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Best methods of infertility treatment

Best methods of infertility treatment:

Nowadays due to advances in medical sciences and various methods for infertility treatment, the joy of having a child is within the reach of almost anybody. Medical treatments along with assisted reproduction techniques has improved the chance for many men and women with infertility problems to have children. This article gives you useful information about prominent methods of infertility treatment.

The process of infertility treatment:

After various diagnostic tests, different methods of infertility treatment will be applied in accordance with the cause of infertility. After explaining each method and its success rate, doctor provides the couple with different treatment options to choose the one that suits them the most regarding their situation and preferences.

• In vitro fertilization or IVF:

IVF is a prevalent method to treat infertility problems and consisted of a complex series of procedures. During IVF, after stimulating ovaries and ovulation, mature eggs are retrieved from ovaries and fertilized by sperm outside the uterus in a lab. After the conception of embryo in the lab, the embryo is then placed inside the uterus.

This method is usually offered in conditions where sperm can’t reach the egg naturally, such as blocked fallopian tubes, pelvic adhesions, low sperm count or low sperm mobility.

• Intrauterine insemination IUIDuring intrauterine insemination IUI which is a simple and painless procedure to facilitate fertilization, the sperm is placed inside the uterus. For IUI to work(hazf) , the fallopian tubes need to be healthy. In this method the egg is not retrieved from ovaries and the process of ovulation and conception occurs naturally.
• Ovulation stimulation by advanced protocols:
• Ovulation stimulation is helpful for women with irregular ovulation, ovulation disorder or polycystic ovary (PCO) and mostly used to increase the quantity and quality of eggs and boost the chance of fertilization. There are medications that induce the same effect on egg quality and quantity which are known as ovulation induction medicine.
• Micro injection or intracytoplasmic sperm injection ICSI
• Micro injection is an infertility treatment method that a sperm cell is injected directly into the cytoplasm of an egg and cultivate it for a specific period of time in an incubator. After conception and cell division, embryo is made.
• In vitro maturation IVM:
• With IVM, instead of increasing follicle growth in body (metaphase 2), immature eggs are extracted from ovaries using a vaginal sonography. Afterwards, extracted eggs are grown in a laboratory and fertilized before being replaced into the womb.
• Gamete intrafallopian transfer GIFT:

• GIFT method is mostly used in cases of surrogate womb and is similar to IVF in terms of egg retrieving and sperm preparation. Afterwards, the egg along with adequate amount of sperm are placed directly into the fallopian tubes using a laparoscope.

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IVF: success rate

IVF: success rate

What is IVF success rate in Iran?

IVF success rate is an important point you should noticebefore performing IVF.

IVF is an infertility treatment technique for infertilecouples with appropriate and high success rate in Iran compared to othercountries.

What is IVF success rate in Iran compared to other countries?

Fortunately, Iran has a lot of experience in infertilitytreatment science with high IVF success rate compared to countries all over the worldand many patients travel to Iran to treat their infertility problems everyyear.

To evaluate IVF success rate, patients are divided into 2groups: women age less than 35 years old and women age more than 35 years old.

The success rate of IVF in first group (women <35 y/o)is approximately 40 % and the success rate of IVF in second group (women >35 y/o) is 15- 20% on average.

IVF success rate differs in fertility clinics and centersdepend on many factors.

IVF success rate in Iran is equal or more than globalstatistics.

IVF in Iran has affordable costs which make Iran anattractive destination for infertility treatment and medical travelers.

High medical care experiences along with fair priceshighlight Iran as a leading destination for infertility treatment all over theworld.

What affects IVF success rate?

IVF is a technique to treat infertility problems such assperm count, shape or motility problems or insufficient egg production.

IVF is done in special laboratory environment and manyfactors affect IVF success rate which mentioned as below:

Age:

First and most important factor affecting the successrate of IVF is age. The older you get, the lower your chance of successful IVF.In younger people, the chance of access to fresh and young egg and sperm ishigher.

