Infertilityis usually best managed by Fertility Clinics. As well as specific treatment complicationsthere are other risks such as multiple pregnancies, ectopic (tubal) pregnanciesand emotional problems including anxiety, stress, depression and occasionally,psychiatric conditions. Fertility Clinics usually treat couples holistically toaddress all aspects, including realistic expectations. Being mobility impaireddoes not mean you will be infertile.
Atreatment plan should be drawn up according to your diagnosis, duration ofinfertility and the woman’s age - with specific timeframes for re-evaluationand consideration of alternative treatments.
Cervical,and most male, problems can usually be solved with artificial, or intra-uterine,insemination (IUI), where the sperm is manually inserted into the female. Ifthe partner’s sperm is not suitable donor sperm may be used. Success rates varydue to many factors but about 85% of the successful pregnancies are achievedwithin the first four cycles.
Anabsence of the uterus or vagina previously meant you would never have your“own” child, but in vitro fertilization (IVF) and surrogate mothers havechanged that. Most problems with the uterus can usually be corrected with fairlygood pregnancy outcomes.
Afibroid uterus may not require treatment (if small and asymptomatic), butshould be treated if it causes abnormal bleeding or is thought to be causinginfertility. Drugs can be used to reduce the size of fibroids prior to surgery,but this is temporary and has significant side effects (including a loss offertility). Surgery can be via keyhole or, in the case of large fibroids, by a laparotomy.Uterine Artery Embolisation cuts off the blood supply to fibroids but is not agood procedure for women who wish to fall pregnant.
Tubalreconstructive surgery requires a highly skilled surgeon. A woman’s suitabilityfor surgery depends on her age, severity of the problem and other issues likeendometriosis or pelvic adhesions. The extent of tubal damage can be assessedvia a hysterosalpingogram which may also help to determine the correcttreatment.
Ifyou have been sterilised, and wishto reverse it, this will require microsurgery. Success depends on the method ofsterilisation and the skill of the surgeon. Again it can be donelaparoscopically or by laparotomy. Pregnancy rates vary widely and the risk ofectopic pregnancy is increased.
Treatmentof endometriosis depends on theseverity of the disease and alternatives include wait-and-see (for less severecases), medical, surgical and combined. Severe endometriosis can be burned,vaporized, excised or lasered. Drugs may also be prescribed to suppress oestrogenproduction.
Forwomen with a history of irregularmenstruation, and Polycystic Ovarian Syndrome, ovulation induction (chemicallyencouraging the production of eggs) is the most appropriate treatment with clomiphene citrate being the mostcommonly used drug. Clomiphene citrate should not be used in women with ovariancysts, liver disease or, possibly, those with a history of breast cancer in thefamily. This treatment can cause Ovarian Hyperstimulation syndrome (OHSS) sothe patient needs to be monitored. Women who do not ovulate after severalcycles of induction may have other underlying causes. Once treated there is agood chance of pregnancy.
Semenanalysis will indicate the best treatment route and sometimes it is as simpleas having intercourse at the right time. In severe cases donor sperm may haveto be considered for success. A small group of couples have unexplainedinfertility and may fall pregnant without any help, others may require assistance.
Thisis just a very brief overview of options available. Medical advice should alwaysbe sought at your nearest fertility clinic.