Fertility Facts

Research shows that as many as one in seven couples experience some difficulty with achieving a pregnancy.

Difficulties are found as often with the male as with the female partner. We suggest that you share the problems and work together to solve them. It is quite normal to take a year to achieve a pregnancy even when there is no problem.

Heightened publicity in recent years has made people more aware of the implications of infertility and the new modalities of treatment that are available. It is important to understand that many couples can be helped to conceive without resorting to such specialized treatment as In-vitro Fertilisation (IVF), sometimes referred to as ‘test tube baby’. Those patients for whom this form of treatment is appropriate are very much in the minority.

Regrettably, even with today’s technical advances there is no guarantee of success. Some couples eventually may have to come to terms with their childlessness.

What is G.I.F.T?
This stands for Gamete Intra Fallopian Transfer. A gamete is the medical term for the cells of reproduction, in other words, the egg and sperm. The preparation for G.I.F.T. involves the use of drugs to stimulate the ovaries for the formation of eggs which are collected at laparoscopy, and immediately mixed with the partner’s sperm and replaced in the fallopian tube. In nature, fertilisation occurs in the Fallopian tube.

If GIFT is not advisable, for example if your fallopian tubes are blocked or damaged, the doctor may advise you that IVF would be the preferable method of treatment for you. This decision can also take place at operation for the proposed GIFT procedure.

What is I.V.F?

In-vitro fertilization means fertilization of eggs by sperm outside the body. IVF is used as a treatment for infertility in couples where there is impaired sperm function, problems with passage of the sperm to the egg, and in some cases of unexplained infertility.

The preparation for IVF is similar to that of GIFT. Drugs are used to stimulate the ovaries to produce eggs, which are collected under ultrasound guidance. The eggs are then placed with the partner’s sperm in the laboratory and the fertilized eggs (embryos) are replaced two days later in the womb.

In a natural cycle, it is usual to produce one egg, which is released from the developing follicle two weeks before the next period starts. The follicle is a fluid filled cyst which grows to about 16-22mm before releasing its eggs. A mature follicle will usually contain an egg.

In IVF cycles, the aim is to achieve the growth and development of several follicles in order to maximize the chance of collecting several eggs. Once fertilization has taken place, the best 2 to 3 embryos can be selected and replaced in the womb.

When fertility drugs stimulate the ovaries, it is usual for several follicles to develop in the ovaries. It is important that we do the egg collection produced by the pituitary gland in the brain. FSH and LH stimulate the growth of follicle, which produce oestrogen before ovulation and progesterone after ovulation. Oestrogen promotes growth of the lining of the womb (endometrium), and progesterone maintains the endometrium in a favorable state for the implantation of the embryo(s).

What is I.C.S.I?

In vitro fertilization (i.e. fertilization outside the body) has undoubtedly revolutionized the treatment of infertility. In the space of two decades it has progressed from a highly experimental research technique, available in a handful of centers throughout the world, to a standard fertility treatment. In the same time span, the indications for In-vitro fertilization have expanded. Initially, it was only used for patients with blocked fallopian tubes, but now this group forms only about half of all treated couples. IVF is now seen as a recognized treatment for infertility associated with endometriosis and immunological problems as well as in couples where no cause can explain their difficulty in having a baby. One of the more recent applications of IVF is in infertility due to problems with the sperm. Here too IVF has enabled many couples to have children who might otherwise not have done so. However, IVF is not a universal cure. It has limitations, particularly in the treatment of low sperm count.

Intra-cytoplasmic Sperm Injection (ICSI)

ICSI is the latest and most successful microsurgical fertilization technique to be developed. It assists fertilization when the sperm is of extremely poor quality. The technique employs the same technology and microsurgical expertise a PZD and SUZI. However, when ICSI is performed, a single sperm only is injected directly into the centre of the egg (cytoplasm). In this way, the sperm is not required to penetrate any of the barriers surrounding the egg. Once injected, the eggs are incubated for sixteen hours.

The embryologist will the check to see if fertilization has occurred, and if it has, up to three of the resulting embryos will be transferred in to the woman’s uterus as in normal IVF treatment.
       
When is ICSI appropriate?

ICSI may be appropriate in the following:

  1. Patients whose eggs have not fertilized using IVF.
  2. Patients who have too few sperm for conventional IVF
  3. Patients who have extremely low sperm motility (movement)
  4. Patients who have a high number of abnormally formed sperm
  5. patients with antisperm antibodies present.
  6. When sperm have been surgically aspirated from the epididymis, part of the testes or extracted from a testicular biopsy.

 

What are the advantages for ICSI over conventional IVF?

  1. It can be used in cases where patients have only a few hundred sperm.
  2. It can be used in cases where hardly any of the sperm are moving.
  3. It can be used where semen samples contain a high number of abnormally formed sperm.

What are the disadvantages of ICSI?

  1. As ICSI is a very delicate procedure, eggs may be damaged during the procedure thereby making them unsuitable for transfer.
  2. As ICSI is a new technique, there is limited information relating to any possible risks to a child conceived by ICSI.
  3. There are some indications that there is an increased risk of congenital, chromosomal or developmental abnormalities following this procedure.
  4. Some infertile men may pass the same type of subfertility to their sons
  5. A minority of men with no sperm or a severely low sperm count may be carriers of cystic fibrosis or sex chromosome abnormalities. In selected cases, genetic testing of both partners is advisable and the unit will counsel patients according to their individual circumstances.
  6. There may be an increased miscarriage rate with ICSI pregnancies.
  7. Further research into ICSI is being undertaken in many centers and we closely monitor all research in this area.

Success Rate For ICSI:

Most centres around the world currently achieve encouraging pregnancy rates. ICSI has been available as a treatment worldwide now for over 7 years and the overall success rates has been over 25% clinical pregnancy.

Infertility Treatment.
Infertility affects millions of people both men and women. Although there is no one cause for the inability to have children naturally, many causes have been identified and can be treated. Today, fertility specialists offer many infertility treatment options such as in vitro fertilization (IVF). In vitro fertilization is a procedure in which the sperm and embryo are united in the lab. Other infertility treatment options include intrauterine insemination (IUI), intracytoplasmic sperm injections (ICSI), the use of donor eggs or donor sperm, surrogacy, and tubal reversal (an operation to “untie” fallopian tubes). In addition to this , advances in genetics allow couples to select the gender of their child or children or to help ensure that their child will not be genetically predisposed to certain disorders (preimplantation genetic diagnosis, or PGD).

If you are infertile, a fertility specialist will be able to diagnose fertility problems, recommend treatment options and perform infertility treatments. While no advanced reproduction technology is 100% effective, thousands of children have been born because their parents received infertility treatment.

Facts about fertility