Previous successful pregnancy:

If you had a successful pregnancy previously, the successrate of IVF is more for you compared to others.

The reason of infertility:

Infertility reason affects the IVF success rate. IVFsuccess rate decreases in some infertility causes.

Donated egg quality:

If the woman has an ovulation problem, the solution isusing donated egg.

Young and fresh eggs have more success rate.

Life style:

Some daily habits have a negative impression on IVFsuccess rate including smoking, obesity, high daily stress, etc.

Infertility clinic quality:

Experienced fertility specialists and embryologists alongwith high-tech laboratory equipment will increase IVF success rate to a greatextent.

Iran is an attractive destination for IVF &infertility treatment regarding all positive points we explained.

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IVF : history of IVFinIran

IVF : history of IVFinIran

Thehistory of IVFinIranhasbeen shaped by the interaction between the pioneers of IVF and aninterdisciplinary groupof experts, together with the endorsementand strong support of the Shia jurists.

• 1992 – Birth of the first baby following retrogradeejaculation using intrauterine insemination (IUI) first started in 1989 inAban Hospital by Dr. Jalil Pakravesh (personal communication).
• 1994 – Birth of the first baby resulting from intracytoplasmicsperm injection (ICSI) and the birth of the first baby through eggdonation carried out in Yazd by Dr. Mohmmad-Hossein Amir Arjomand(personal communication).
• 1996/97–Use of ICSI+ percutaneous epididymal spermaspiration (PESA) resulting in the birth of a baby at Shariati Hospital,Tehran, carried out by Dr. Hojat-Allah Saeedi (personal communication).
• 1998–First case of transferring an embryo produced fromtesticular spermatozoon by microinjection carried out by Dr. Akhondi (theauthor).
• 2004–Birth of the first baby bornfollowing pre-implantation genetic diagnosis (PGD) Royan Institute,Tehran, carried out by Dr. Leila Karimian (personal communication).

Indeed, the use ofIVFin a range of contexts such asPGD(more…)(as a preventive measure for diseases with a geneticbasis or for sex selection); sperm, egg and embryo donation; surrogacy;fertility preservation; and animal conservation (freezing of egg, sperm andembryo), are commonplace inIran.

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IVF : Infertility treatment in Iran

IVF : Infertility treatment in Iran

According to the World Health Organization(WHO), infertility is a disease of the reproductive system defined by thefailure to achieve a clinical pregnancy after 12 months of trying.

Infertility affects an estimated 20.4 % ofcouples globally.

The figure will drop to 12.4 percent after twoyears of trying, adding it shows that many infertile couples can have a baby ifthey keep trying.

The couples aged 35 years and above are not recommendedto use the method because any delay in childbearing would aggravate theirinfertility problems(more…).

Iranian couples no longer need to travel abroad forconsultation or treatment forinfertilityas advanced methods of treatmentfor couples who have problems to conceive, are available in the country.

There are 3 million infertile couples in thecountry. Around 3-4% of young Iranian women suffer from recurrentmiscarriages. Infertility rate is about 2.5% and secondary infertility is moreprevalent than primary infertility. When a woman is not able to conceive atall, (due to infertility in either spouse), it is referred to as primaryfertility. Secondary infertility is when a woman is unable to conceive againafter the first successful pregnancy andchildbirth. While causes of secondary infertility vary, the most important riskfactors are advanced reproductive age, weight gain, abdominal surgeries, spermquality and quantity, and smoking.

Microsurgical reconstruction for male infertility, newmethods of maleinfertility treatment(more..)(medication, surgery, andIntracytoplasmicSperm Injection (ICSI)(more…)), the role ofcomplementary therapies and medicines to improve fertility, and new imagingtechniques for assessment of infertility problems in both genders, are amongthe main important topics that will be discussed.

At present, there are 80 infertility centersacross the country and 20 more will be launched by the end of the current year.

