Tapasya and her husband have undergone investigations to find out why they are having problems conceiving. His sperm count was less than 20 million per millilitre, even on a repeat test. Their gynaecologist has suggested that they undergo intrauterine insemination.
What is intrauterine insemination (IUI)?
Intrauterine insemination (IUI) is a treatment for infertility that is used when the sperm count is more than 10 million but less than 20 million per millilitre. It may also be used in couples that have ‘unexplained infertility'. In unexplained infertility, all the investigations seem to be normal but the couple still has trouble conceiving.
The woman is given medication to stimulate ovulation. Using ultrasound scanning, the growth of the egg is tracked. When the follicle (in which the egg is growing) reaches an optimum size, she is given an injection to help the release of the egg from the ovary. On the appropriate days, the husband's sperms are then placed inside the uterus. The sperms are separated from the seminal fluid in a special manner so that only the most active sperm will be placed inside the uterus.
Intrauterine insemination is an outpatient procedure. You will be usually asked to wait for 15-30 minutes before you go home. The success rate of the procedure varies between 10-25 per cent.
What next?
Sometimes there are conditions where natural conception cannot occur. The woman's fallopian tubes might be blocked. The husband's sperm counts might be very low. Occasionally, all factors may be normal but conception is just not occurring. Your infertility specialist will advise you on the need for further treatment, which is called assisted reproductive technology .
What is assisted reproductive technology (ART) ?
All fertility treatment in which both eggs and sperm are handled, are called assisted reproductive technology. In general, ART procedures involve removing eggs from a woman's ovaries and combining them with sperm in the laboratory. This results in the formation of an embryo (in-vitro fertilisation or IVF) . This embryo is then transferred into the woman's uterus (embryo transfer or ET) . Since the fertilisation occurs in the laboratory, these procedures have been termed ‘test tube baby technology' by lay people.
What are the steps in IVF?
Ovarian stimulation:
Starting on the third day of menstruation, fertility medications are provided to the patient in order to stimulate the growth of multiple eggs in the ovaries. Under close monitoring, the patient receives hormonal injections for 10-12 days.
Collecting the eggs (oocyte retrieval):
When the eggs reach an optimal size, they are collected from the ovaries. An ultrasound-guided needle is used to reach the ovaries. The retrieval procedure takes around 20 minutes.
Fertilisation:
The collected eggs are prepared for fertilisation. The sperms are placed in the culture media and incubated with the eggs. The fertilised eggs are then placed in a special growth medium till the embryos are composed of 4-8 cells.
Embryo transfer:
This is the most delicate part of the procedure. The embryos that are of good quality are placed gently into the uterus using a thin, flexible plastic tube (catheter).
Intracytoplasmic sperm injection (ICSI) is often used for couples in whom there are major problems with the sperm. In ICSI, a single sperm is injected into a mature egg. This increases the chance of fertilisation. The embryo that forms is transferred to the uterus.
How successful is ART?
Success rates vary and depend on many factors. The age of the couple, the cause of infertility, the quality control in the IVF unit, all play a role in determining the success rates. A good unit may have success rates of up to 30- 40 per cent in women between the ages of 35 and 40. The success rates drop with increasing age.
How expensive is ART?
Due to the cost of the medications to stimulate egg formation and the high-tech nature of ART, these procedures can be very expensive. Most couples will try one or two cycles and then give up due to the expense involved.
Are babies born by ART abnormal?
The rate of birth defect is related directly to the age of the mother. The chance of having a child with a birth defect is the same for a woman using IVF or ICSI techniques as it is for a woman of the same age having a child naturally.
The author is an obstetrician and gynaecologist practising in Chennai and has written the book 'Passport to a Healthy Pregnancy'.
www.passport2health.in
