Treatment is highly individualised based on underlying problem(s), and the fertility specialist will discuss with the couple regarding the best option.
For disorders of ovulation, ovulation induction medications (Clomifene or Letrozole) may sometimes be prescribed. Assisted reproductive techniques (ART) include intrauterine insemination (IUI) and in-vitro fertilisation (IVF).
Damaged or blocked tubes
Under certain circumstances, surgery or cannulation of the tube may 'open' up the tubes. If despite treatment, there is no conception or the tubes cannot be unblocked, then in-vitro fertilisation (IVF) will be the treatment of choice.
Problems with ovulation
Problems with ovulation such as polycystic ovary syndrome (PCOS). Patients with PCOS who are overweight should lose weight as this may lead to resumption of ovulation. Screening for medical conditions like diabetes and high cholesterol should also be strongly considered. Ovulation induction with Clomifene or Letrozole may be used.
Endometriosis
Treatment of endometriosis is highly individualised. Patients with large endometriotic cysts (>5 cm) or with severe pain may consider surgery. IVF may be the next step if there is no conception postoperatively. Not all endometriotic cysts require surgery, as repeated surgeries can further reduce ovarian reserves. As endometriosis tends to recur, it is advisable to consider medical treatment to prevent recurrence if fertility is not desired.
Fibroids and polyps
Fibroids and polyps that distort the womb cavity can be removed through the hysteroscope, a telescope that allows visualisation of the womb cavity. The camera is introduced through the vagina.
Premature ovarian failure
Premature ovarian failure (early menopause) is a condition where the woman's ovaries stop releasing eggs. Under these circumstances, an egg donor is necessary as there is no proven treatment to reverse this condition. It can be genetic or caused by medical treatments (e.g., cancer treatment). Hence, prior to any cancer therapy, both women and men are counselled about how they can preserve their fertility. Men can bank their sperm and women can bank their eggs, ovarian tissue or embryo (if they are married) for future use.
Age
The number and quality of eggs diminish with age. There is no proven treatment that can reverse the effects of age and hence for women older than 35, infertility investigations may commence after six months of trying.
Low or no sperm
Hormonal tests, chromosomal tests and an ultrasound of the scrotum may be performed to find the underlying cause. In a small percentage of men, the cause is hormonal and replacement of hormones may allow the resumption of sperm production.
For men with low sperm count, intracytoplasmic sperm injection where sperms are injected directly into the egg at IVF will give the sperm the opportunity to fertilise the egg.
For men with no sperm, sperm may be obtained directly from the testis or epididymis via a surgical procedure. As the number of sperm retrieved are low, IVF/ICSI is necessary. For those where no sperm is retrieved, sperm donation can be considered.
For men with erectile dysfunction, psychosocial counselling and medication like Viagra may be helpful.
Other treatments
Intrauterine insemination (IUI)
This is a treatment where washed sperm is introduced into the womb with a cannula through the cervix at the time of ovulation. This is indicated for women with unexplained subfertility, at least one patent tube, with mild sperm problem or couples with sexual dysfunction (problem of nonconsummation, vaginismus or erectile dysfunction). IUI may be performed together with ovulation induction medications or with hormonal injection.
In-vitro fertilisation (IVF)
IVF is a procedure which involves daily hormone injections to grow multiple eggs. Eggs are then retrieved from the woman and are inseminated with the husband's sperm in the laboratory. The resultant embryo is then placed back into the womb a few days later.
IVF is indicated for the following problems:
Despite advances in IVF, the chances of conception vary from 20-35% depending on a woman's age.
Subscribe to our mailing list to get the updates to your email inbox...