Additionally, 35 state-run universities of medicalsciences have equipped with new laboratory equipment and devices foridentification and treatment of infertility problems.

IVF is never the first stepin the treatment of infertility. Instead, it’s reserved for cases in which other methods such as fertility drugs, surgery, and artificialinsemination haven’t worked.

On average, an IVF cycle costs $2,300-$2,900in the country, while the majority of women have per-cycle success rates of20-35%, which means they may need multiple tries to get pregnant.

IVF may be an option if one of the spouses or both hasbeen diagnosed with problems like endometriosis, low sperm count, problems withovulation, antibody problems that harm sperms or eggs, and unexplainedfertility problems.

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IVF: side effects Typical side effects include: •Passing a small amount of clear or bloody fluid shortly after the procedure — due to the swabbing of the cervix before the embryo transfer •Breast tenderness due to high estrogen levels •Mild bloating •Mild cramping •Constipation If you develop m

IVF: side effects

Typical side effects include:

• Passing a smallamount of clear or bloody fluid shortly after the procedure — due to theswabbing of the cervix before the embryo transfer
• Breasttenderness due to high estrogen levels
• Mild bloating
• Mild cramping
• Constipation

If you develop moderate or severe painafter the embryo transfer, contact your doctor. He or she will evaluate you for complications such as infection,twisting of an ovary (ovarian torsion) and severe ovarian hyperstimulationsyndrome.

About 12 days to two weeks after egg retrieval,your doctor will test a sample of your blood to detect whether you’re pregnant.

• If you’re pregnant, your doctor will refer you to anobstetrician or another pregnancy specialist for prenatal care.
• If you’re not pregnant, you’ll stop taking progesterone andlikely get your period within a week. If you don’t get your period or youhave unusual bleeding, contact your doctor. If you’re interested inattempting another cycle of in vitro fertilization (IVF), your doctor might suggest steps you cantake to improve your chances of getting pregnant through IVF.

The chances of giving birth to a healthybaby after using IVF depend on various factors, including:

• Maternal age. The younger you are, the more likelyyou are to get pregnant and give birth to a healthy baby using your owneggs during IVF. Women age 41 and older are often counseled to considerusing donor eggs during IVF to increase the chances of success.
• Embryo status. Transfer of embryos that are moredeveloped is associated with higher pregnancy rates compared with lessdeveloped embryos (day two or three). However, not all embryos survive thedevelopment process. Talk with your doctor or another care provider aboutyour specific situation.
• Reproductive history. Women who’ve previously given birthare more likely to be able to get pregnant using IVF than are women who’venever given birth. Successrates are lower forwomen who’ve previously used IVF multiple times but didn’t get pregnant.
• Cause of infertility. Having a normal supply of eggsincreases your chances of being able to get pregnant using IVF. Women whohave severe endometriosis are less likely to be able to get pregnant usingIVF than are women who have unexplained infertility(more…).
• Lifestyle factors. Women who smoke typically have fewereggs retrieved during IVF and may miscarry more often. Smoking can lower awoman’s chance of success using IVF by 50 percent. Obesity can decreaseyour chances of getting pregnant and having a baby. Use of alcohol,recreational drugs, excessive caffeine, and certain medications also canbe harmful.

Talk with our doctors about any factorsthat apply to you and how they may affect your chances of a successfulpregnancy.

 

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Typical side effects include:

• Passing a smallamount of clear or bloody fluid shortly after the procedure — due to theswabbing of the cervix before the embryo transfer
• Breasttenderness due to high estrogen levels
• Mild bloating
• Mild cramping
• Constipation

If you develop moderate or severe painafter the embryo transfer, contact your doctor. He or she will evaluate you for complications such as infection,twisting of an ovary (ovarian torsion) and severe ovarian hyperstimulationsyndrome.

About 12 days to two weeks after egg retrieval,your doctor will test a sample of your blood to detect whether you’re pregnant.

