Infertility other therapies

Intrauterine insemination[edit | edit source]

Intrauterine insemination is the process of extracting sperm either from husband or a sperm donor and depositing it in the uterine cavity.
IUI is successful in women who have ovulatory cycles but have trouble conceiving. Other indications are oligospermia, cervical stenosis or unexplained infertility.^[1]
For IUI to be successful, the sperm count in the husband/donor must be >1 million.
Since the released oocyte only survives for 12-24 hours, the process of insemination might be repeated 2-3 times over the period of 2-3 days.
Some recommend controlled ovarian hyperstimulation with clomiphene for better results.^[2]

In vitro fertilization and embryo transfer[edit | edit source]

In vitro fertilization is indicated in patients with disease of the fallopian tube, unexplained infertility, endometriosis, failure of ovulation induction, mullerian agenesis.^[3]
The first step in IVF is down regulation of pituitary to prevent LH surge with GnRH agonists.
Once Luteinizing hormone surge is prevented and adequate down regulation is achieved, controlled ovarian hyper stimulation is done with exogenous gonadotropins.
Growth of follicles is measured with sonography. When 2 or more follicles of adequate size are seen, 5000-10,000 IU human chorionic gonadotropin is given intramuscularly, following which oocyte is retrieved.
Retrieved oocyte is placed in culture and washed sperm is placed in the same culture media. The oocyte is then watched for signs of fertilization.
The ova which is fertilized and at 6-8 blastomere stage is placed into the uterine cavity.
Excess oocytes and embryos can be cryopreserved for the future.

Gamete intrafallopial transfer[edit | edit source]

In this procedure, both thr sperm and unfertilized oocytes are transferred into the fallopian tubes.^[4]
This procedure requires that the woman have patent tubes and a normal uterine cavity.
Ovarian hyperstimulation is done as in IVF and the collected oocytes along with sperm are placed laparoscopically into the distal end of the fallopian tube.
This procedure is more expensive than IVF but has a better success rate.

Zygote intrafallopial transfer[edit | edit source]

The fertilized oocyte is placed in the fallopian tube one day after in vitro fertilization.^[5]
Placement is done either laparoscopically or via uterine ostium.
The risk of ectopic pregnancy is higher in this procedure compared to IVF.

Intracytoplasmic sperm injection[edit | edit source]

This procedure is indicated in oligospermia, asthenospermia, congenital absence of vas deferens, unexplained infertility etc.^[6]
A single spermatid or spermatozoon is injected directly into the cytoplasm of an oocyte by puncturing the zona pellucida through an operating microscope.
ICSI is found to be more effective than the other methods of micro manipulation such as subzonal implantation.

Others[edit | edit source]

Embryo or oocyte donation can help in cases of premature ovarian failure, anovulation, old age, failed ART cycles.
Women without a functional uterus may benefit from gestational surrogacy.^[7]
Oocyte cryopreservation can be done in women who are to undergo chemotherapy or radiotherapy.^[8]

References[edit | edit source]

↑ Soysal C, Ozmen U (2018). "Intrauterine insemination in ovulatory infertile patients". Niger J Clin Pract. 21 (10): 1374–1379. doi:10.4103/njcp.njcp_64_17. PMID 30297574.
↑ Farquhar CM, Liu E, Armstrong S, Arroll N, Lensen S, Brown J (2018). "Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, open-label, randomised, controlled, two-centre trial". Lancet. 391 (10119): 441–450. doi:10.1016/S0140-6736(17)32406-6. PMID 29174128.
↑ Bortoletto P, Bakkensen J, Anchan RM (2018). "Embryo transfer: timing and techniques". Minerva Endocrinol. 43 (1): 57–68. doi:10.23736/S0391-1977.17.02649-9. PMID 28381082.
↑ Abramovici H, Dirnfeld M, Bornstein J, Lissak A, Gonen Y (1993). "Gamete intrafallopian transfer. An overview". J Reprod Med. 38 (9): 698–702. PMID 8254592.
↑ Patton GW, Holtz G, Edwards A, Swartz K (1994). "Transvaginal embryo transfer during the zygote intrafallopian tube transfer procedure". Am J Obstet Gynecol. 171 (2): 359–63, discussion 363-4. doi:10.1016/s0002-9378(94)70035-4. PMID 8059813.
↑ Esteves SC, Roque M, Bedoschi G, Haahr T, Humaidan P (2018). "Intracytoplasmic sperm injection for male infertility and consequences for offspring". Nat Rev Urol. 15 (9): 535–562. doi:10.1038/s41585-018-0051-8. PMID 29967387.
↑ Patel NH, Jadeja YD, Bhadarka HK, Patel MN, Patel NH, Sodagar NR (2018). "Insight into Different Aspects of Surrogacy Practices". J Hum Reprod Sci. 11 (3): 212–218. doi:10.4103/jhrs.JHRS_138_17. PMC 6262674. PMID 30568349.
↑ Argyle CE, Harper JC, Davies MC (2016). "Oocyte cryopreservation: where are we now?". Hum Reprod Update. 22 (4): 440–9. doi:10.1093/humupd/dmw007. PMID 27006004.

[pmid30297574-1] Soysal C, Ozmen U (2018). "Intrauterine insemination in ovulatory infertile patients". Niger J Clin Pract. 21 (10): 1374–1379. doi:10.4103/njcp.njcp_64_17. PMID 30297574.

[pmid29174128-2] Farquhar CM, Liu E, Armstrong S, Arroll N, Lensen S, Brown J (2018). "Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, open-label, randomised, controlled, two-centre trial". Lancet. 391 (10119): 441–450. doi:10.1016/S0140-6736(17)32406-6. PMID 29174128.

[pmid28381082-3] Bortoletto P, Bakkensen J, Anchan RM (2018). "Embryo transfer: timing and techniques". Minerva Endocrinol. 43 (1): 57–68. doi:10.23736/S0391-1977.17.02649-9. PMID 28381082.

[pmid8254592-4] Abramovici H, Dirnfeld M, Bornstein J, Lissak A, Gonen Y (1993). "Gamete intrafallopian transfer. An overview". J Reprod Med. 38 (9): 698–702. PMID 8254592.

[pmid8059813-5] Patton GW, Holtz G, Edwards A, Swartz K (1994). "Transvaginal embryo transfer during the zygote intrafallopian tube transfer procedure". Am J Obstet Gynecol. 171 (2): 359–63, discussion 363-4. doi:10.1016/s0002-9378(94)70035-4. PMID 8059813.

[pmid29967387-6] Esteves SC, Roque M, Bedoschi G, Haahr T, Humaidan P (2018). "Intracytoplasmic sperm injection for male infertility and consequences for offspring". Nat Rev Urol. 15 (9): 535–562. doi:10.1038/s41585-018-0051-8. PMID 29967387.

[pmid30568349-7] Patel NH, Jadeja YD, Bhadarka HK, Patel MN, Patel NH, Sodagar NR (2018). "Insight into Different Aspects of Surrogacy Practices". J Hum Reprod Sci. 11 (3): 212–218. doi:10.4103/jhrs.JHRS_138_17. PMC 6262674. PMID 30568349.

[pmid27006004-8] Argyle CE, Harper JC, Davies MC (2016). "Oocyte cryopreservation: where are we now?". Hum Reprod Update. 22 (4): 440–9. doi:10.1093/humupd/dmw007. PMID 27006004.

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