Infertility: The Pain and The Hope

At least 15 percent of couples usually experience some degree of infertility with all of its feelings and frustrations at some point in their life. This issue is not less important than our problem regarding over crowded population.

Today, more women and men seeking treatment for infertility are educated and an established group of the society. Norwadays, more women postpone marriage and childbearing until they are in their 30s or even later due to their career – which has contributed the situation.

Lack of knowledge about infertility could also be a potensial risk factor. So, it is important for both partners to understand the problems, treatment available in light of advancements of reproductive science all over the world and issues related to this.

Many couples who are unable to conceive easily may have a specific problem hindering their ability to conceive. In Asian societies it is common to blame the female partner. But in fact worldwide the problem is quite interesting, with 30 percent of the problem being attributable to the male and 30 percent to the female. In about 20 percent of all cases, the problem is traced to both partners. Even after exhaustive testing, the remaining 20 percent remains unexplained.

Recent advancement of infertility treatments falls into six basic areas.
1. Hormonal Therapy
2. Surgical procedure and micro surgery
3. Artificial insemination
· Intrauterine insemination (IUI)
· Gamete intra-fallopian transfer (GIFT)
· Micro-injection intra-fallopian transfer (MIFT)
4. Asisted reproductive technology (ART)
. In-vitro fertilization and embryo transfer (IVF-ET)
. Intracytoplasmic sperm injection and embryo transfer (ICSI-ET)
5. Cryopreservation (preservation of embryo/sperm in liquid nitrogen)
. Slow-cooling (Embryo/sperm freezing by low speed of cooling for subsequent use)
. Vitrification (Embryo/sperm freezing by ultra-rapid speed of cooling)
6. Pre-implantation genetic diagnosis (PGD)

IUI: Couples with moderate male factor infertility may respond well to this. This procedure is also effective to treat infertility caused by cervical mucus or immunological factors in the women.

In this technique, ovaries are stimulated by drugs to release two to three eggs in the tubes and sperm is prepared using simple centrifuge machine. Thus concentration and motility improves. Usually 0.2ul-2ml of prepared sperm is inserted into the uterus pre-vaginally using an insemination catheter. Generally accepted pregnancy rate per cycle by this techniques is 10 to 20 percent.

IVF: There are several procedures designed to unite sperm and eggs, and collectively they are called ART. IVF is the first ART, developed and most commonly used since 1978. This techniques is highly effective in overcoming a variety of infertility issues, particulary in tubal dysfunction.

It is a four-stage procedure.
Stage1: Controlled ovarian hyper-stimulation is used to stimulated the development of multiple folicles (two-40), to promote final maturation, and release of the eggs.
Stage2: Eggs are retrieved per-vaginally under ultrasonic guidance.
Stage3: Eggs are transferred to the laboratory where they are fertilized by the prepared sperm collected freshly from the husband or from previously frozen sperm.
Stage4: After fertilization eggs become embryo, which are then cultured in the sequential culture medium commonly up to five days until they form a blastocyst (when cavity appears inside the embryo). Then usually one or two embryo are tranferred into the uterus per-vaginally under ultrasonic guidance and the rest are frozen by cryo-preservation technique for future use if the women fails to fall pregnant.

ICSI: This is a micromanipulation technique, whereby a single sperm is immobilized, caught and injected into the egg. This procedure is indicated to overcome male infertility, unexplained infertility or where sperm are unable to penetrate the egg wall. Other steps are same as the IVF technique. This technique has a high fertilization rate of 80 to 90 percent and pregnancy rate of 40 percent.

PGD: One or two cells from three or five-day-old embryos are collected and analyzed using the Polymeric Chain Reaction technique or the Fluorescent In-Situ Hybridization procedure, common used to test whether an embryo has any genetic disease. Subsequently, only normal embryo are transferred into the uterus. However, this technique is highly expensive and offered only to couple who have previously diagnosed genetic disease.

– Fatima Montaz/ANN/Dialy Star