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Reproductive endocrinology and infertility treatment

Reproductive Endocrinology and Infertility Treatment


According to the new reports there is an alarming increase in infertility rates because of lifestyle changes resulting in stress and obesity caused by lack of physical exercise, changes in eating habits and pollution accompanied by medical disorders like diabetes. There was a time when infertility was only limited to women. Now, male infertility is the cause in 50% of the cases where couples cannot conceive naturally. Nearly 15 of 100 couples need infertility treatment and the numbers are increasing.

CIMS has come up with comprehensive Infertility Centre. We are backed up by state-of-the-art equipment and team of highly experienced obstetricians, embryologists, reproductive endocrinologists, neonatologists, endoscopic surgeons, pathologists, pharmacists, psychologists, lab technicians, nurses and allied health professionals.

Conceived patients are taken care in high risk pregnancy unit with continuous CTG monitoring and facility for painless delivery (Epidural analgesia).

Infertility affects nearly fifteen percent of couples during childbearing years and the diagnosis can be due to –

  • Female fertility factors such as ovulation disorders, blocked fallopian tubes and other problems with the uterus or cervix
  • Male fertility factors commonly related to sperm abnormalities
  • Combination of factors from both partners

Approximately 20-25 percent of couples will receive a diagnosis of “unexplained infertility” which means the specific cause of infertility cannot be determined.

At CIMS, IVF treatment is offered and attempted only after less expensive options have failed.

TREATMENT FOR MEN

Treatment of male infertility includes management of general sexual problems or lack of healthy sperm.

Treatment may include:

  • Antibiotic treatment: Antibiotic treatment may sometimes be helpful.
  • Treatments for sexual intercourse problems: Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
  • Hormone treatments and medications: We sometimes recommend hormone replacement or medication in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
  • Surgery: Correction of an epididymal blockage and surgical extraction of sperm

Surgical extraction of sperm may be an option for men with:

  • An obstruction that prevents the release of sperm, such as an injury or infection
  • A congenital absence of the vas deferens (men born without the tube that drains the sperm from the testicle)
  • A vasectomy or a failed vasectomy reversal
  • Assisted reproductive technology (ART)

TREATMENTS FOR FEMALE INFERTILITY

  1. Medication Treatments for Female Infertility

Although a woman may need just one or two therapies to restore fertility, it’s possible that several different types of treatment may be needed before she’s able to conceive.

  • Medicines often used to assist fertility are listed below. These are usually prescribed for women, although in some cases they may also be prescribed for men.
  • Clomifene helps to encourage ovulation (the monthly release of an egg) in women who do not ovulate regularly or who cannot ovulate at all.
  • Metformin is particularly beneficial for women with polycystic ovary syndrome (PCOS).
  • Gonadotrophins can help stimulate ovulation in women.
  • Gonadotrophin-releasing hormone and dopamine agonists are other types of medication prescribed to encourage ovulation in women.
  • However, medication that stimulates the ovaries should not be given to women with unexplained infertility, as it is not thought to be an effective treatment in these circumstances.
  1. Surgical Treatments for Female Infertility

If surgery is required for fertility treatment, either conventional open surgery or keyhole surgery may be offered.

The main surgical procedures that are used to investigate infertility are:

  • Examination under anaesthesia
  • Hysteroscopy
  • Laparoscopy and dye test

At our hospital, surgery is done if:

  • fallopian tubes are blocked
  • presence of fibroids, mild endometriosis or another condition that affects the uterus, tubes or ovaries
  • polycystic ovary syndrome (PCOS) that has not responded to drug treatment
  • reversal of surgical sterilization

The following types of surgery are performed for treating various fertility problems:

  • Unblocking the fallopian tubes
  • Adhesiolysis-Freeing adhesions
  • Treating polycystic ovary syndrome (PCOS)
  • Treating mild endometriosis
  • Removal of fibroids
  • Sterilisation reversal 
  1. Assisted Conception 
  • Intrauterine insemination (IUI)
    Intrauterine insemination (IUI). During IUI, healthy sperm that have been collected and concentrated are placed directly in the uterus around the time the woman’s ovary releases one or more eggs to be fertilized. Depending on the reasons for infertility, the timing of IUI can be coordinated with  normal cycle or with fertility medications. 
  • In vitro fertilisation (IVF)

