Treating infertility needs a comprehensive and well-thought approach considering the complexities involved Dr Purva Sahakari, an Obstetrician, Gynecologist and Infertility Specialist, gives us some interesting insights on the same.
Who should visit a doctor?
Considering that both the female and male factors could be responsible for infertility, both the husband and the wife should visit the infertility specialist. In case of females above the age of 35 years, it is advisable to visit the doctor earlier to allow sufficient time for fertility testing and guard against the declining fertility in females beyond 3o years of age.
A detailed history and examination of the couple would be the first step towards identifying the cause of infertility and help in early and proper management. Various investigations are performed to rule out the causes of infertility.
What are the investigations which are asked for when treating infertility?
Females are usually advised to do blood tests to check the hormonal status, an ultrasound of the abdomen and a radiographic evaluation (a special x-ray of lower abdomen-hysterosalpingography) to rule out any tubal blocks etc.
Male partners are advised a semen analysis and relevant blood investigations, scrotal ultrasound as per the requirement.
What are the treatment options available for infertility?
As the choice of treatment depends on the relevant medical history and other individual parameters specific to the couple, the treatment for infertility should be individualized and customized as per the factors involved.
Depending upon the cause, the infertility specialist would offer the necessary medical and surgical treatment.
Factors like tubal blocks, any structural abnormalities like uterine septum, endometriosis are treated surgically, where laparoscopy (look inside the abdominal cavity) and hysteroscopy (look inside the uterus and treat) are the first-line treatment.
Diagnostic laparoscopy with hysteroscopy helps identify various causes of infertility.
Ovulation induction includes the use of oral or injectable medications to help in the growth of the follicle (with the egg inside it) and facilitates its release from the ovary. This is offered to women with abnormalities of ovulation.
Male partners with semen abnormalities or low sperm counts are offered medications in the form of necessary supplements as a supportive therapy.
Causes like a varicocele (enlargement of veins in the scrotum) leading to poor semen parameters are treated surgically or medically.
Intrauterine insemination- it is commonly known as IUI (insertion of semen into the uterus artificially) is usually offered as a first-line treatment in females undergoing ovulation induction cycles, cases of mild male factor abnormalities, use of donor semen.
In-vitro fertilization (IVF) – In this technique, the egg and sperm (taken from the mother and father or donors respectively) are fertilized in a lab and transferred to the uterus. This treatment is often offered to cases of failed IUI, unresolved tubal blocks, the advanced age of mother, severe male factor abnormalities, azoospermia etc.
Surrogacy (hire a womb) - In this process, the egg is retrieved ( taken) from the mother ( the woman hiring the womb), which is then fertilized with the sperm of the father in the lab ( in vitro) and is then transferred to the womb of the surrogate who bears the child for the entire term of the pregnancy. Such an option is offered to women unable to carry the fetus intrauterine, due to absence of uterus, unresolved congenital structural abnormalities of the uterus or severe medical complications in the woman.
Despite all the available treatment options for infertility, we still face failures in achieving a positive outcome in the form of pregnancy in a few cases. We hope the next development in the currently available science could bridge the existing gaps and help us spread the joy a pregnancy brings.
For more queries, contact Dr Purva Sahakari at purvapals@yahoo.co.in
