Contd from last Tuesday
Intrauterine insemination/Fallopian tube sperm perfusion: A number of patients become pregnant with intensive cycle monitoring and super ovulation with the gonatrophins as well as intrauterine insemination or fallopian tube sperm perfusion, excluding factors such as cervical hostility.
In Vitro Fertilisation: In IVF, the female is inseminated with approximately three drops of sperm solution from the male partner. Usually, the patient is given fertility drugs to increase the number of eggs that are produced at ovulation. The eggs are isolated from the aspirated follicle and allowed to rest in the incubator for a while before insemination. The inseminated eggs are kept in the incubator in the IVF laboratory for about three days. The fertilised embryo will rapidly divide into the two-cell, four-cell and eight-cell stages, at which point about three or four good embryos are selected and transferred into the uterus through the cervix.
IVF is a good treatment option when the fallopian tubes are blocked or in endometriosis and when the male partner has low sperm count.
Assisted fertilisation: In some couples, fertilisation during IVF does not come easily. Consequently, there are several techniques that would ensure fertilisation based on the laboratory assessments of the sperm and egg. They include high concentration sperm insemination, micro-drop insemination, media enhancements and more.
Embryo development: Several culture techniques have been developed to ensure that fertilisation takes place in an IVF laboratory. There are also several gamete manipulations that can be utilised for the fertilisation process. They include embryo development with a blastocyst culture and cytoplasmic transfer.
Micro manipulation: When the infertility in the couple is due to very low sperm count, the technique of Intra Cytoplasmic Sperm Injection, ICSI, provides a solution to getting pregnant. Under a very specialised microscope, one sperm cell is aspirated from the very few ones, and it is injected directly into the egg cytoplasm. This ensures fertilisation in significantly high numbers.
Assisted development/Assisted hatching: The procedure is usually reserved for patients over the age of 38, as well as patients with prior unsuccessful IVF attempts. Patients in this category would normally produce eggs at stimulation in IVF cycle and could have some embryos transferred at the four-cell or eight-cell stages. However, they would not get pregnant after the transfer. This is because the embryos will stop dividing at this stage, as it has refused to hatch. Using micromanipulation techniques enables the doctor to drill a small hole in the zona pellucida (outer) lining. Now, the embryo that would originally have ceased to grow at the hatching stage has a better chance of further development in the uterus. There are a number of patients who are able to carry their pregnancies to term by using this procedure.
Cryopreservation of oocytes and embryos: The excess embryos can be preserved for years by freezing the embryos in straws and then storing them in liquid nitrogen tanks. They can be thawed when needed.
Pre-Implantation Genetic Diagnosis: Patients who have genetic disorders like sickle cell can now have the disease gene eliminated from the children at conception. When embryos are fertilised, the process of pre-implantation genetic diagnosis can eliminate genetic disorders. One or two blastomeres can be removed from the fertilised embryos. The technique of Fluorescence In-Situ Hybridization (FISH) is employed to analyse the chromosomal abnormalities, while another technique, the Polymerase Chain Reacting, PCR, is used to detect sickle gene disorder. Simply put, a couple with genotype HbAS would expect to have offspring with AS, SS, and AA. With PGD, we can select just the AA embryos for insemination, thereby producing AA only babies.
Transplantation, cryopreservation of ovarian tissue: This is still one of the areas that is still under research. Some clinics now freeze the ovaries for patients who need to undergo radiotherapy or chemotherapy. Once they have finished treatment, they can have the ovarian tissue grafts transplanted and then conceive if they wish.
Oocyte and embryo donation: This procedure is available for patients with premature ovarian failure and menopausal patients who still want to have babies. Many clinics encourage a number of their successful patients to donate their embryos. Some also have the embryo polling association where patients join to help each other for such assistance.
Uterine Receptivity and Embryo Transfer: One of the areas that some ART clinics have made significant change in pregnancy rate is the devotion to the problem of implantation defects and uterine receptivity. Patients are evaluated to ensure that they eliminate several implantation defects, increase the receptivity of the uterus for the embryos and support the early phase of placental development.
Holistic medicine, modern Mayr therapy, detoxification, acupuncture and other complimentary medicine: In the last decade, the American Society for Reproductive Medicine, and the European Society for Human Reproduction and Embryology have witnessed scientific presentations and publications on the beneficial effect of holistic medicine, detoxification, acupuncture and the use of orthomolecular supplements (such as vitamins and minerals) in improving fertility or increasing success rate in IVF.
We discovered that once the patients go through Mayr therapy, there is improvement in oocyte yield and fertility rate, while pregnancy outcome is enhanced in a number of patients.