Discussing the options with our fertility specialist
Written by Dr Irfana Koita for Doctify
What are the fertility treatment options?
Women who do not ovulate, usually present with irregular or completely absent periods. The most common cause for this is a condition known as Polycystic Ovary Syndrome (PCOS). Ovulation induction is performed using oral tablets containing Clomifene or hormonal injections containing Follicle Stimulating Hormone (FSH). During your treatment, you will require regular scans to monitor the response of your ovaries. You may either aim for spontaneous conception through intercourse or have Intrauterine Insemination treatment (IUI). Ovulation induction may lead to the development of more than one follicle resulting in multiple pregnancy.
Intrauterine insemination (IUI)
Intrauterine Insemination (IUI) is a type of fertility treatment where a semen sample is purified in the laboratory and then deposited into the womb using a thin, soft catheter. This can either be performed in a natural cycle without the use of medication, following ovarian stimulation (see above) or with hormonal injections containing Follicle Stimulating Hormone (FSH). This is a non-invasive form of fertility treatment. However, the success rate ranges between 10 and 15%.
In Vitro Fertilisation (IVF) – Stimulated / Mild Stimulation / Natural Cycle
During In Vitro Fertilisation (IVF), an egg is removed from the woman’s ovaries and fertilised with sperm in a laboratory. The fertilised egg, called an embryo, is then returned to the woman’s womb to grow and develop.
Fertility drugs (Stimulated IVF Treatment) may be given to the female partner to stimulate the production of multiple eggs which are contained in follicles on the ovaries. Progress is monitored using ultrasound and blood tests. The eggs are then collected via ultrasound-guided vaginal aspiration whilst the patient is sedated. The eggs are mixed with the sperm in a petri dish and closely monitored for signs of fertilisation. The embryologists analyse the embryos for quality and select the most suitable embryo for transfer. The embryo is loaded into a fine catheter. This is placed into the womb and the embryo is released. Two weeks after the embryo transfer, a pregnancy test is performed to confirm implantation was successful.
Mild ovarian stimulation for IVF treatment aims to achieve a cost-effective, patient-friendly option which optimises the balance between outcomes and risks of treatment. This option is most suitable for those with very active ovaries also known as polycystic ovaries. The risk of over response (ovarian hyper stimulation syndrome) in this group is very high, hence a mild stimulation approach is most appropriate.
Natural Cycle IVF is a type of IVF treatment where no stimulating medication is used. The first IVF baby in the world, Louise Brown, was born using this method of treatment. It is usually used for women where (i) medication is unlikely to help in recruiting a higher number of eggs due to a low ovarian reserve; (ii) in those women with a previous suboptimal response to ovarian stimulation; or (iii) in those with a very high risk of ovarian over-stimulation. However, Natural Cycle IVF tends to have a high cancellation rate (approximately 30%) due to either high hormonal levels at the start of a cycle, an arrest in follicular growth or premature ovulation.
Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic Sperm Injection (ICSI) is a type of IVF treatment where sperm is injected directly into the egg. This technique is used when the sperm is not optimal, whether due to a low count, motility or morphology. At times, it may be used due to the presence of bacteria or raised antibody levels in the semen sample.
Intracytoplasmic Morphologically Selected Sperm Injection (IMSI)
Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) is a new technique used to assist sperm selection for fertilisation. This technique uses high power magnification to look inside the sperm allowing specialists to pick the sperm with the highest chance of achieving a successful fertilisation. This technique is particularly important in cases of repeated IVF failures, in those with a history of miscarriage or in those with high sperm DNA fragmentation. DNA fragmentation occurs when there is an alteration or a break in one of the DNA strands inside the sperm itself and can affect the possibility of a successful pregnancy.
Preimplantation Genetic Screening (PGS)
Preimplantation Genetic Screening (PGS) is a type of IVF treatment where the assessment of the chromosomes within the embryos is performed prior to them being transferred. This allows accurate embryo selection and is hence most likely to result in a healthy, successful pregnancy. This form of treatment is most suited for those who have had recurrent miscarriages or implantation problems.
Preimplantation Genetic Diagnosis (PGD)
Preimplantation Genetic Diagnosis (PGD) is a method of detecting chromosomal and genetic abnormalities in embryos before they are implanted into the uterus. It is used for patients at risk of transmitting specific chromosomal and genetic abnormalities to their children.
Men may be unable to produce sperm due to various reasons. Treatment using donor sperm for certain couples can take different forms. These include Intrauterine Insemination (IUI-D) or In Vitro Fertilisation (IVF-D). These methods are the same as IVF and IUI treatments with a partner’s sperm except that donor sperm is used.
Some women are unable to have children because they are unable to produce eggs. This can occur for numerous reasons including poorly developed ovaries, premature menopause, previous surgery or chemotherapy. For these women, IVF using donated eggs offers them their only chance of becoming pregnant. In egg donation, the donated eggs are fertilised by the recipient’s partner’s sperm (where appropriate) or the donor’s sperm. The embryo is then implanted into the woman’s uterus.
A surrogacy arrangement or surrogacy agreement is the carrying of a pregnancy for intended parents. There are two main types of surrogacy:
Gestational surrogacy (also known as host or full surrogacy)
In gestational surrogacy, the pregnancy results from the transfer of an embryo created by in vitro fertilization (IVF), in such a manner that the resulting child is genetically unrelated to the surrogate. Gestational surrogates are also referred to as gestational carriers.
Traditional surrogacy (also known as partial, genetic, or straight surrogacy)
In traditional surrogacy, the surrogate is impregnated naturally or artificially, but the resulting child is genetically related to the surrogate.
Intended parents may seek a surrogacy arrangement when either pregnancy is medically impossible, pregnancy risks present an unacceptable danger to the mother’s health or where it is a same sex couple’s preferred method of procreation. Monetary compensation may or may not be involved in these arrangements. If the surrogate receives money for the surrogacy the arrangement is considered commercial surrogacy. If she receives no compensation beyond reimbursement of medical and other reasonable expenses, it is referred to as altruistic surrogacy.