Infertility Investigations & Management
- Infertility is defined as the inability to conceive after 1 year of having regular intercourse without using contraception. About 15% of couples are infertile.
- If you have been trying to conceive for more than a year without success, you should see a gynaecologist to get investigated for possible causes of infertility. If you are over 35 years old and have been unsuccessful, you should seek medical help after 6 months as the risk of genetic disorders, miscarriage and infertility increase as we age.
Testing may involve:
- Thorough medical history and physical examination
- Ultrasound and hysterosalpingography (HSG)
- Semen analysis
- Ovulation assessment
- Hysteroscopy to look inside the uterus. During this procedure, samples of the endometrium may be taken to study.
- Laparoscopy which is a surgical procedure to inspect the tubes, ovaries, and the outside of the uterus. Assessment to see if the tubes are patent or blocked is also performed. Any endometriosis, pelvic adhesions or ovarian cysts can be surgically treated.
- Depending on the result of these tests, treatments like ovulation induction, surgery to remove growths (polyps or fibroids) or adhesions, superovulation intra-uterine insemination (SO-IUI) or in vitro fertilization (IVF) may then be recommended.
Super-ovulation and Intra-Uterine Insemination (SO-IUI)
- Both tubes must be patent in order for SO-IUI to be performed. Couples with mild endometriosis, mild male factory infertility, unexplained infertility and cervical factor infertility can undergo SO-IUI.
- Oral clomiphene citrate or gonadotropin (GnRH) injections are given to stimulate several follicles (eggs) to grow and mature. Ultrasound scans are done regularly to determine the number and size of eggs within the ovary.
- On insemination day, a fresh sample of the husband semen is brought to the lab. The semen undergoes special preparation and is then placed directly into the womb through a fine tube. Medications are given to improve the chances of implantation and pregnancy. A pregnancy test is performed 14-17 days after the insemination.
In-Vitro Fertilization (IVF) and Intra-Cytoplasmic Sperm Injection (ICSI)
- In Vitro Fertilization (IVF) uses sperm to fertilize eggs from the woman in a lab. This is offered to women with irreparably damaged fallopian tubes, blocked fallopian tubes, severe endometriosis, ovulatory problems, unexplained infertility and severe sperm disorders.
- High dose gonadotropin (GnRH) injections are given to stimulate several follicles (eggs) to grow and their maturation progress is monitored with serial ultrasound scans. When these follicles are sufficiently developed, they are removed from the ovaries. Under direct ultrasound guidance, a needle is inserted through the vagina and into the ovary to retrieve the follicles. These are combined with healthy sperm in the lab to see if they become fertilized.
- Intracytoplasmic Sperm Injection (ICSI) is similar to IVF except that a single sperm is injected directly into each individual egg to increase the chances of successful fertilization. This may be a good option if there is very low quality sperm. It can be used alone or in combination with IVF.
- A few days later, one or two fertilized eggs (embryos) are placed in the woman’s uterus through her vagina. Any extra embryos that are not used may be frozen and stored for later use.
- To improve the chances of implantation and pregnancy, hormonal support is recommended. A pregnancy test is then performed 14-17 days after the embryo transfer.