The decision to opt for reproductive medicine is taken only after intensive investigations and a lot of deliberation. A couple chooses modern reproductive medicine only after intense scrutiny to determine possible causes of infertility. The next step involves a detailed consultation – How long have you been trying to have a child in vain? Do you both want one? What medications have you tried? How regular are your periods? It is only with after questions like these are answered that the doctor create an individualised treatment plan.
Blocked Fallopian tubes
If the fallopian tubes are blocked, the doctor may open them with a microsurgical operation (laparoscopy). This depends on the condition of the ovaries and the age of the patient: almost any doctor will recommend surgery on a 37-year-old woman. Fertility treatment usually improves the chances of getting pregnant.
Sometimes IVF Is best
The hormonal treatment of the woman begins on the third day of the cycle. Every day, a certain amount of fertility drugs is injected. Depending on the doctor’s diagnosis, medicines like tablets are started. Usually, egg maturation is controlled from the eighth day of the cycle with the help of ultrasound and blood test. The hormone is dosed accordingly. If the follicle is large enough, ovulation is triggered by another hormone. This is followed by fertilisation – either through sexual intercourse or through reproductive medicine, for example, by artificial insemination or the introduction of sperm into the uterus with assistive technology.
Intrauterine Insemination (IUI)
IUI means sperm transfer into the uterus. This is done when there are mild to moderate disorders of sperm motility and density. The path of the sperm to egg is shorter and there is a higher probability of
fertilisation. Faulty sperm reduces the number of eggs that fertilise. In IUI, hormone treatment helps fertilise several eggs. A prerequisite for the success of IUI is accurate determination of the date. Pregnancy rate per attempt is 15 to 20 per cent
In-Vitro Fertilization (IVF)
Here, fertilisation takes place outside the body. For example, if the fallopian tubes are damaged beyond repair or if the male has limited fertility. In this form of treatment, the egg and sperm are brought together in a glass bowl, and after fertilisation, the fetilised egg is inserted into the uterus via a thin tube.
Intra-Cytoplasmic Sperm Injection (ICSI)
ICSI is a further development of IVF and is used when the sperm is very slow. The woman also takes hormonal stimulation to mature several eggs. Under a special microscope, a single sperm is raised into a thin pipette and introduced directly into the egg. If the egg fertilises two to three days later, the embryos can be transferred into the uterus.
Pregnancy rate after ICSI is about 20 per cent.
MESA / TESE
MESA or Microsurgical Epididymal Sperm Aspiration refers to the extraction of sperm from the epididymis. TESE stands for Testicular Sperm Extraction. Here, a tissue sample is taken from the testes, where it picks up sperm even if the body doesn’t ejaculate them. Using ICSI, the sperm is transferred into the egg. Pregnancy rate: 10 to 15 per cent.
Scientific advisor: Prof. Dr. med. Wolfgang cubes from Kinderwunsch Centrum München