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INFERTILITY TREATMENT

In case if within a year of regular sexual life without use of contraceptives you did not get pregnant, it does not necessarily mean that you are infertile.

The likelihood of spontaneous pregnancy is still possible, but chances are dwindling every year. In order not to lose the chances, one has to seek help from the specialists to be examined and to receive timely treatment.

Due to the success of modern reproductive medicine, the infertility is not inevitable anymore. Despite the prevailing opinion that female infertility occurs more often than the male one, statistically, there are 40% of cases that fall on the share of both sexes nowadays. The remaining 20% represent the immunogenic incompatibility of the partners, also known as unexplained infertility.

Individual choice of treatment can be made upon complete diagnostics only.

Choice of the tactics and method of treatment depends on the cause of infertility by default.

It can be treated by medications or surgically.

Final diagnosis is preceded by a number of specific tests and examinations of the couple, including consultations of related specialists, such as a mammologist, andrologist, physician, endocrinologist, etc.

All required examinations and consultations of specialists can be performed and are available directly on the premises of the Clinic.

Should the treatment outcomes fail to provide the intended effect and no success in getting pregnant achieved within a year, it is then recommended to use the methods of assisted reproductive technologies, including:

IUI — Intrauterine insemination with the husband’s or donor’s sperm. Seminal fluid should first be washed and enriched, and then injected into the uterine cavity through the cervical canal of the cervix using the specific catheter, which should be done during ovulation.

IVF — extracorporeal fertilization, better known as «in vitro» fertilization, is performed by induction of superovulation, aspiration of follicular contents, retrieval of oocytes, and then adding 100-150 thousand active sperm cells to each of them, and then the resulting embryos are inserted in the uterine cavity.

ICSI (intracytoplasmic sperm injection) is applied for the so called “male factor infertility”. In case of male infertility, characterized by no sperm count in the ejaculate, invasive methods of sperm cells retrieval are used:

TESA (testicular sperm aspiration, which is a needle biopsy of several areas of the testicles. It is the least invasive method of the sperm cells retrieval. Should there be no sperm cells detected upon 5-6 sessions of each testicle puncturing, upon the patient’s consent the next step shall be the microsurgical variation of puncture – ТESЕ.

TESE (testicular sperm extraction) – is the aspiration of testicular tissue for the subsequent extraction of the sperm cells. This is one of the most efficient methods to treat male infertility. TESE implies a testicular biopsy. Sperm cells are then retrieved from the obtained tissue in order to fertilize the egg.

Methods

TESA (testicular sperm extraction) — is the aspiration of the sperm cells from the testicle. This method is one of the most efficient in treatment of male infertility.

The process is usually as follows: a small amount of the testicular tissue is aspirated using a syringe with a fine needle. It is then immersed in a culture medium and sent to the laboratory for a microscopic examination to detect the sperm cells. TESA enables the sperm cells retrieval that could then be possibly used to fertilize the oocytes in conjunction with the ICSI (intracytoplasmic sperm injection).

It is the least invasive method of the sperm cells retrieval. In cases of non-obstructive azoospermia the method is then limited in itself with respect to its efficiency. Should there be no sperm cells detected, upon the patient’s consent the next step shall be the microsurgical variation of puncture – ТESЕ.

TESE (testicular sperm aspiration) — is the extraction of sperm cells from the testicle, i.e. the process of removing a small portion of tissue from the testicle and microscopic confirmation of the viable sperm cells present in that tissue. The sperm cells so obtained can be immediately used. They can also be frozen for later use in order to avoid any difficulties during the repeated procedure.

These sampling methods are used to retrieve the sperm cells in case of blockage of vas deferens. Considering that the sperm count in such cases is low and often the antisperm antibodies are detected, the fertilization method to be used is the ICSI. The sperm cells can be preserved for a later use, or the biopsy can be performed on the same day when the follicles puncture takes place. Back in the day, the infertile couples that wanted to have a child, had only one option (namely, to use donor sperm), but today the infertility can and should be treated!

ICSI (Intracytoplasmic Sperm Injection) — is an injection or insertion of the sperm cells into the oocyte cytoplasm.

The principle of this method is in selection of the morphologically normal and progressively motile sperms by an embryologist in order to insert them into the oocyte cytoplasm. Same technique is used to fertilize all of the eggs retrieved during the puncture. The ICSI procedure itself is a complicated process demanding very accurate work of the embryologist. The manipulation is performed at 40x magnification using the high-precision micromanipulator system.

