Treatment Options for Infertility

1
Treatment Options for Infertility

• Association of Reproductive Health Professionals
• www.arhp.org

2
Learning Objectives

• State at least three infertility treatment
  options available for females.
• State at least three infertility treatment
  options available for males.
• List two available ovulation-inducing drugs.

3
Basic Services for Infertile Couples
2. Conduct appropriate diagnostic workup
Stewart GK. 1998
4
Fertility Treatments Can Work


With thorough evaluation and application of
current treatments short of IVF, embryo transfer,
or GIFT, 5060 of infertility couples will
conceive.
Meldrum DR 1998
Meldrum DR. 1998.
5
Causes Treatments for Male Infertility
Azospermia
Inject FSH and LH
Surgical sterilization
Reverse vasectomy
Impaired sperm motility
Repair varicocele
Nelson AL, Marshall JR. 2004.
6
Main Causes of Female Infertility
Ovulation disorders
Endometriosis
Tubal abnormalities
Nelson AL, Marshall JR. 2004.
7
Treatments for Female Infertility

• Maintain normal body weight
• Clomiphene
• Metformin
• Gonadotropin therapies
• Laparoscopic ovarian drilling

Ovulation disorders
Endometriosis
Tubal abnormalities
more
Nelson AL, Marshall JR. 2004.
8
Treatments for Female Infertility (continued)

• In vitro fertilization
• With or without salpingectomy
• Tuboplasty (tubal ligation reversal)

Tubal abnormalities
Endometriosis
Tubal abnormalities
more
Nelson AL, Marshall JR. 2004.
9
Treatments for Female Infertility (continued)

• Laparoscopic ablation
• Intrauterine insemination with controlled
  hyperstimulation
• In vitro fertilization

Endometriosis
Endometriosis
Tubal abnormalities
Nelson AL, Marshall JR. 2004.
10
Ovulation-Inducing DrugsClomiphene

• Chemically stimulates pituitary gland to produce
  hormones that trigger ovulation process
• Usual dosage 50 mg/day for 5 days
• Numerous side effects
• May not be appropriate for patients with
• Large fibroid tumors
• Ovarian cysts
• Liver problems

more
Harkness C. The Infertility Book. 1992.
11
Ovulation-Inducing DrugsBromocriptine

• Reduces production of prolactin hormone
• Dosage 2.5 mg 13 times/day
• Some side effects
• May not be appropriate for patients with
  pituitary tumors gt1 cm

Harkness C. The Infertility Book. 1992.
12
Ovulation-Inducing Drugs

• Human Menopausal Gonadotropins (hMG)
• Follicle-Stimulating Hormone (FSH)
• Stimulate ovary to develop follicles
• 75150 IU/day (with hCG)
• 2040 possibility of multiple births
• May not be appropriate in cases of pituitary
  tumor, ovarian cysts

more
Harkness C. The Infertility Book. 1992.
13
Ovulation-Inducing Drugs (continued)

• Gonadotropin-Releasing Hormone (GnRH)
• Triggers normal pituitary hormonal activity so
  ovulation can occur
• Effective in women with hypothalamic amenorrhea
• No known physical side effects
• Ovulation pump administers injections every 90
  minutes
• User must carry pump with attached IV tubing for
  12 weeks or until ovulation occurs

Harkness C. The Infertility Book. 1992.
14
Endometriosis Treatment with Surgery

• Pregnancy rates after surgery

4575
60
3548
After Stage 1 or 2
Stage 3
Stage 4
Jennings VH, et al. 1998.
15
Endometriosis Drug Therapies

• GnRH agonists
• Birth control pills

Jennings VH, et al. 1998.
16
Polycystic Ovarian Disease Treatment

• Ovulation induction
• Clomiphene
• HMG, FSH, GnRH
• Insulin sensitizers (e.g. metformin,
  rosiglitazone)

Jennings VH, et al. 1998.
17
ART Treatments for Infertility
IVF with embryo transfer
A
Gamete intrafallopian transfer (GIFT)
R
Zygote intrafallopian transfer (ZIFT)
Cryopreservation
T
Intracytoplasmic sperm injection (ICSI)
American Society for Reproductive Medicine.
2003. American Society for Reproductive Medicine.
2001.
18
IVF with Embryo Transfer
Egg and sperm are retrieved from couple,
donor(s), or both
Combined in a petri dish, incubated for 25 days
If fertilization and cleavage occurs, embryo is
transferred through a catheter to uterus
Clapp DN. 2002.
19
Gamete Intrafallopian Transfer (GIFT)
Oocytes retrieved via laparoscopy
Oocytes and sperm placed in same catheter
Injected directly into the fallopian tube via
laparoscopy
Embryo travels through the fallopian tube to the
uterus for implantation
Clapp DN. 2002.
20
Zygote Intrafallopian Transfer (ZIFT)

• Combines techniques used in IVF and GIFT

Ova are placed in a petri dish with sperm

• If fertilization occurs, the zygote
• Is injected into fallopian tube
• Travels through tube to uterus
• Implants in uterus

Clapp DN. 2002.
21
Cryopreservation

• Sperm or embryos are preserved by freezing for
  replacement in subsequent cycles

Clapp DN. 2002. Photo source http//www.dcmsonlin
e.org
22
Intracytoplasmic Sperm Injection (ICSI)

• A single sperm is injected directly into the
  cytoplasm of the oocyte
• Increases probability of fertilization

American Society for Reproductive Medicine.
2004. Photo source www.fertilitycentre.ca
23
ART Options for Same-Sex Couples

• Combination of their own and donor sperm and eggs
  through IVF
• Surrogacy
• Can parent biological children

Bateman S. 2004.