WHAT TO CHOOSE?
Infertility has a huge emotional burden on the couple’s mind. With the global rise of infertility cases, the right treatment to choose is a big dilemma. While choosing a particular infertility treatment, a few things should be kept in mind. The age of the couple, particularly the female’s age, is one of the most important deciding factors. As the age of the woman increase, the ovarian reserve decreases at a faster pace. Ovarian reserve is checked with the help of blood test i.e. AMH and AFC on ultrasound. Also, the duration of marriage and cohabitation helps in deciding. The ovarian reserve is the most important criterion which ultimately decides which fertility options are going to benefit the best. Tubal patency is necessary for natural conception. If the fallopian tubes are blocked or damaged beyond repair, IVF (test tube baby) is the only treatment option left with the couple. Husband semen quality is another very important factor. Advanced age, varicocele, testicular trauma, genetic disorders, etc. significantly impair the sperm quality.
Ovulation Induction and Timed contact: A young couple with short married life, good ovarian reserve, no apparent pelvic pathologies, and good husband semen analysis can opt for ovulation-inducing medicines for 6 months. Ovulation induction medicines are given orally or in injection form, to allow 2-3 egg forming follicles to grow. Serial ultrasounds are done, and timed contact is advised according to the day of ovulation.
Ovulation Induction with Intra-uterine insemination (IUI): Couples who don’t get benefit from ovulation induction and timed contact are suggested to undergo intra-uterine husband semen inoculation with the help of a special catheter. Also, the couple with male factor, i.e. husband with low sperm count or motility are advised for IUI as the first line of treatment. Tubal patency is a must for this procedure, as the fallopian tubes act as a transporter of egg and sperms and are the site of fertilization. The success rate of 3-6 cycles of IUI is around 18-25%.
In-vitro fertilization (IVF)/ Intracytoplasmic Sperm Injection (ICSI): When the above treatment options fail or wife has advanced age with poor ovarian reserve, tubes are not patent, or husband has very low or no sperm count or severe sperm dysfunction, IVF/ICSI is the only treatment option that can give best results in a short period of time. IVF involves a series of medical procedures by which an egg is fertilized by sperms in a petridish (test tube). ICSI is a specialized procedure in which an egg is inoculated by a single sperm with the help of a special needle. Injectable medicines are given to allow multiple ovarian follicular growth, eggs are retrieved with the help of a special needle under anesthesia, and embryos are formed outside the body in a controlled environment in a specialized laboratory, following which the embryos are transferred in the woman’s uterus. The average success rate of IVF/ICSI is 50-60%. Women in which the uterus is absent or severely damaged, surrogacy is a good option, and embryos of the couple are put in the uterus that is rented from another woman.
Additional beneficial points to remember during infertility treatment: A healthy lifestyle including a balanced diet, adequate sleep, regular exercise, and stress control are keys to a successful fertility treatment apart from the clinician’s expertise and laboratory set-up. Individual and group counseling, yoga, meditation, etc. help in reducing the stress level and boost the fertility treatments success rate.
Dr Anadeep Chandi is a Reproductive Medicine specialist & Trained laparoscopic surgeon MS, DNB, FRM, FICOG.
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author. The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.