Investigation and Infertility

   

(1)What investigations does a couple have to undergo in infertility work up?

(2)What is diagnostic hysterosaparoscopy  (Video endoscopy)? Is it necessary in all cases?

(3)Is it necessary to get all these investigations done & spend so much money?

(4)What are the usual treatment options given to the patient?

(5)What is IVF-ET (In Vitro Fertilization Embryo Transfer) Test-Tube baby? When is this needed to be done?

(6)What is ICSI and when is it done?

(7)What are the other options for patients with nil sperms or very low count of sperms?

 

 

  

What investigations does a couple have to undergo in infertility work up?

 

Ans(1) - Routine blood counts, blood group, VDRL, HbsAg & HIV and semen analysis is done in all cases. If hormonal problem is suspected then day 2 of cycle

  1.  FSH / LH / E2 / Prolactin / TSH + T3 T4 TSH (if necessary in females)

  2.  FSH / LH / Testosterone in males.

Testicular biopsy is preferred in males if they have Azospermia  (nil sperms)

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What is diagnostic hysterosaparoscopy  (Video endoscopy)? Is it necessary in all cases?

 

Ans(2) - Diagnostic & SOS therapeutic hysterosaparoscopy is a small operation ( Procedure ) done under anesthesia ( CA ). It is a day care procedure and patients is discharged on the same day. In this operation a laparoscope is introduced. In the abdomen the uterus, tubes, ovaries, pouch of douglas and bowel is visualized. Tubal potency is confirmed by injection of dye. Small corrective operations are also done through laparoscope such as ovarian drilling, adhesionolysis excision of myomas, endometriomas, cauterisation etc. Through hysteroscope the uterine cavity is visualised. Polyps, fibroids, septum etc is diagnosed & treated. Tubal osteas can be visualized and can be treated if necessary. At the end of a hysteroslaparoscopy the diagnosis of infertility is definitely established and a treatment plan is made. It is better to do a hysteroslaparoscopy in all cases of infertility before strong treatment. However it may be differed or delayed in some cases such as :

  1. Young patients just married with no obvious disease who may be given trial by direct Treatment Cycle.

  2. Cost Consideration: If patient refuses to spend for it then alternative methods of determining tubal potency such as HSG or sonosalpingography may be performed.

  3. If patient has undergone laparoscopy earlier.

  4. If patient is unfit to undergo operation.

A good diagnostic hysteroslaparoscopy is the gold standard basic investigation in infertility work up.


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Is it necessary to get all these investigations done & spend so much money?

Ans(3) - A good work up at a good centre pays in the long run, results will come faster and cheaper in the long run. Incomplete work up will result in half hearted treatment which will delay pregnancy and total cost will go up.

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What are the usual treatment options given to the patient?

Ans(4) -   Usually during a hysterolaparoscopy, undergoing problems are diagnosed and treated. The following treatment options are available to the patient :

                1)    Planned Relations

                2)    Super ovulation with intra uterine insemination. In super ovulation with IUI the woman is given hormones (oral and injectables) to stimulate  her ovaries to produce more eggs. follicular developments is monitored using serial ultrasonography when the follicles are mature, a hormonal injection is given to help them rupture. Then an intra uterine insemination is done using washed capacitated sperms. If the sperm count is good then this procedure has a 40-50%  success rate and the patient has a good chance of getting pregnant in 3 cycles.

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 What is IVF-ET (In Vitro Fertilization Embryo Transfer) Test-Tube baby? When is this needed to be done?

Ans(5) -  IVF-ET is needed to be done is patients with blocked fallopian tubes. It may also be done in other forms of infertility where IUI super ovulation has failed. In this the woman is subjected to controlled ovarian hyperstimulation using hormonal injections. Many more injection are required because we want to retrieve as many eggs as possible. Once the follicles have reached an appropriate size, vaginal ovum aspiration is done and the ova are collected in a petridish with a media. Capacitated sperms are then mixed with oocytes and fertilisation is achieved into the uterus. Once embryos are formed then they (2-3 embryos) are transferred into the uteros on day 3 or day 5. Progesterone support is then given chemical pregnancy is diagnosed by  B-HCG on day 30. Live pregnancy is confirmed by 5 weeks by seeing a live foetal heart on vaginal sonography.

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What is ICSI and when is it done?

Ans(6) -  ICSI is Intra Cytoplasmic Sperm Injection. In this, a single sperm is injected into the oocyte using an robotic micro manipulator. Other steps are same as IVF.

            Indication of ICSI include:

            a.    Severe Oligospermia

            b.    Azospermia where sperms are retrieved from epididymis or test.

            c.    Failed fertilisation in IVF

In fact ICSI has revolutionized treatment of male factor infertility.

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What are the other options for patients with nil sperms or very low count of sperms?

Ans(7) - The other options apart from ICSI are :

            a.    Donor insemination 

            b.    Adoption

Donor may be brought by the patient ( relative, friend etc) or may be from sperm bank. Many case of donor sperm donor must be screened for VDRL, HIV, HbsAg, genetic disorders, Blood Group, caste, educational status, built color of skin, hair, eyes and any other specific features are also taken into consideration.


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