• If you’re pregnant,your doctor will refer you to anobstetrician or another pregnancy specialist for prenatal care.
• If you’re not pregnant,you’ll stop taking progesterone andlikely get your period within a week. If you don’t get your period or youhave unusual bleeding, contact your doctor. If you’re interested inattempting another cycle of in vitro fertilization (IVF), your doctor might suggest steps you cantake to improve your chances of getting pregnant through IVF.

The chances of giving birth to a healthybaby after using IVF depend on various factors, including:

• Maternal age.The younger you are, the more likelyyou are to get pregnant and give birth to a healthy baby using your owneggs during IVF. Women age 41 and older are often counseled to considerusing donor eggs during IVF to increase the chances of success.
• Embryo status.Transfer of embryos that are moredeveloped is associated with higher pregnancy rates compared with lessdeveloped embryos (day two or three). However, not all embryos survive thedevelopment process. Talk with your doctor or another care provider aboutyour specific situation.
• Reproductive history.Women who’ve previously given birthare more likely to be able to get pregnant using IVF than are women who’venever given birth. Successrates are lower forwomen who’ve previously used IVF multiple times but didn’t get pregnant.
• Cause of infertility.Having a normal supply of eggsincreases your chances of being able to get pregnant using IVF. Women whohave severe endometriosis are less likely to be able to get pregnant usingIVF than are women who have unexplainedinfertility(more…).
• Lifestyle factors.Women who smoke typically have fewereggs retrieved during IVF and may miscarry more often. Smoking can lower awoman’s chance of success using IVF by 50 percent. Obesity can decreaseyour chances of getting pregnant and having a baby. Use of alcohol,recreational drugs, excessive caffeine, and certain medications also canbe harmful.

Talk with our doctors about any factorsthat apply to you and how they may affect your chances of a successfulpregnancy.

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IVF: Ovulation induction

IVF:Ovulation induction

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If you’re using your own eggsduring IVF, at the start of a cycle you’ll begin treatment with synthetichormones to stimulate your ovaries to produce multiple eggs — rather than thesingle egg that normally develops each month. Multiple eggs are needed becausesome eggs won’t fertilize or develop normally after fertilization.

You may need several different medications,such as:

• Medications for ovarian stimulation.To stimulate your ovaries, you might receivean injectable medication containing a follicle-stimulating hormone (FSH),a luteinizing hormone (LH) or a combination of both. These medicationsstimulate more than one egg to develop at a time.
• Medications for oocyte maturation.When the follicles are ready for egg retrieval— generally after eight to 14 days — you will take human chorionicgonadotropin (HCG) or other medications to help the eggs mature.
• Medications to prevent prematureovulation.These medications prevent your bodyfrom releasing the developing eggs too soon.
• Medications toprepare the lining of your uterus.On theday of egg retrieval or at the time of embryo transfer, your doctor might recommend that you begin taking progesterone supplements tomake the lining of your uterus more receptive to implantation.

Your doctor will work with you todetermine which medications to use and when to use them.

Typically, you’ll need one to twoweeks of ovarian stimulation before your eggs are ready for retrieval. Todetermine when the eggs are ready for collection, your doctor will likelyperform:

• A vaginal ultrasound,an imaging exam of your ovaries to monitor thedevelopment of follicles — fluid-filled ovarian sacs where eggs mature
• Blood tests,to measure your response to ovarianstimulation medications — estrogen levels typically increase as folliclesdevelop and progesterone levels remain low until after ovulation

Sometimes IVF cycles need to be canceled beforeegg retrieval for one of these reasons:

• Inadequate number of follicles developing
• Premature ovulation
• Too many follicles developing, creating arisk of ovarian hyperstimulation syndrome
• Other medicalissues

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IVF FAQs

·        IVF

FAQs

1.   How many embryos will be transferred? Thenumber of embryos transferred is typically based on the age and number of eggsretrieved. Since the rate of implantation is lower for older women, moreembryos are usually transferred — except for women using donor eggs. Mostdoctors follow specific guidelines toprevent a higher order multiple pregnancies — triplets or more — and in somecountries, legislation limits the number of embryos that can be transferred atonce. Make sure you and your doctor agree on the number of embryos that will betransferred before the transfer procedure.

