What Are Common Causes Of Infertility?
The gonadotropins in these formulations are FSH, and in some cases, a combination of FSH and LH (luteinizing hormone).
These injections are taken nightly, typically for 5 to 10 days, and act directly on the cells of the ovary to stimulate egg development.
Once a follicle containing an egg reaches a mature size, another hormone injection called HCG is often given to mimic the natural LH surge that occurs at the time of ovulation.
This leads to the final maturation and release of the egg.
• Insemination: Intrauterine insemination, also known as IUI, is a process by which sperm is washed and prepared for placement into the uterine cavity, thereby bypassing the cervix and bringing a higher concentration of motile sperm closer to the tubes and ovulated egg.
To accomplish this, the semen is washed with a solution safe for sperm and eggs, and then centrifuged to separate motile sperm from immotile sperm and other cells.
The motile and viable sperm are then placed in a very small amount of solution and gently injected into the uterine cavity using a very thin, soft, and flexible catheter.
At least one open tube is required for IUI, and any sperm abnormality cannot be severe; otherwise, the sperm will not be able to swim to and fertilize the egg.
• In Vitro Fertilization (IVF): In vitro means “outside the body.” IVF is a process whereby eggs are collected and then fertilized by sperm outside the body in an embryology laboratory.
The first IVF baby was born in 1978 in England. Not long after, the United States delivered its first IVF baby, and the use of IVF has grown dramatically.
IVF was a major breakthrough because it allowed for successful pregnancies in women that were previously deemed permanently infertile, such as when the fallopian tubes are both markedly damaged.
IVF involves the removal of eggs directly from the ovary, fertilization with sperm in the laboratory, followed by the transfer of the embryos directly into the uterus, thereby bypassing the tubes.
Although tubal disease was the original indication for IVF, many more indications have developed over the years.
These include advancing maternal age, severe male factor infertility (whereby ICSI can be used to fertilize the egg), and endometriosis, among many others.
IVF is Generally Performed in the Following Manner:
The woman undergoes gonadotropin injections, which stimulate the ovaries to produce many eggs.
Once the follicles (fluid-filled sacs containing the eggs) reach a mature size, an HCG injection is administered, which leads to the final development and maturation of the eggs.
Just before those eggs would otherwise be ovulated, they are retrieved under mild anesthesia in an operating room.
This procedure is done under ultrasound guidance when the surgeon utilizes a narrow needle to retrieve eggs from the ovary through the vaginal wall.
This sterile needle is attached to sterile suction tubing and a collecting vial.
Once the fluid containing the eggs is removed from the follicles into the vials, it is handed to the embryologist, who finds the eggs, places them in tiny droplets on a Petri dish, and then fertilizes the eggs using either their partner’s or donor sperm.
The sperm can either be mixed with the eggs to allow normal fertilization (conventional insemination) or injected into each mature egg (ICSI).
The fertilized eggs, now embryos, are allowed to grow and develop in culture media for typically 3 to 5 days.
Then, generally, one or two embryos that have demonstrated appropriate development are carefully and gently transferred into the uterine cavity. Embryo transfer is performed in the office under abdominal ultrasound guidance using a small, soft, sterile, and flexible catheter.
The embryos are placed within the tip of the transfer catheter and then injected into the uterine cavity once the catheter is placed through the cervical canal to the ideal spot within the uterus.
The pregnancy test is then performed 2 weeks after the egg retrieval.