubes next to the ovary,
  • Intravaginal Insemination which places sperm into the vagina
  • Donor Insemination (DI)

Please read "Artificial Insemination" for further details.

4. ASSISTED REPRODUCTION TECHNOLOGY (ART):

  • In Vitro Fertilisation (IVF)
  • Intra-Cytoplasmic Sperm Injection (ICSI)
  • Gamete Intra-Fallopian Transfer (GIFT)
  • Zygote Intra-Fallopian Transfer (ZIFT)
  • Blastocyst Transfer
  • Assisted Hatching

THE AMOUNT OF INTERVENTION REQUIRED TO CONCEIVE

The differing techniques mentioned above and described in detail in the following few pages can by viewed on a scale from methods that are closest to natural conception (least amount of assisted conception required) to those furthest from nature (most amount of assisted conception required);

  • Least assisted -----------------------------------------> Most assisted
  • AI ---> GIFT ---> ZIFT ---> IVF ---> Blastocyst Transfer ---> ICSI

In this scale, clearly, variations will be present as unstimulated cycles (those requiring no drugs) will be closer to natural conception as they require less intervention than stimulated cycles (those requiring drugs to stimulate egg development). Many assisted conception methods can also be combined with other techniques such as Assisted Hatching which again increase the complexity of the procedure.

You can read about the Drugs Used in Infertility Treatment in the Faqs section.

Failure of Treatment

No assisted conception clinic can possibly guarantee that you will conceive and successfully deliver a baby. At best, conception rates are around 30% per cycle which is about the same as natural conception. For some couples, especially where the woman is older than 35 years, conception rates are much lower than this.

Just as with natural conception, several attempts at assisted conception may be required before a pregnancy is successful. It is therefore safest to assume before starting treatment that more than one attempt will be required.

Infertility treatment can be demanding in many ways. It can stress you and your partner physically, emotionally and financially. It is therefore best to be well prepared for these eventualities. The more information you have access to and the more knowledgeable you become about infertility, the better the chances of coping with these stresses.

Despite this, the realisation of treatment failure is quite understandably devastating for most people. Most specialist clinics should offer counselling before, during and after your treatment. It is highly recommended that you make full use of any counselling available especially if your treatment is unsuccessful. Thereafter, most specialists would suggest that you defer any further treatment for about 2 months to recover from the psychological and physical effects of the failed treatment cycle.

Before resuming treatment, a full discussion with your specialist is vital to understand any potential problems, the cause of treatment failure (if known) and which method of assisted conception should be tried next.

A specific point to note is that when couples try to conceive naturally, many will have miscarriages that are unrecognised as such. This is because many miscarriages occur very early on in pregnancy before a woman is even aware she has conceived and carries out a pregnancy test. Menstruation may be delayed for a few days and then begins after the miscarriage. Women may simply see this as a late period. But when having infertility treatment, women are generally fully aware of what is happening. There is therefore no chance of missing a miscarriage and every miscarriage is therefore recognised. This gives the false impression of a higher failure rate when in fact, it may be very similar to nature.

WHY DOES TREATMENT FAIL?

Treatment can fail at any of the many complex steps that are required for conception. In IVF for example, treatment may fail due to;

  • a failure of the ovaries to respond to stimulation to produce eggs,
  • the ovaries becoming hyper-stimulated because of infertility drugs. This may cause OHSS,
  • a lack of eggs: empty egg sacs may form under stimulation from infertility drugs,
  • a failure to fertilise eggs after successful collection. This may be due to a problem with the eggs or sperm,
  • fertilised embryos failing to mature. No transfer into the womb can then take place,
  • transferred embryos into the womb fail to implant or develop inside the womb.

Failure of embryos to develop after transfer into the womb is the commonest cause of infertility treatment failure. There may be many reasons for this including;

  • a developmental problem with the egg before fertilisation,
  • failure of the embryo to develop properly before transfer. This may not be obvious before transfer,
  • chromosomal disorders: though outwardly, many embryos may look healthy, they may contain defective chromosomes. These embryos have a much reduced chance of success. Please read the page entitled "Genetic Testing" for further details regarding this. A new test called PGS may help to solve such problems in the future,
  • poor blood flow to the womb: this means that even if your embryos are healthy, they stand a lesser chance of developing into a healthy baby as the womb is unable to sustain a pregnancy,
  • immunological problems: it has been recently suggested that several immunological disorders in the woman may be the reason for failure to conceive. This area is still open to debate but some clinics may be able to offer highly specialised tests to determine if this is the case,
  • unexplained reasons: despite all the investigations that are available, it remains unclear in many cases why implantation and pregnancies fail.

WHAT SHOULD YOU DO NEXT?

This is an extremely difficult question to answer as the correct answer really varies from couple to couple and individual to individual. You should understand the options available to you and make an informed decision on what to do next. Your options include;

  • repeat the whole treatment cycle again, after a "rest" of around 2 months,
  • use any eggs or embryos you have left from previous cycles so as to reduce the number of steps needed,
  • consider the use of donor sperm, eggs or embryos if it becomes clear that there is a problem with your own,
  • if the specialist considers it unlikely that you will conceive, then you need to re-evaluate the whole process of conception and what your options might be. This is an extremely difficult process.

Coming to terms with the fact that you may never conceive is a hugely traumatic experience.

WHAT HAPPENS THEN?

There are several options worth considering then. These include;

  • surrogacy: if you cannot fall pregnant yourself, you may wish to find a surrogate mother who may be willing to carry your unborn child to term. This is a highly controversial subject and there may be many legal barriers to negotiate before this is possible,
  • fostering: this may be a realistic option and one which can help many unfortunate children. It can be a highly rewarding experience,
  • adoption: this again can be highly rewarding as you become the legal guardian of a child. You will then become the main parental figure(s) in a child's life despite the child not being biologically your own.

If none of these options is possible or realistic for you, then coming to terms with the possibility of never having children may be the only option. Clearly, this will be very traumatic and difficult. Counselling is therefore vital in the acceptance process at this stage.