2.   What will you do with any extra embryos? Extraembryos can be frozen and stored for future use for several years. Not allembryos will survive the freezing and thawing process, although most will.Cryopreservation can make future cycles of IVF lessexpensive and less invasive. However, the live birth rate fromfrozen embryos is slightly lower than the live birth rate from fresh embryos.Or, you might be able to donate unused frozen embryos to another couple or aresearch facility. You might also choose to discard unused embryos.

3.   How will you handle a multiple pregnancy? Ifmore than one embryo is transferred to your uterus, IVF canresult in a multiple pregnancy — which poses health risks for you and yourbabies. In some cases, a fetal reduction can be used to help a woman deliverfewer babies with lower health risks. Pursuing fetal reduction, however, is amajor decision with ethical, emotional and psychological consequences.

4.   Have you considered the potential complicationsassociated with using donor eggs, sperm or embryos or a gestational carrier? Atrained counselor with expertise in donor issues can help you understand theconcerns, such as the legal rights of the donor. You also may need an attorneyto file court papers to help you become legal parents of an implanted embryo.

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IVF

IVF

When choosing an in vitrofertilization (IVF) clinic, keep in mind that a clinic’s successrate depends onmany factors, such as patients’ ages and medical issues, as well as theclinic’s treatment population and treatment approaches. Askfor detailed information about the costs associated with each step of the procedure.

Before beginning a cycle of IVF using your own eggs and sperm, youand your partner will likely need various screenings, including:

• Ovarian reserve testing.To determine the quantity and quality of youreggs, your doctor might test the concentration of follicle-stimulatinghormone (FSH), estradiol (estrogen) and antimullerian hormone in yourblood during the first few days of your menstrual cycle. Test resultsoften used together with an ultrasound of your ovaries, can help predicthow your ovaries will respond to fertility medication.
• Semen analysis.If not done as part of your initial fertilityevaluation, your doctor will conduct a semen analysis shortly before thestart of an IVF treatment cycle.
• Infectious disease screening.You and your partner will both be screened forinfectious diseases, including HIV.
• Practice (mock) embryo transfer.Your doctor might conduct a mock embryotransfer to determine the depth of your uterine cavity and the techniquemost likely to successfully place the embryos into your uterus.
• Uterine cavityexam.Your doctor will examine youruterine cavity before you start IVF. This might involve asonohysterography — in which fluid is injected through the cervix intoyour uterus — and an ultrasound to create images of your uterine cavity.Or it might include a hysteroscopy — in which a thin, flexible, lightedtelescope (hysteroscope) is inserted through your vagina and cervix intoyour uterus

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IVF

IVF

Specific steps of an in vitro fertilization (IVF) cycle carry risks,including:

• Multiple births.IVF increases the risk of multiple births if more than oneembryo is implanted in your uterus. A pregnancy with multiple fetusescarries a higher risk of early labor and low birth weight than pregnancy witha single fetus does.
• Premature delivery and lowbirth weight.Research suggests thatthe use of IVF slightly increases the risk that a baby will be born earlyor with low birth weight.
• Ovarian hyperstimulationsyndrome.Use of injectable fertility drugs,such as human chorionic gonadotropin (HCG), to induce ovulation can causeovarian hyperstimulation syndrome, in which your ovaries become swollenand painful. Signs and symptoms typically last a week and include mild abdominal pain, bloating, nausea,vomiting, and diarrhea. If you become pregnant, however, your symptomsmight last several weeks. Rarely, it’s possible to develop a more severeform of ovarian hyperstimulation syndrome that can also cause rapid weightgain and shortness of breath.
• Miscarriage.The rate of miscarriage for women who conceiveusing IVF with fresh embryos is similar to that of women who conceivenaturally — about 15 to 25 percent — but the rate increases with maternalage. Use of frozen embryos during IVF, however, may slightly increase therisk of miscarriage.
• Egg-retrieval procedurecomplications.Use of an aspiratingneedle to collect eggs could possibly cause bleeding, infection or damageto the bowel, bladder or a blood vessel. Risks are also associated withgeneral anesthesia is used.
• Ectopic pregnancy.About 2 to 5 percent of women who use IVF willhave an ectopic pregnancy — when the fertilized egg implants outside theuterus, usually in a fallopian tube. The fertilized egg can’t surviveoutside the uterus, and there’s no way to continue the pregnancy.
• Birth defects.The age of the mother is the primary risk factorin the development of birth defects, no matter how the child is conceived.More research is needed to determine whether babies conceived using IVFmight be at increased risk of certain birth defects. Some experts believethat the use of IVF does not increase the risk of having a baby with birthdefects.
• Ovarian cancer.Although some early studies suggested there maybe a link between certain medications used to stimulate egg growth and thedevelopment of a specific type of ovarian tumor, more recent studies donot support these findings.
• Stress.Use of IVF can be financial, physically andemotionally draining. Support from counselors, family, and friends canhelp you and your partner through the ups and downs of infertilitytreatment.

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IVF

IVF

Why it’s done

Sometimes,IVFisoffered as a primary treatmentfor infertility in women over age 40. IVF can also be done if you have certainhealth conditions. For example, IVF may be an option if you or your partnerhas:

• Fallopian tube damage or blockage.Fallopian tube damage or blockagemakes it difficult for an egg to be fertilized or for an embryo to travelto the uterus.
• Ovulation disorders.If ovulation is infrequent orabsent, fewer eggs are available for fertilization.
• Premature ovarian failure.Premature ovarian failure is the loss ofnormal ovarian function before age 40. If your ovaries fail, they don’tproduce normal amounts of the hormone estrogen or have eggs to release regularly.
• Endometriosis.Endometriosis occurs when the uterine tissueimplants and grows outside of the uterus — often affecting the function ofthe ovaries, uterus and fallopian tubes.
• Uterine fibroids.Fibroids are benign tumors in the wall of theuterus and are common in women in their 30s and 40s. Fibroids caninterfere with implantation of the fertilized egg.
• Previous tubal sterilization or removal.If you’ve had a tubal ligation — a type ofsterilization in which your fallopian tubes are cut or blocked topermanently prevent pregnancy — and want to conceive, IVF may be analternative to tubal ligation reversal.
• Impaired sperm production or function.Below-average sperm concentration, weakmovement of sperm (poor mobility), or abnormalities in sperm size andshape can make it difficult for sperm to fertilize an egg. If semenabnormalities are found, your partner might need to see a specialistdetermine if there are correctable problems or underlying health concerns.
• Unexplained infertility.Unexplained infertility means no cause ofinfertility has been found despite evaluation for common causes.
• A genetic disorder.If you or your partner is at risk of passingon a genetic disorder to your child, you may be candidates forpreimplantation genetic diagnosis — a procedure that involves IVF. Afterthe eggs are harvested and fertilized, they’re screened for certaingenetic problems, although not all genetic problems can be found. Embryosthat don’t contain identified problems can be transferred to the uterus.
• Fertilitypreservation for cancer or other healthconditions.If you’re about to start cancer treatment —such as radiation or chemotherapy — that could harm your fertility, IVFfor fertility preservation may be an option. Women can haveeggsharvested from their ovaries and frozen in an unfertilized state for lateruse. Or the eggs can be fertilized and frozen as embryos for future use.Women who don’t have a functional uterus or for whom pregnancy poses aserious health risk might choose IVF using another person to carry thepregnancy (gestational carrier). In this case, the woman’s eggs arefertilized with sperm, but the resulting embryos are placed in thegestational carrier’s uterus.

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