Theres more to fertility treatments than just IVF – The Indian Express

By Dr Nisha Pansare

With the rapidly evolving world of Assisted Reproductive Technology (ART), many couples are confused between Intrauterine insemination (IUI), a type of fertility treatment where sperm are placed directly into a womans uterus, and In vitro fertilisation (IVF), which involves retrieving eggs from a womans ovaries and fertilising them with sperm. In recent times, ICSI (Intracytoplasmic Sperm Injection) is another process that is opted by the patients, where the sperm is injected into the mature egg by a team of skilled embryologists in a fertility clinics laboratory.

It is imperative that a couple first consult a fertility specialist, who is well-equipped to guide them to undergo the apt fertility treatment. Each couples fertility treatment requirements are different, and the method suggested is subjective.

Read on to clear all the confusion one might have around the different types of ART-related treatments.

When does one need IUI?

There are different indications for IUI and IVF. When talking about IUI, the indication would be the male or female factor. IUI is usually the treatment suggested when the husband has any sort of an ejaculatory, erectile dysfunction or abnormal semen parameters such as Oligospermia (low sperm count)/ Azoospermia (no sperms)/ Teratozoospermia (abnormal sperm shape). In Azoospermia, IUI treatment is done with donor sperm.

Retrograde ejaculation is when the sperm is ejaculated at the time of urination. Organic impotence (for example: the foreskin doesnt move) or psychogenic impotence (for example: the husband is away from his wife or staying abroad) could also be reasons why a couple will have to opt for IUI.

HIV negative women with the husband being HIV positive can go for IUI. Instead of coming into direct contact, IUI can be used to avoid transmission. Double washing methods can be used in her case and the negative female can get pregnant through IUI.

In cases of females, tubes will have to be normal. There should not be any tubal irregularities, only after which the female can go ahead with IUI. Severe dyspareunia (a recurring pain in the genital area) or within the pelvis during sexual intercourse can be due to cervical or immunological factors. Immunological factors include anti-sperm or antibodies produced by the vaginal secretion and are secreted when the semen is introduced. In that case, the sperms will be dead. Hence, it is better to go ahead with IUI in such cases.

It is not necessary that a couple has to undergo an IVF procedure only, in case of a donor option being pursued. It can be IUI with a donor sample. There are cases wherein the wife is Rh-negative and the husband is positive. So, if the baby doesnt survive in this situation then, one can go ahead with IUI with donor sample for the woman.

When does one need IVF / ICSI?

Breaking down the difference between IVF and ICSI the fundamental difference between IVF and ICSI is how the sperm fertilises the egg. During IVF, the multiple sperms and eggs are left in a petri dish in the laboratory to fertilize naturally, on their own. In the case of ICSI, one sperm is directly injected into the egg by a team of highly-skilled and extensively trained embryologists.

Male factors such as azoospermia, wherein the sperms are not seen in the semen sample, ejaculatory dysfunction, cancer patients who have ahead with malignancy treatment namely chemotherapy or radiotherapy, a couple in advanced age, they can opt for IVF/ICSI which is one of a type of fertility treatment.

In females, factors such as premature ovarian failure, poor ovarian reserve, moderate to severe endometriosis, immunological infertility patients, or ones with multiple IUI cycle failure that is more than 5-6 cycles of failure can go ahead with IVF or ICSI.

Whenever genetically transmitted diseases are known prior to the couple trying to get pregnant naturally, then in that case, after the diagnosis, one can go ahead with IVF/ICSI with a PGT (Pre-implantation Genetic Testing) for a normal pregnancy when the embryos are tested genetically normal.

IVF/ICSI can be opted in case of non-repairable tubal pathologies such as fallopian tube blockages, or severe Polycystic Ovarian Syndrome (PCOS). If the female partner has frozen her eggs for social or medical reasons prior to marriage, then she can go ahead with ICSI at a later stage when she and her partner want to get pregnant. If there is a tubal occlusion, or in the case of secondary fertility, the IVF/ICSI process can be chosen as IUI will not be effective.

To conclude, a couple should consult a fertility specialist if they have not successfully conceived naturally after trying for the duration of one year. A fertility specialist will be able to guide a couple to make an informed decision to fulfill their dreams of parenthood.

(The writer is Fertility Consultant, Nova IVF Fertility, Pune)

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Theres more to fertility treatments than just IVF - The Indian Express

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