Infertility other therapies: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
|||
| Line 7: | Line 7: | ||
* Some recommend controlled ovarian hyperstimulation with [[clomiphene]] for better results.<ref name="pmid29174128">{{cite journal| author=Farquhar CM, Liu E, Armstrong S, Arroll N, Lensen S, Brown J| title=Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, open-label, randomised, controlled, two-centre trial. | journal=Lancet | year= 2018 | volume= 391 | issue= 10119 | pages= 441-450 | pmid=29174128 | doi=10.1016/S0140-6736(17)32406-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29174128 }} </ref> | * Some recommend controlled ovarian hyperstimulation with [[clomiphene]] for better results.<ref name="pmid29174128">{{cite journal| author=Farquhar CM, Liu E, Armstrong S, Arroll N, Lensen S, Brown J| title=Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, open-label, randomised, controlled, two-centre trial. | journal=Lancet | year= 2018 | volume= 391 | issue= 10119 | pages= 441-450 | pmid=29174128 | doi=10.1016/S0140-6736(17)32406-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29174128 }} </ref> | ||
====In vitro fertilization and embryo transfer==== | ====In vitro fertilization and embryo transfer==== | ||
*In vitro fertilization is indicated in patients with disease of the [[fallopian tube]], unexplained infertility, [[endometriosis]], failure of ovulation induction, [[mullerian agenesis]]. | *In vitro fertilization is indicated in patients with disease of the [[fallopian tube]], unexplained infertility, [[endometriosis]], failure of ovulation induction, [[mullerian agenesis]].<ref name="pmid28381082">{{cite journal| author=Bortoletto P, Bakkensen J, Anchan RM| title=Embryo transfer: timing and techniques. | journal=Minerva Endocrinol | year= 2018 | volume= 43 | issue= 1 | pages= 57-68 | pmid=28381082 | doi=10.23736/S0391-1977.17.02649-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28381082 }} </ref> | ||
* The first step in IVF is down regulation of [[pituitary]] to prevent [[Luteinizing hormone|LH]] surge with GnRH agonists. | * The first step in IVF is down regulation of [[pituitary]] to prevent [[Luteinizing hormone|LH]] surge with GnRH agonists. | ||
* Once [[Luteinizing hormone]] surge is prevented and adequate down regulation is achieved, controlled [[ovary|ovarian]] hyper stimulation is done with exogenous [[gonadotropin]]s. | * Once [[Luteinizing hormone]] surge is prevented and adequate down regulation is achieved, controlled [[ovary|ovarian]] hyper stimulation is done with exogenous [[gonadotropin]]s. | ||
| Line 15: | Line 15: | ||
* Excess oocytes and [[embryo]]s can be cryopreserved for the future. | * Excess oocytes and [[embryo]]s can be cryopreserved for the future. | ||
====Gamete intrafallopial transfer==== | ====Gamete intrafallopial transfer==== | ||
* In this procedure, both thr sperm and unfertilized [[oocyte]]s are transferred into the [[fallopian tube]]s. | * In this procedure, both thr sperm and unfertilized [[oocyte]]s are transferred into the [[fallopian tube]]s.<ref name="pmid8254592">{{cite journal| author=Abramovici H, Dirnfeld M, Bornstein J, Lissak A, Gonen Y| title=Gamete intrafallopian transfer. An overview. | journal=J Reprod Med | year= 1993 | volume= 38 | issue= 9 | pages= 698-702 | pmid=8254592 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8254592 }} </ref> | ||
* This procedure requires that the woman have patent tubes and a normal [[uterus|uterine]] cavity. | * This procedure requires that the woman have patent tubes and a normal [[uterus|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. | * 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. | * This procedure is more expensive than IVF but has a better success rate. | ||
====Zygote intrafallopial transfer==== | ====Zygote intrafallopial transfer==== | ||
* The fertilized oocyte is placed in the [[fallopian tube]] one day after [[in vitro fertilization]]. | * The fertilized oocyte is placed in the [[fallopian tube]] one day after [[in vitro fertilization]].<ref name="pmid8059813">{{cite journal| author=Patton GW, Holtz G, Edwards A, Swartz K| title=Transvaginal embryo transfer during the zygote intrafallopian tube transfer procedure. | journal=Am J Obstet Gynecol | year= 1994 | volume= 171 | issue= 2 | pages= 359-63; discussion 363-4 | pmid=8059813 | doi=10.1016/s0002-9378(94)70035-4 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8059813 }} </ref> | ||
* Placement is done either [[laparoscopic surgery|laparoscopically]] or via uterine ostium. | * Placement is done either [[laparoscopic surgery|laparoscopically]] or via uterine ostium. | ||
* The risk of [[ectopic pregnancy]] is higher in this procedure compared to IVF. | * The risk of [[ectopic pregnancy]] is higher in this procedure compared to IVF. | ||
====Intracytoplasmic sperm injection==== | ====Intracytoplasmic sperm injection==== | ||