Indications for ICSI

Currently there are following indications for ICSI, mostly related to the spermatogenesis disorders:

  • Great number of antisperm antibodies;
  • Failed fertilization after the classic IVF, at normozoospermia;
  • Pathozoospermia with failed correction of sperm parameters (count is less than 2 million, motility is less than 5%);
  • Failed IVF attempts in the past at normozoospermia;
  • Obstructive and non-obstructive azoospermia;
  • Sperm acrosomal reaction disorder;

Preparation for ICSI. Fertilization:

  • Oocyte retrieval. At this stage, the embryologist shall analyze the retrieved follicular fluid under the microscope in order to detect the oocytes, which are then washed in the oocyte wash medium and placed in the CO2 incubator in the specific culture medium for subsequent fertilization.
  • Preparation of sperm cells. A sperm selected based on its morphological criteria is inserted into the oocyte cytoplasm after being immobilized in the microneedle. All of these manipulations are performed with great caution, and all of the equipment units in the Clinic are installed on the special anti-vibration tables.

There are many married couples encountering the infertility problems and the sooner they start seeking medical aid, the more chances are there for success. One of the methods of assisted reproductive technologies is the extracorporeal fertilization (IVF). This method involves conception outside the woman’s body — the sperm cells and eggs are joined outside the organism (in vitro), and in a few days the fertilized eggs – the embryos, are transferred into the uterus where they would develop within the following nine months.

The process starts from preparation of a man and a woman for the extracorporeal fertilization, then the embryos cultivation takes place and after selection, the healthy embryos are transferred to the uterus for fertilization.

IVF procedure consists of several stages

Induction of superovulation – is a process of several oocytes (egg cells) maturation within one menstrual cycle of a woman. Several eggs are required in case if some of they shall not be fertilized, or if the resulting embryos shall be arrested in their development.

Retrieval of egg cells by puncturing the ovarian follicles using the puncture needle that is introduced transvaginally. The procedure is performed under anesthesia (10-20 minutes) and using the ultrasound.

In vitro egg fertilization. A fertility specialist extracts eggs from the follicular fluid and then an embryologist shall inject the sperm cells into the eggs. Cultivation of embryos takes 2 to 6 days in vitro. There are incubators in the laboratories that are approximated to the natural conditions of the uterus. This is where the embryos are cultivated before being transferred to the uterus.

Embryo transfer — one or several good quality embryos are transferred to the uterus under the ultrasound guidance. Should it be necessary (according to medical reasons) to segment the cycles, the embryo transfer shall be cancelled in this IVF cycle and shall performed in the subsequent medical cycle.

Upon the embryo transfer, the patient shall be prescribed medications for luteal phase support that increase the implantation probability. The patient shall also be given recommendations for a regime to follow within the next 2 weeks. During the period between the embryo transfer and HCG (human chorionic gonadotropin) test, it is prohibited to sunbathe, attend sauna, take a hot bath, attend swimming pool, gym, consume alcohol, coffee, chocolate, citrus fruit, use hygienic tampons, take any non-prescribed medications.

Intrauterine insemination (IUI) with the husband or donor’s semen – is a manipulation when a prepared by embryologists and processed husband or donor’s semen is inserted into the uterine cavity through the cervical canal during ovulation using a catheter of a very small diameter.

This procedure can be performed both: in a stimulated (using medications to induce ovulation) as well as in the natural cycle (without medication). Control of ovulation allows securing the “meeting” of sperm cells with an egg at the most optimal time for fertilization, and there is no influence of the cervical mucus on the sperm cells.

Following are indications for the IUI:

For men:

  • male infertility;
  • low concentration and fertilizing ability of sperm cells;
  • sexual disorders;
  • problems with ejaculation.

For women:

  • cervical infertility (change of mucus properties in the cervix);
  • vaginismus (involuntary contraction of vaginal muscles caused by fear of sexual intercourse).

This procedure is painless and does not require use of anesthesia. After the insemination, you remain in a horizontal position for 40-45 minutes, and then you get dressed and discuss with your doctor further peculiarities of treatment and lifestyle. The patient shall also be given recommendations on the regimen for the next 2 weeks. The HCG test should be done on the 10-14 day after the insemination. During the period after the insemination and before the HCG (human chorionic gonadotropin) test, it is prohibited to take a hot bath, attend sauna, sunbathe, attend swimming pool, gym, use hygienic tampons, take any non-prescribed medications, consume alcohol, coffee, chocolate, citrus fruit.

Treatment tactics

Consultation of a fertility specialist. Individual examination plan.

Examination of a couple. Identification of infertility causes. Selection of treatment tactics.

Selection of treatment method using ART (assisted reproductive technologies) like IUI, IVF, ICSI, if there is no chance of treatment-independent pregnancy.

Pregnancy diagnostics. Dynamic follow-up of the patient’s condition.

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