This refers to the process of solving seemingly impossible or difficult infertility problems with new technology. Such technology usually involves the complex handling of human gametes consisting of the sperm and egg in order to achieve conception and subsequent pregnancy, leading to the delivery of a healthy baby.
In the United States of America, after the initial errors in California in which gametes were improperly handled, resulting in a black couple giving birth to a white baby while a white couple had a black baby, mandatory training and examination was stipulated and required before someone could be appointed the director of an IVF programme or laboratory.
They must be licensed by examination bodies such as High Complexity Clinical Laboratory Director under the supervision of the American Board of Bio-analysis. These organisations have helped in maintaining the practice of Assisted Reproductive Technology in USA.
What type of infertility problem can be helped?
There are several problems that can be helped with the new technology. They can be considered as those with male, female or even unexplained infertility.
Male infertility problems
Low sperm count and congenital absence of the sperm duct can be helped by the new technology. In this situation, men who were born with missing sperm ducts, today, are now able to have children of their own by ART procedure.
Female infertility problems
Anovulation: This occurs in 10 per cent of infertility cases. This female may go through a menstrual cycle but she is not ovulating, that is, not producing eggs. The process of ovulation is complex and involves secretions of several hormones in the brain, hypothalamus, pituitary and the ovary as well as other related endocrine glands such as the thyroid gland, adrenal, pancreas and the parathyroid. These endocrine glands secrete hormones, which work like the orchestra in a symphony to cause ovulation. If any of these hormones should play out of tune, ovulation will not occur. It is now possible to control this process externally by administering various hormones to the patient. This is done after a very careful analysis of the patients’ hormonal status and deficiencies.
Tubal blockage: The tubes that carry the egg to the site of fertilisation may be blocked or restricted in their movement. This may result in failure to conceive, even though the patient may be ovulating normally. Blocked tubes occur in about 20 per cent of infertility cases. The cause is usually from previous infections. Sometimes, the woman may not know she had these infections. Even a simple appendicitis when young can lead to a scarring around the area of the tube, which can interfere with the pickup mechanism of the eggs from the ovary. An X-ray called hysterosalphinogram (HSG), which is a slightly painful but non-surgical procedure that does not require hospitalization, can determine if the tube is structurally sound. Most recently, there is a virtually painless procedure that is able to determine whether the tube is structurally intact. It is the use of ultrasonography with saline infusion. It is called hysterosonography.
Immunology: This includes cervical hostility. In this situation, the woman’s cervix recognises the sperm as a hostile foreign body (antigen) and immediately produces antibodies to kill it. Invariably, most of the sperm cells are destroyed just at the cervical entrance and do not pass beyond the cervix. This condition can be detected by examining a swab of the sperm removed from the cervix after intercourse. It is called Post Coital Cervical Sperm Analysis. There are a number of other immunological factors that can affect pregnancy, conception on to the implantation of embryo phase.
Hormonal factors: Apart from the hormones that control ovulation directly, some hormones can indirectly affect ovulation. Prolactin, a stress hormone, is one of such hormones. The elevation of this hormone can cause the secretion of milk in the breast of a non-pregnant woman. This is a disaster situation if left untreated. It makes ovulation difficult, if not impossible. Even if ovulation does occur, this hormone will attack fertilisation and embryo implantation processes, doing everything possible to terminate the conception. In layman’s language, the high prolactin acts as if the woman is already pregnant and tries to prevent the occurrence of another pregnancy in that pregnant cycle. New hormones have recently been recognised as having an inhibitory effect on ovulation or implantation. They include prostaglandin, the growth factors and receptor hormones. They can disrupt any of the conception stages. Measuring the hormones in the blood and getting a good interpretation of the result with good clinical judgment can detect a number of these conditions.
High FSH level: Specifically, some women may have elevated Follicle Stimulating Hormone. This is only normally elevated just before ovulation. When it is elevated at other times of the cycle, like the third day of the period when it is supposed to be very low, there is a big problem. FSH is also high in women who have reached menopause. Consequently, the ovary of the menopausal woman is inactive. A high FSH level in a woman still desiring to have children means that the ovary is sleeping or inactive.
It is not possible for such a woman to ovulate and get pregnant. This condition is detected by taking the blood from the patient on the third day of her period to measure the FSH level. It is called “Day 3 FSH.”
To be concluded