| Management of Infertility |
To recap in a nutshell, a couple opting for infertility management need a few basic investigations:
For the Husband:
For the Wife:
These basic investigations will help pin-point the factor responsible and treatment options will then become easier.
Treatment of Male Infertility
Treatment of defective sperm formation is not all that encouraging. Empirical therapy includes use of vitamin E, B12, Folic acid, small doses of thyroid extracts and supplements containing Zinc preparations. Other medications are also used. Another options that can be tried is hormone replacement therapy.
Surgery may be indicated in some cases of anatomical defects or obstructions.
Artificial Insemination Homologus: in cases of hypospadias, premature ejaculation, impotence, the husband's semen is collected by masturbation and is deposited in the upper part of the vagina.
Intra-Uterine Insemination: the semen is processed to eliminate the debris and dead sperms. Good-grade motile sperms are then transferred into the uterine cavity by use of a catheter designed for this purpose.
Intra-Cytoplasmic Sperm injection: in cases of severe absense of sperm formation.
Artificial Insemination using donor semen is thought of in cases of total absence of sperm formation.
Management of Female Infertility
Induction of Ovulation: Fertility pills (Clomiphene citrate) can be used under supervision and monitoring of the cycle. Monitoring is done with follicular studies and cervical mucous study. Planned intercourse or IUI is advocated according to the case. Other drugs are also available and can be used in specific cases.
Hormones are also used to induce ovulation. Constant monitoring of E2 levels and follicular studies are required under the supervision of a gynaecologist trained in the use of these hormones.
Gonadotropins are hormones used to stimulate the ovary in a controlled way.
The tubal factor has to be considered in case of blockage of the fallopian tubes. This may require surgical intervention. Diagnostic laparoscopy and hystero-salpingo-graphy will give enough insight into this problem. Micro-surgery is sometimes indicated to correct a tubal blockage.
Sometimes the uterus is responsible for the problem, the diagnosis of which is usually made by hysteroscopy.
The cervical factor, if responsible for the problem, can be tackled by giving small doses of estrogen replacement therapy (hormones) at the time of ovulation. Intra-uterine insemination is the other method adopted to take care of the cervical factor.
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If all the above modalities fail to yield results, one needs to consider artificial reproductive techniques like IVF-ET (in-vitro fertilization and embryo transfer), ICSI (intra-cytoplasmic sperm injection), etc. |
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Dr.
Shyam Kulkarni |
