Assisted conception guide

About 10-15% of couples will experience fertility problems.
 
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  • Updated:30 Apr 2011
 

02.Fertility treatments

Natural fertility

There is a growing trend for couples to try natural methods to help conceive a baby. This may be undertaken as an exclusive way to treat infertility or used in combination with fertility medical treatments. Taking a natural approach may entail attending a specialised natural fertility clinic or seeking the advice of a practitioner such as a Chinese herbalist and acupuncturist.

Natural fertility specialists generally look at the entire circumstances of the couple, mainly in relation to their health and lifestyle. They aim to use a holistic approach to work on both emotional and physical levels to increase the chances of conception. Treatments often entail recommending a healthy diet, having regular exercise, looking at both partners' lifestyle habits as well as stress management. The practitioner may recommend supplementing with vitamins and minerals (such as Zinc), possibly taking herbs and/or having acupuncture or perhaps homeopathy, massage or reflexology to improve the general health of a couple.

For some people, using a natural approach may be their first step towards treating suspected infertility, perhaps before seeking medical treatments. Other couples prefer natural treatments if their medical tests conclude their infertility is unexplained or they are not keen to undertake further medical interventions.

Bear in mind that while many couples have conceived through the support of natural fertility methods, there are no guarantees. Health and lifestyle modifications will not work if either partner has a definite physical problem that is preventing conception.

Surgery

One or both partners may require an operation for a physical problem affecting their fertility. This may be to repair or reconstruct a blocked duct that carries semen for the man or to clear the woman's fallopian tubescalled a tuboplasty. If the woman has endometriosis she may need endometrial tissue removed or scar tissue cleared. The success of having an operation alone to rectify infertility varies.

Around 10% of men with fertility problems require surgical sperm retrieval or SSR. This is because they have little or no sperm present in their ejaculate due to blocked vas deferens ducts, but still produce healthy sperm in their testes. SSR involves a reproductive urologist obtaining sperm surgically from the epididymis or directly from the testes under local or general anaesthetic. The procedure takes about 20 minutes.

Artificial Insemination

Artificial insemination of the woman or AI may be recommended if the couple are unable to have normal sexual intercourse or the man is having difficulty ejaculating efficiently or the sperm is donated by another man. Intrauterine insemination or IUI may be necessary if the woman's cervical mucus is inhibiting the man's sperm from surviving, or preventing his sperm from travelling through her cervix into her uterus to fertilise an egg.

Intrauterine insemination is also commonly used by fertility clinics when the woman is taking medications to help induce ovulation such as Clomid, as a side effect is thickening the woman's cervical mucus and preventing sperm from entering her uterus.

Intrauterine insemination involves the caregiver placing the man's semen directly inside the woman's uterus (in a similar procedure to a pap test). It takes about 5 minutes and does not require anaesthetic. Some women feel mild discomfort or intermittent cramping during the procedure. The semen is inserted high in the woman's uterus near her fallopian tubes where fertilisation normally occurs, bypassing her cervical mucus and the acidic environment of her vagina, to help increase sperm survival and the chances of conception.

Medications

The woman may be given medications to regulate her hormones and menstrual cycle and/or help stimulate her egg production (induce ovulation). The types of medications prescribed are many and varied and depend on the particular fertility problem that is trying to be corrected. Medications are often given in combinations with other fertility treatments the woman is undergoing. The most common medications prescribed are Clomiphene citrate tablets, known as Clomid or Serophene or daily FSH injections called Puregon or Gonal F.

Clomiphene citrate tablets

Clomiphene citrate tablets are taken for 5 days during the first half of the menstrual cycle to increase follicle stimulating hormone (FSH) produced by the woman's brain. The aim is to regulate the cycle and induce ovulation. About 70% of women who take Clomid will ovulate and about 30 to 40% of these will conceive while being treated over a 6 month period. Because Clomid thickens the woman's cervical mucus and makes it more hostile to sperm, intrauterine insemination is usually also performed by the fertility clinic when there are an optimum number of mature sized follicles present, around the time of ovulation. Clomid can also affect the lining of the uterus and impair implantation of a fertilised egg.

Clomid generally stimulates more than one follicle (immature egg) to grow so that more than one egg can be released in a month. This is why twins (or more) are conceived in up to 20% of cases. Side effects of the medication can include nausea, abdominal bloating, hot flushes, vaginal dryness, dizziness, mood swings, irritability, stomach upsets, headaches, breast discomfort and occasionally rashes. These usually subside once the 5 day course ceases each month.

FSH injections

FSH injections are commonly used for assisted reproductive technology. The injections are self-administered for 10 to 14 days using fine needles under the skin, similar to insulin injections used by diabetics. FSH induces the development of multiple follicles in the woman's ovaries, which needs to be closely monitored with regular blood tests and ultrasounds. Couples are advised not to have sex from day 3 of the injections as there is an increased risk of twins, triplets, quads or higher order multiple pregnancies if too many eggs are released and spontaneous conception occurs. The side effects of FSH are bloating and mood changes.

Rare side effects. A relatively rare (1 to 2%) but life-threatening complication from both types of ovulation inducing medications is Ovarian Hyper-Stimulation Syndrome or OHSS. This is where the ovaries severely enlarge resulting in abdominal pain as fluid leaks into the woman's abdomen and sometimes the chest cavity, producing feelings of excessive abdominal pressure, nausea and shortness of breath. The blood can also thicken, affecting other body organs. If you are experiencing symptoms like these, you should contact your caregiver immediately.

Both Clomid and FSH are usually only prescribed for about 4 to 12 menstrual cycles (on average 6 cycles) because they have been associated with an increased risk of ovarian cancer with long term use.

HCG injections and progesterone

If a woman is taking FSH injections to stimulate follicles or eggs to develop, once one (or more) follicles are measured to be the right size using ultrasound a Human Chorionic Gonadotrophin (HCG) injection is given to stimulate ovulation, which usually happens about 38 hours later so that egg collection can occur for assisted reproductive technology techniques.

When these fertilised eggs develop into embryos (2 to 5 days in the laboratory) one or two are returned to the woman's uterus and extra doses of HCG or progesterone pessaries or gel (administered vaginally) may be given for the rest of the woman's cycle to support a possible pregnancy until the outcome is known, usually 14 to 16 days after egg collection when a pregnancy test can be done.

Sourced with permission from birth.com.au

 

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