In vitro fertilization (IVF) is a process by which an egg is fertilized by sperm outside the body: in vitro (“in glass”). The process involves monitoring and stimulating a woman’s ovulatory process, removing an ovum or ova (egg or eggs) from the woman’s ovaries and letting sperm fertilize them in a liquid in a laboratory. The fertilized egg (zygote) is cultured for 2–6 days in a growth medium and is then implanted in the same or another woman’s uterus, with the intention of establishing a successful pregnancy.
IVF can be used to treat infertility with the following patients

  • Blocked or damaged fallopian tubes
  • Male factor infertility including decreased sperm count or sperm motility
  • Women with ovulation disorders, premature ovarian failure, uterine fibroids
  • Women who have had their fallopian tubes removed
  • Individuals with a genetic disorder
  • Unexplained infertility

Basic steps in the IVF and embryo transfer process

  • Monitoring and stimulation of the development of healthy egg(s) in the ovaries
  • Collection the eggs
  • Securing the sperm
  • Combining the eggs and sperm together in the laboratory and providing the appropriate environment for fertilization and early embryo growth
  • Transferring embryos into the uterus

Side effects of in vitro fertilization

Most women can resume normal activities the following day.Some side effects after IVF may include

  • Passing a small amount of fluid (may be clear or blood-tinged) after the procedure
  • Mild cramping
  • Mild bloating
  • Constipation
  • Breast tenderness

If you experience any of the following symptoms, call your doctor immediately

  • Heavy vaginal bleeding
  • Pelvic pain
  • Blood in the urine
  • A fever over 100.5 °F (38 °C)

Risks associated with in vitro fertilization

Fertility medications can have various side effects including headaches, mood swings, abdominal pain, hot flashes, and bloating, amongst other side effects. Although it is rare, fertility medications may cause ovarian hyper-stimulation syndrome (OHSS). Symptoms of OHSS may include abdominal pain or a feeling of being bloated. More severe symptoms include the following:

  • Nausea or vomiting
  • Decreased urinary frequency
  • Shortness of breath
  • Faintness
  • Severe stomach pains and bloating
  • More than 4kgs weight gain within three to five days
  • If you experience any of these symptoms above, please feel free to contact us.

Additional risks of IVF include the following:

  • Egg retrieval carries risks of bleeding, infection, and damage to the bowel or bladder.
  • The chance of a multiple pregnancy is increased with the use of fertility treatment. There are additional risks and concerns related to multiples during pregnancy including the increased risk of premature delivery and low birth weight.
  • Assisted reproductive technology (ART) involves a significant physical, financial, and emotional commitment on the part of a couple. Psychological stress and emotional problems are common, especially if in vitro fertilization (IVF) is unsuccessful.

How successful is in vitro fertilization? 

The success rate of IVF clinics depends on a number of factors including reproductive history, maternal age, cause of infertility, and lifestyle factors. It is also important to understand that pregnancy rates are not the same as live birth rates.

How many embryos should be created or transferred? 

The number of embryos transferred typically depends on the number of eggs collected and maternal age. As the rate of implantation decreases as women age, more eggs may be implanted depending on age to increase the likelihood of implantation. However, a greater number of eggs transferred increases the chances of having a multiples pregnancy.

  • Intracytoplasmic sperm injection (ICSI)

Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm  is injected directly into an  egg  ICSI is often used when semen quality is a problem, there are few sperms, or if fertilization attempts during prior IVF cycles failed.

Other techniques sometimes used in an IVF cycle, such as:

  • Donor eggs or sperm

Usually  ART is done using the woman’s own eggs and her partner’s sperm. However, if there are severe problems with either the eggs or sperm, one  may choose to use eggs, sperm or embryos from a known or anonymous donor.

  • Gestational carrier

Women who don’t have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using a gestational carrier. In this case, the couple’s embryo is placed in the uterus of the carrier for pregnancy.