Infertility Health Article

Treatment

Treatment of infertility first involves addressing underlying conditions in the male and female partners. If these fail to produce a pregnancy, additional steps can be undertaken to assist pregnancy.

Treatment of male infertility includes first addressing known reversible factors such as discontinuing any medication known to have an effect on spermatogenesis or ejaculation, decreasing alcohol intake, or treating thyroid or other endocrine disease. Varicoceles can be treated surgically. Testosterone in low doses can improve sperm motility.

Other treatments of male infertility include collecting semen samples from multiple ejaculations, after which the semen is put through a process that allows the most motile sperm to be sorted out. These motile sperm are pooled together to create a concentrate that can be deposited into the female partner's uterus at ovulation. In cases where the male partner's sperm is proven unviable, with the consent of both partners, donor sperm may be used. Depositing the male partner's sperm or donor sperm by mechanical means into the female partner is a form of artificial insemination.

Treatment of ovulatory problems depends on the cause. If a thyroid or pituitary problem is responsible, treating that problem can restore fertility. Medication such as Clomid and Pergonal can be used to stimulate fertility. These drugs may increase the risk of multiple births (twins, triplets, etc.).

Pelvic adhesions can be excised with laparoscopy. Endometriosis can be treated with certain medications, but may also require surgery to repair any obstruction caused by adhesions.

Treatment of cervical factors includes antibiotics in the case of an infection, steroids to decrease production of anti-sperm antibodies, and artificial insemination techniques to completely bypass the cervical mucus.

Assisted reproductive techniques include in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), and zygote intrafallopian tube transfer (ZIFT). These are usually used after other techniques to treat infertility have failed.

IVF involves the use of a drug to induce the simultaneous release of many eggs from a female's ovaries. These are surgically retrieved. Meanwhile, several semen samples are obtained from the male partner, and a sperm concentrate is prepared. The ova and sperm are then combined in a laboratory, where several of the ova may be fertilized. Cell division is allowed to take place up to the embryo stage. While this takes place, the female may be given drugs to prepare her uterus to receive an embryo. Three or four of the embryos are transferred to the female's uterus, and the wait begins to see if any or all of them implant and result in an actual pregnancy.

Success rates of IVF are still rather low. Most centers report pregnancy rates between 10–20%. Since most IVF procedures put more than one embryo into the uterus, the chance for a multiple birth is greatly increased in couples undergoing IVF.

GIFT involves retrieval of both multiple ova and semen, and the mechanical placement of both within the female partner's fallopian tubes. ZIFT involves the same retrieval of ova and semen and the fertilization and growth in the laboratory up to the zygote stage, at which point the zygotes are placed in the fallopian tubes. Both GIFT and ZIFT have higher success rates than IVF.

Prognosis

It is very difficult to obtain statistics regarding the prognosis of infertility because many different problems may exist within an individual or couple trying to conceive. In general, of all couples who undergo a complete evaluation of infertility followed by treatment, about half will ultimately have a successful pregnancy. Of those couples who do not choose to undergo evaluation or treatment, about 5% will go on to conceive after a year or more of infertility.

Health care team roles

Gynecologists who specialize in infertility lead most investigations. Registered nurses (RNs) assist throughout investigations and other associated procedures. Laboratory technicians conduct laboratory tests and evaluations of ova and sperm. Other technicians may assist in preparing eggs and sperm for IVF, or readying women for GIFT or ZIFT. Pharmacists dispense the many drugs that are required for GIFT, ZIFT, or IVF.