At first, we usually propose the simplest technique. In case of failure, the other possibilities will be used. In other situations, the fertility test will reveal a major cause of infertility and these couples will be referred to in infertility treatment.
For each problem there is a solution?
In women, ovulation problems come to the fore (more than 30% of cases) of the causes of infertility. Tubal obstruction following ectopic pregnancy or infection is also common. However, this last reason for infertility has declined in recent years: the increased use of condoms has reduced the number of STDs that once favored tubal infections. In women, infertility can also have many other causes, such as endometriosis, uterine tissue-related disease outside the uterus, cervical abnormality, and changes in cervical mucus that prevent the passage of spermatozoa or the formation of antibodies directed against them.
Causes of infertility and associated treatments
IVF with ICSI
Obstacle in the fallopian tubes associated with an absence of spermatozoa or an inherited disease in humans
Induction of ovulation
Attempting to obtain quality ovulation is often the first proposition made to a couple. This simple ovarian stimulation is reserved for women suffering from anovulation (absence of ovulation) or dysovulation (when ovulation is not done correctly at each cycle). We speak then about the induction of ovulation. For this reason it is necessary to have ascertained the normality of the uterine cavity, the tubes and the sperm.
To stimulate ovulation, it is possible to use clomiphene. It is prescribed at the beginning of the menstrual cycle. The major adverse effect of this treatment is the possible alteration of cervical mucus. This then requires the additional supply of estrogen or the addition of gonadotropins. With the top fertility clinics this is the best deal.
These gonadotropins are recombinant FSH (genetically engineered) or a mixture of FSH and LH, hormones usually secreted by the pituitary to stimulate the ovaries. These gonadotropins are used alone or in combination with clomiphene one injection every day or every other day for 6 to 12 days, in the first part of the cycle. Their use makes it necessary to monitor the growth of ovarian follicles by ultrasound and hormonal assays to avoid ovarian hyperstimulation syndrome and multiple pregnancies.
When the abnormality responsible for ovulation disorders is in the hypothalamus, it is possible to use a GnRH pump (hypothalamic hormone stimulating the pituitary gland) and thus reproduce almost physiological cycles.
Artificial insemination (intrauterine)
This technique may be necessary when:
- Spermatozoa have abnormalities of number and / or mobility;
- The obstacle to fertility lies in the cervix (in the absence of mucus, for example).
- It may also be indicated in cases of repeated failure of stimulation of ovulation in case of difficulty to ovulate or in case of abnormality of the cervix.
The principle of intrauterine insemination is:
Stimulate follicular growth
Trigger ovulation by injection of chorionic gonadotropins (HCG), a hormone with the effect of LH.Insemination will generally be undertaken 32 to 38 hours after the LH surge or HCG injection. It consists in introducing a thin catheter, connected to the syringe containing sperm of the spouse (or a donor), either inside the uterine cavity (intrauterine insemination) or in the cervix (intracervical insemination).