* This procedure is indicated in [[oligospermia]], [[asthenospermia]], congenital absence of [[vas deferens]], unexplained infertility etc. | * This procedure is indicated in [[oligospermia]], [[asthenospermia]], congenital absence of [[vas deferens]], unexplained infertility etc.<ref name="pmid29967387">{{cite journal| author=Esteves SC, Roque M, Bedoschi G, Haahr T, Humaidan P| title=Intracytoplasmic sperm injection for male infertility and consequences for offspring. | journal=Nat Rev Urol | year= 2018 | volume= 15 | issue= 9 | pages= 535-562 | pmid=29967387 | doi=10.1038/s41585-018-0051-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29967387 }} </ref> | ||
* A single [[spermatid]] or [[spermatozoon]] is injected directly into the [[cytoplasm]] of an [[oocyte]] by puncturing the [[zona pellucida]] through an operating [[microscope]]. | * 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. | * ICSI is found to be more effective than the other methods of micro manipulation such as subzonal implantation. | ||
====Others==== | ====Others==== | ||
* [[Embryo]] or [[oocyte]] donation can help in cases of [[premature ovarian failure]], [[anovulation]], old age, failed [[Assisted reproductive technology|ART]] cycles. | * [[Embryo]] or [[oocyte]] donation can help in cases of [[premature ovarian failure]], [[anovulation]], old age, failed [[Assisted reproductive technology|ART]] cycles. | ||
* Women without a functional [[uterus]] may benefit from gestational surrogacy. | * Women without a functional [[uterus]] may benefit from gestational surrogacy.<ref name="pmid30568349">{{cite journal| author=Patel NH, Jadeja YD, Bhadarka HK, Patel MN, Patel NH, Sodagar NR| title=Insight into Different Aspects of Surrogacy Practices. | journal=J Hum Reprod Sci | year= 2018 | volume= 11 | issue= 3 | pages= 212-218 | pmid=30568349 | doi=10.4103/jhrs.JHRS_138_17 | pmc=6262674 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30568349 }} </ref> | ||
* [[Oocyte]] cryopreservation can be done in women who are to undergo [[chemotherapy]] or [[radiotherapy]]. | * [[Oocyte]] cryopreservation can be done in women who are to undergo [[chemotherapy]] or [[radiotherapy]].<ref name="pmid27006004">{{cite journal| author=Argyle CE, Harper JC, Davies MC| title=Oocyte cryopreservation: where are we now? | journal=Hum Reprod Update | year= 2016 | volume= 22 | issue= 4 | pages= 440-9 | pmid=27006004 | doi=10.1093/humupd/dmw007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27006004 }} </ref> | ||
==References== | |||
Latest revision as of 16:17, 30 September 2020
Intrauterine insemination
- 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 and embryo transfer
- In vitro fertilization is indicated in patients with disease of the fallopian tube, unexplained infertility, endometriosis, failure of ovulation induction, mullerian agenesis.[3]
- 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.
Gamete intrafallopial transfer
- In this procedure, both thr sperm and unfertilized oocytes are transferred into the fallopian tubes.[4]
- 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.
Zygote intrafallopial transfer
- The fertilized oocyte is placed in the fallopian tube one day after in vitro fertilization.[5]
- Placement is done either laparoscopically or via uterine ostium.
- The risk of ectopic pregnancy is higher in this procedure compared to IVF.
Intracytoplasmic sperm injection
- This procedure is indicated in oligospermia, asthenospermia, congenital absence of vas deferens, unexplained infertility etc.[6]
- 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.
Others
- Embryo or oocyte donation can help in cases of premature ovarian failure, anovulation, old age, failed ART cycles.
- Women without a functional uterus may benefit from gestational surrogacy.[7]
- Oocyte cryopreservation can be done in women who are to undergo chemotherapy or radiotherapy.[8]
References
- ↑ Soysal C, Ozmen U (2018). "Intrauterine insemination in ovulatory infertile patients". Niger J Clin Pract. 21 (10): 1374–1379. doi:10.4103/njcp.njcp_64_17. PMID 30297574.
- ↑ Farquhar CM, Liu E, Armstrong S, Arroll N, Lensen S, Brown J (2018). "Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, open-label, randomised, controlled, two-centre trial". Lancet. 391 (10119): 441–450. doi:10.1016/S0140-6736(17)32406-6. PMID 29174128.
- ↑ Bortoletto P, Bakkensen J, Anchan RM (2018). "Embryo transfer: timing and techniques". Minerva Endocrinol. 43 (1): 57–68. doi:10.23736/S0391-1977.17.02649-9. PMID 28381082.
- ↑ Abramovici H, Dirnfeld M, Bornstein J, Lissak A, Gonen Y (1993). "Gamete intrafallopian transfer. An overview". J Reprod Med. 38 (9): 698–702. PMID 8254592.
- ↑ Patton GW, Holtz G, Edwards A, Swartz K (1994). "Transvaginal embryo transfer during the zygote intrafallopian tube transfer procedure". Am J Obstet Gynecol. 171 (2): 359–63, discussion 363-4. doi:10.1016/s0002-9378(94)70035-4. PMID 8059813.
- ↑ Esteves SC, Roque M, Bedoschi G, Haahr T, Humaidan P (2018). "Intracytoplasmic sperm injection for male infertility and consequences for offspring". Nat Rev Urol. 15 (9): 535–562. doi:10.1038/s41585-018-0051-8. PMID 29967387.
- ↑ Patel NH, Jadeja YD, Bhadarka HK, Patel MN, Patel NH, Sodagar NR (2018). "Insight into Different Aspects of Surrogacy Practices". J Hum Reprod Sci. 11 (3): 212–218. doi:10.4103/jhrs.JHRS_138_17. PMC 6262674. PMID 30568349.
- ↑ Argyle CE, Harper JC, Davies MC (2016). "Oocyte cryopreservation: where are we now?". Hum Reprod Update. 22 (4): 440–9. doi:10.1093/humupd/dmw007. PMID 27006004.