What are the Best Treatment for Infertility

INTRODUCTION

Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least one year. Around 10 – 20 % couples are affected by infertility. In rough terms, about one-third of infertility cases can be attributed to male factors and about one-third to female factors. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or, in about 20 percent of cases it is unexplained.

The treatment of infertility will depend upon the cause, duration of the marriage, treatment done so far and the age of the couple primarily that of the female. So investigating thoroughly should be our primary aim through a battery of tests thereby confirming our diagnosis after which a treatment plan can be formulated.

The various treatment options are –

1. Lifestyle management- A couple trying to get pregnant is usually advised to keep their BMI < 30, decrease the intake of caffeine and alcohol. Both the couple are advised against smoking as it decreases the quality of oocyte and sperm. Along with it regular exercise, adopting healthy food habits is advocated to increase the chances of pregnancy

2. Ovulation induction – It includes use of drugs such as clomiphene citrate, letrozole or injectable gonadotropins alone or easily coupled with timely intercourse/ IUI to increase the likelihood of pregnancy. This is usually done initially when all investigations are normal or there is an ovulation problem.

3. IUI: -It includes placement of washed sperm into uterine cavity intrauterine insemination around time of ovulation and, it can be performed with natural ovulation. However ovulation induction combined with IUI gives better results as compared to IUI alone. However for IUI female’s fallopian tube should be patent and semen should have healthy sperms of more than 10 million/ml. We should also keep in mind that success rate of IUI is only 10-15%,so ideally we should not do it for more than 3-6 cycles and move on higher better treatment options if not successful

4. IVF (In Vitro Fertilization)
In vitro fertilization is a process of fertilization where an egg is combined with sperm outside the body, in vitro. The process involves monitoring and stimulating a woman’s ovulatory process, removing an ovum or ova from the woman’s ovaries and letting sperm fertilize them in a liquid media in an embryology laboratory and transfer the embryos so formed into the uterus of the female. The advent of IVF came as a boon for those women whose both the fallopian tubes are blocked and also in those where other treatment modalities have failed. With the advancement in technology like laser-assisted hatching, blastocyst culture, close working chamber, advanced culture media and instruments in embryology lab, the success rate of IVF has increased from 30% initially to 70-80%.

ICSI (intracytoplasmic sperm Injection).- In this the process of ovulation induction and oocyte retrieval is same as that of IVF but here a single sperm is directly injected into a mature egg instead of letting the sperm fertilize the egg by itself. It is most helpful in male factor infertility with defective sperm morphology or having sperm count less than 5 million/ml as we here need only one sperm for fertilization of one egg.

Preimplantation genetic testing (PGT) – It is a technique used to identify genetic defects in embryos created through in vitro fertilization before pregnancy. Preimplantation genetic diagnosis refers specifically to when one or both genetic parents has a known genetic abnormality and testing is performed on an embryo to determine if it also carries a genetic abnormality. In contrast, preimplantation genetic screening refers to techniques where embryos from presumed chromosomally normal genetic parents are screened for aneuploidy.

So, In the present day scenario treatment of an infertile couple needs to be individualized so that they get the best treatment from an array of treatment options available in order to maximize their chances of fulfilling their dream of parenthood.