We realised quite quickly that infertility is a maze of terms, procedures and biology lessons that can all be a bit confusing. We have spent hours researching and reading up on infertility and all the different treatments. So here is a beginners guide summarising the key points of unexplained infertility, IUI and IVF.
WHAT IS UNEXPLAINED INFERTILITY?
Couples who have been trying to get pregnant for more than a year, and women over the age of 35 who have tried for more than six months should seek medical advice to help them on their path to parenthood. Most people begin the process with a visit to their obstetrician/gynecologist (OB/GYN) who can help diagnose and treat infertility. Sometimes, a couple maybe referred to a Reproductive Endocrinologist who are specialists in treating infertility.
In order to become pregnant naturally, a series of events must occur in a specific order.
- A woman must have a reserve of good quality eggs
- The egg must be ovulated each month
- The Fallopian tubes have to be open and clear of blockage
- The sperm count has to be high and the quality normal
- The egg and sperm must bind together
- The embryo has to develop and be genetically normal
- The uterus must be able to accept the developing embryo
- Hormone levels have to be sufficiently high to support the pregnancy
The doctor will test for as many of these potential areas as possible, but sometimes the doctor will fail to find a diagnosis for Infertility. This is called ‘Unexplained Infertility’ and affects around 25% of infertile couples. Since the cause of infertility is unknown it is impossible to know how much intervention is required to get pregnant. It can be very frustrating not knowing why and difficult to accept. Since there is no abnormality to treat, all options for treatment are possible. So far we have chosen IUI (and was unsuccessful with three rounds) and now we are trying IVF. There are some other options available, such as gestational carrier and surrogacy, but hopefully IVF will work for us, there are just many unknowns with unexplained infertility. We will learn more about our infertility by going through the IVF process.
WHAT IS IUI? AN INTRODUCTORY GUIDE
Intrauterine Insemination (IUI), also known as artificial insemination, is an infertility treatment that places washed sperm directly into the uterus to give a greater chance of conception to occur.
Step 1. Ovulation stimulation. Ovulation stimulation medications may be used to help encourage the maturation of more than one follicle to give a greater chance of success. Monitoring using transvaginal ultrasound is performed to help determine when to trigger ovulation and time insemination.
Step 2. Ovulation trigger. An ovulatory trigger/injection maybe used to induce ovulation in order to perfectly time the insemination 24-36 hours before.
Step 3. Semen wash. A semen sample is “washed” by the lab to separate the semen from the seminal fluid providing the best sperm for the insemination.
Step 4. Insemination. 24-26 hours after the ovulation trigger catheter is placed into the uterus and the washed sperm is directly injected into the uterus. This process maximises the number of sperm placed directly into the uterus increasing the chances of conception. The procedure only takes a few minutes and involves minimal discomfort. The woman lies down for 15-20 minutes after the procedure.
Step 5. The two week wait. Progesterone suppositories may be taken during the two week wait. But the next two weeks is spent waiting for signs and symptoms of pregnancy. A pregnancy test is taken 14 days after the insemination.
WHAT IS IVF? AN INTRODUCTORY GUIDE
In-Vitro Fertilisation is another technique that helps treat infertility. The procedure involves removing an egg from a woman’s ovaries and fertilising it with sperm in a laboratory. The fertilised egg (embryo) is placed back into the uterus to grow and develop. What happens at each stage varies from clinic to clinic, but typically follows these steps…
Step 1. Suppressing the natural menstrual cycle. The woman takes medication that suppresses the natural cycle, these can be in various forms: injections, sprays or pills.
Step 2. Boosting the egg supply. After the natural cycle is suppressed, a hormone called FSH (Follicle Stimulating Hormone) is taken daily through injections for about 8-12 days. The FSH increases the number of eggs produced. The more eggs that are produced, the more chances there are for fertilisation in-vitro success.
Step 3. Checking progress. The clinic monitors the woman over the period through vaginal ultrasound and blood tests in order to adjust the levels of medication and control the egg stimulation process. When the conditions are right, about 34-48 hours before egg retrieval, an injectible hormone is given to help mature the eggs.
Step 4. Collecting the eggs. The woman is sedated and her eggs collected using a needle that passes through the vaginal wall and into the ovaries using ultrasound to guide the needle. This is a minor surgical procedure that takes about 15-20 minutes, but requires about 24 hours to recover. After egg collection, the woman uses hormones to help prepare the womb lining through injections, suppositories or gels.
Step 5. Fertilising the eggs. Whilst the eggs are being collected the man provides a sperm sample (or donor sperm is used). The collected eggs are mixed with the sperm in the laboratory (In-vitro means in glass). Sometimes, couples may need to use an additional procedure called ICSI – Intra-Cytoplasmic Sperm Injection. This procedure is where a single sperm is selected and directly injected into each egg. After 16-20 hours the fertilised eggs are checked to see if fertilisation has been successful. The embryos are then grown and continually monitored in the laboratory for 2-5 days.
Step 6. Embryo transfer. A few days after the egg collection, the embryos are transferred into the uterus. This is done using a small catheter inserted directly into the uterus. Depending on the circumstances of the woman’s age, number of previous IVF attempts, and embryo quality will dictate how many embryos are transferred. The more embryos that are transferred, the greater the chance of multiple babies. After the embryos are transferred the woman is on bed rest for 24 hours.
Step 7. The two week wait. The hormones that support a healthy pregnancy are continued to be taken by injection, suppository or gel for the two weeks that follow the embryo transfer. Strenuous activities are to be avoided during this period of time, whilst the signs and symptoms of pregnancy are monitored. A pregnancy test, usually a blood test, is taken after this period of time to confirm if the embryos survived and developed in the womb.
If you would like to find out more, a good website to visit it www.resolve.org.