Infertility other therapies

Intrauterine insemination is the process of extracting sperm either from husband or a sperm donor and depositing it in the uterine cavity.
IUI is successful in women who have ovulatory cycles but have trouble conceiving. Other indications are oligospermia, cervical stenosis or unexplained infertility.^[1]
For IUI to be successful, the sperm count in the husband/donor must be >1 million.
Since the released oocyte only survives for 12-24 hours, the process of insemination might be repeated 2-3 times over the period of 2-3 days.
Some recommend controlled ovarian hyperstimulation with clomiphene for better results.^[2]

In vitro fertilization is indicated in patients with disease of the fallopian tube, unexplained infertility, endometriosis, failure of ovulation induction, mullerian agenesis.
The first step in IVF is down regulation of pituitary to prevent LH surge with GnRH agonists.
Once Luteinizing hormone surge is prevented and adequate down regulation is achieved, controlled ovarian hyper stimulation is done with exogenous gonadotropins.
Growth of follicles is measured with sonography. When 2 or more follicles of adequate size are seen, 5000-10,000 IU human chorionic gonadotropin is given intramuscularly, following which oocyte is retrieved.
Retrieved oocyte is placed in culture and washed sperm is placed in the same culture media. The oocyte is then watched for signs of fertilization.
The ova which is fertilized and at 6-8 blastomere stage is placed into the uterine cavity.
Excess oocytes and embryos can be cryopreserved for the future.

In this procedure, both thr sperm and unfertilized oocytes are transferred into the fallopian tubes.
This procedure requires that the woman have patent tubes and a normal uterine cavity.
Ovarian hyperstimulation is done as in IVF and the collected oocytes along with sperm are placed laparoscopically into the distal end of the fallopian tube.
This procedure is more expensive than IVF but has a better success rate.

The fertilized oocyte is placed in the fallopian tube one day after in vitro fertilization.
Placement is done either laparoscopically or via uterine ostium.
The risk of ectopic pregnancy is higher in this procedure compared to IVF.

This procedure is indicated in oligospermia, asthenospermia, congenital absence of vas deferens, unexplained infertility etc.
A single spermatid or spermatozoon is injected directly into the cytoplasm of an oocyte by puncturing the zona pellucida through an operating microscope.
ICSI is found to be more effective than the other methods of micro manipulation such as subzonal implantation.

Embryo or oocyte donation can help in cases of premature ovarian failure, anovulation, old age, failed ART cycles.

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