At least 15 percent of couples usually experience some degree of infertility with all of its feelings and frustrations at some point in their life. This issue is not less important than our problem regarding over crowded population.
Today, more women and men seeking treatment for infertility are educated and established group of the society. Now-a-days, more women postpone marriage and childbearing until they are in around 30s or even later in mid 30s due to their career — which has contributed the situation.
Lack of knowledge about infertility could also be a potential risk factors. So, it is important for both partners to understand the problems, the treatment that could be offered in the light of current advancement of reproductive science all over the world and issues related to this.
Many couples who are unable to conceive easily may have a specific problem hindering their ability to conceive. In a country like Bangladesh, the common attitude is to blame the female partner.
But practical scenario is quite interesting all over the world, attributing 30% problem to the male; 30% to the female. In about 20% cases fertility problem is traced to the both partners. Even after exhaustive testing, the rest 20% remains unexplained.
Recent advancement of infertility treatment falls into six basic areas.
1. Hormonal Therapy
2. Surgical procedure and microsurgery
3. Artificial insemination
* Intrauterine insemination (IUI)
* Gamete intra-fallopian transfer (GIFT)
* Micro-injection intra-fallopian transfer (MIFT)
4. Assisted reproductive technology (ART)
* In-vitro fertilization & embryo transfer (IVF-ET)
* Intracytoplasmic sperm injection and embryo transfer (ICSI-ET)
5. Cryopreservation (preservation of embryo/sperm in liquid Nitrogen for long time)
* Slow-cooling (Embryo/sperm freezing by low speed of cooling for subsequent use)
* Vitrification (Embryo/sperm freesing by ultra-rapid speed of cooling)
6. Pre-implantation genetic diagnosis (PGD)
In Bangladesh few of our prominent physicians have been offering medical and some degree of microsurgical treatments since 1990.
It is a matter of hope that ART treatment has been started by very few private practitioners and IUI is the most commonly used treatment option at this moment in Bangladesh.
However, the initiatives for fighting against, if medical and surgical treatment have been failed to bring successful outcome, are almost in primitive stage.
IUI (In vivo fertilisation-fertilisation inside the body)
Couple with moderate male factor infertility may respond well to artificial insemination. This procedure is also effective to treat infertility caused by cervical mucus problem or immunological factors in the women.
In this technique, ovaries are stimulated by drugs to release 2-3 eggs in the tubes and sperm is prepared using simple centrifuge machine. Thus concentration and motility improves. Usually 0.2µl-2ml of prepared sperm is inserted into the uterus per-vaginally using insemination catheter. Generally accepted pregnancy rate per cycle by this technique is 10-20%.
IVF (In vitro fertilisation)
There are several procedures designed to unite sperm and eggs, and collectively they are called ART.
IVF is the first ART, developed and most commonly used since 1978. This technique is highly effective in overcoming a variety of infertility issues, particularly in tubal dysfunction.
It is a four-stage procedure.
Stage1: Controlled ovarian hyper-stimulation is used to stimulate the development of multiple follicles (2-40), to promote final maturation, and release of the eggs.
Stage2: Eggs are retrieved per-vaginally under ultrasonic guidance.
Stage3: Eggs are transferred to the laboratory where they are fertilised by the prepared sperm collected freshly from husband or from previously frozen sperm.
Stage4: After fertilisation eggs become embryo and embryos are cultured in the sequential culture medium commonly up to 5 days till it forms blastocyst (when cavity appears inside the embryo). Then usually 1/2 embryos are transferred into the uterus per-vaginally under ultrasonic guidance and rest are frozen by cryopreservation technique for future use if the women fail to become pregnant by fresh embryo.
ICSI (Intra-cytoplasmic sperm injection)
It is a micromanipulation technique, whereby a single sperm is immobilised, caught and injected into the egg. This procedure is indicated to overcome the male infertility, unexplained infertility or where sperm are unable to penetrate the egg wall. Other steps are same as IVF technique. This technique has a high fertilisation rate of about 80-90% and pregnancy rate of 40%.
PGD (Preimplantation genetic diagnosis)
1-2 cells from 3- or 5-day old embryo are collected and analysed using PCR (Polymeric Chain Reaction) technique or FISH (Fluorescent In-Situ Hybridisation) procedure commonly, to diagnose that whether particular embryo has any genetic disease or not. Subsequently only normal embryo is transferred into the uterus. However, this technique is highly expensive and offered only to the couples who have previously diagnosed genetic disease.
Dr Fatima Momtaz
The writer is a Clinical Embryologist working in Australia.
Source: The Daily Star