Treatment for Female Infertility
Written by Dr.M.D.Mazumdar, MD
The aim of treatment of female infertility is to remove any of the factors identified during the tests for the diagnosis of the cause of infertility.
Most couples appreciate a description of the process of fertilization and conception. A sympathetic hearing of their difficulties goes a long way in decreasing the stress involved in visiting a doctor for treatment of infertility.
An improvement in diet and general health can relieve stress to some degree. Obesity should be brought under control.
On the First Visit
Both the male and the female partner is tested for all the causes of female infertility as well as male infertility . Since the main cause of female infertility is either a lack of ovulation or a block in the genital tracts, treatment is aimed at managing these two causes.
Treatment for Failure in Ovulation
Failure of ovulation or anovulation is usually due to hormonal problems. A low thyroid hormone level, a high prolactin level, a high androgen (male hormone) level or a high insulin level will cause anovulation.
Polycystic Ovary Syndrome is a common cause of female infertility. It is a syndrome characterised by a high androgen and insulin level, anovulation, male pattern hair growth, obesity and irregular menstruation. Ultrasound will show a number of small cysts in the ovary.
The different types of hormonal imbalance can be managed by medicines - either by supplementing a deficiency or by normalizing high hormone levels.
Even after the hormonal levels has been brought to normal, the ovaries may need to be stimulated for the growth of graaffian follicles and to cause ovulation. Various methods of ovulation induction may be used:
Clomiphene CitrateThis is an anti-oestrogen that stimulates the growth of Graafian follicles in the ovary. It is prescribed as 50 mg tablets from the 3rd day of menstruation for 5 days. USG examination from the 8th day is carried out to count the number of follicles, measure their sizes and note the day of ovulation. Normally, follicles rupture when they are 18-20 mm in size without clomiphene. With the drug however, they can grow up to 25 mm or even bigger. Higher doses of 100 mg or even 150 mg of clomiphene can be given depending on the response of the ovaries. Clomiphene citrate alone is the first line of treatment in case of failure of ovulation.
Human Chorionic Gonatrophin (HCG)If the follicles grow to a reasonable size but fail to rupture, HCG is injected on the 12th or 14th day. HCG stimulates ovarian steroids which trigger the LH-FSH surge and cause ovulation.
Gonadotrophin therapyGonadotrophins like FSH and LH should be prescribed in cases of failure of the hypothalamic-pituitary system and only in centers with proper laboratory facilities to monitor the patient.
- Thyroid hormones should be prescribed where failure of ovulation is believed to be due to hypothyroidism.
- Bromoergocriptine: This drug is prescribed to bring down the prolactin level in hyperprolactinaemia. A high prolactin level inhibits ovulation.
- Metformin: Metformin is commonly used to decrease the insulin resistance seen in PCOS. Insulin resistance is associated with anovulation.
- Laproscopic Procedure: Laparoscopy, combined with a hysteroscopy, whether operative or diagnostic, is sometimes carried out as the first line of treatment of infertility in many centers. It is possible to open up any fimbrial block and release peritubal adhesions with the help of a laparoscope. Blocks inside the tubes can be corrected with a salpingoscope.
- Correction of the position of the uterus Retroverted or acutely retroflexed uterus is rarely a cause for infertility but should be corrected if suspected to be responsible.
Intra-Uterine Insemination (IUI)
This method involves collecting the sperm by masturbation and injecting it gently into the uterus, thus bypassing the cervix. It is carried out in cases where it is suspected that the female cervical mucus may be hostile to the sperm or where the number of male sperm is believed to be inadequate for fertilization. The insemination should be done within 2 hours of collecting the semen. There are two types of IUI:
- Insemination with Husbands Semen (AIH)
AIH is done in cases of impenetrable cervical mucous or when disease or deformity of the cervix makes it impossible for the sperm to enter the uterus. It is also carried out in cases of impotence, premature ejaculation or retrograde ejaculation.
- Insemination with Donor Semen (AID) is usually carried out in couples where the husband suffers from azoospermia or complete absence of sperm.
In-vitro fertilization (IVF)
This method is more commonly known as the test-tube baby method. Ovum is collected from the wife and sperm from the husband and fertilization is allowed to occur in the laboratory. In the early experiments, fertilization was allowed to occur in a test-tube, hence the name, 'test-tube baby'. The fertilized ovum is cultured up to a 16-celled stage and replaced in the wife's uterus. Success rate is about 25 - 30 %.
ICSI (Intra-Cytoplasmic Sperm Injeciton)
In this method, a single sperm is injected into a mature ovum. It is a part of the IVF procedure and the advantage lies in the fact that men with a very low sperm count can also utilize this method. It has also been successfully used in men suffering from azoospermia (complete absence of sperm). In these cases, sperm has been aspirated from the testes directly.
- Changes in Cervical mucus during the Menstrual Cycle.
- Centchroman and other Birth Control Methods.
- Genital Warts and other Sexually Transmitted Diseases .
- Symptoms of Pregnancy.