Infertility other therapies

## Contents

* 1 Intrauterine insemination
* 2 In vitro fertilization and embryo transfer
* 3 Gamete intrafallopial transfer
* 4 Zygote intrafallopial transfer
* 5 Intracytoplasmic sperm injection
* 6 Others
* 7 References

#### Intrauterine insemination

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* 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

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* 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

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* 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

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* 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

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* 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

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* 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

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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.
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.CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Multiple names: authors list (link)
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.CS1 maint: Multiple names: authors list (link)