The knowledge and treatment of infertility has improved dramatically in the last four decades encouraging a growing number of couples to seek help in overcoming their problems of low fertility. A variety of options are now available to help identify the cause and ultimately provide the couple with the highest chance of realising their dream of having a baby.
The good news is that the majority of infertile couples who seek help eventually have a baby and the pregnancy rates for assisted reproductive technology (ART) now exceed the monthly fertility rate for most ‘fertile’ couples. But to achieve this it may be necessary to have repeated treatments, so the earlier treatment is sought, the more likely the chance of a successful conception.
Ferring has been helping couples to conceive for a decade with a portfolio of high quality products that work in the same way as the body’s natural hormones, to correct hormonal imbalances and stimulate ovulation, creating a high pregnancy success rate.
Infertility services
The procedures and treatments available from infertility clinics can be divided into four main categories:
The infertility specialist is likely to start with the simplest treatment that is suitable for the cause of infertility in a particular couple. Where a pregnancy is not achieved after a few cycles of treatment another procedure will be selected. Most infertility cases, i.e. 85% to 90%, are treated with conventional medical therapies such as medication or surgery.
Ovulation induction (OI): Can be used as a treatment on its own, or in combination with one of the other infertility treatments such as artificial insemination, or an ART such as in-vitro fertilisation (IVF).
The anti-oestrogens clomifene and tamoxifen have been used traditionally in the treatment of infertility to stimulate ovulation in women with infrequent or irregular periods, or in those whose menstrual cycles have stopped due to polycystic ovaries.
They induce the release of gonadotropins by making the hypothalamus believe the woman’s oestrogen levels are too low. Although successful for many women, they carry a high risk of multiple pregnancies.
Hormonal therapy: Non-ovulating women who do not respond to clomifene, or have hormonal imbalances due to a definite under-active pituitary, can benefit from gonadotropin treatment which acts to replace, or enhance, the hormones produced naturally by the body. Gonadotropin treatment is also used to stimulate ‘super-ovulation’ for assisted conception procedures, including IVF.
Combined treatment with follicle stimulating hormone activity (FSH) and luteinising hormone activity (LH), as found in human menopausal gonadotropin such as Ferring’s menotropin products, is used for super-ovulation therapy. It is recommended by leading experts, for super-ovulation in ARTs, on the basis of economics and its high-rates of success.
Other gonadotropin treatment options include FSH products such as urofollitropin and follitropin and human chorionic gonadotropin.
Artificial insemination: Most often used in cases of infertility due to low sperm count / concentration or reduced motility. It can also be used in cases where the woman has hostile cervical mucus, or produces antibodies against sperm.
The sperm are collected, processed and washed and then inserted directly into the uterus, cervical canal or vagina. Intrauterine insemination is the most common form of AI, but all forms increase the chance of fertilisation. AI can also be performed with donor sperm where necessary.
Surgery: Surgery can be used to correct anatomical abnormalities of the reproductive system in either the woman or the man. In the woman, a number of problems can be corrected including the removal of scar tissue from previous infections, endometriosis or fibroids.
Assisted reproductive technology
ART is a general term covering a range of advanced procedures, including micro-manipulation of sperm, to aid fertilisation and implantation. The procedures have one thing in common. They require the collection of multiple mature eggs (oocytes), which is achieved by hormonal stimulation of the ovaries often described as ‘super-ovulation’.
The main ART procedures include:
IVF: The first and most well-known procedure in the ART group. Its increasing success rate means it is used more often for women with tubal disease and endometriosis, women who produce antibodies to sperm, and cases of unexplained infertility. It is also used in cases where the quality of sperm is suspect, as it enables good sperm to be selected and used.
The procedure has four stages and involves stimulation of the ovaries to produce and release a number of mature eggs, collection of the eggs from the ovaries, fertilisation outside the body to produce young embryos and transfer of the embryos into the uterus.
The transplantation of multiple fertilised eggs increases the chance of implantation and successful pregnancy. The technique is known for producing multiple births.
ICSI: A micro-manipulation technique and the main method used for male infertility. It is used when there are marked abnormalities in the sperm’s quality and ability to penetrate the oocyte or attach to it.
As the name suggests, the technique involves the injection of a selected sperm directly into the mature egg, avoiding the use of poor sperm. It is also used when other techniques have not resulted in fertilisation, as it ensures fertilisation before the egg is returned to the uterus.
GIFT: Used for women who have normally functioning fallopian tubes, but unexplained infertility or endometriosis. Similar to IVF, GIFT involves stimulating and removing eggs from a woman's ovary, combining them with sperm, and using a laparoscope to place the mixture of unfertilised eggs and sperm into the woman's fallopian tubes, instead of the uterus, through a small incision in the abdomen.
In GIFT, fertilisation occurs in the woman. However, the procedure has somewhat been replaced by IVF due to the greater success rates of IVF.
ZIFT: Used for similar cases of infertility as GIFT except that the eggs are fertilised outside the body. Matured eggs are collected from the ovary and fertilised. A laparoscope is then used to place the resulting zygote (fertilised egg) into the woman's fallopian tubes through a small incision in the abdomen.
BT: Blastocyst transfer takes advantage of the advancements made in being able to grow embryos for longer periods outside of the body.
Fertilised eggs can now be nurtured for up to six days by which time they have developed into embryos of about 100 cells (blastocysts). At this stage they are more likely to become implanted in the uterus leading to a pregnancy. Fewer blastocysts are transplanted, reducing the risk of multiple pregnancies.
Micro-manipulation techniques, which include collection of sperm directly from the body, have given hope to men with serious cases of infertility.