Author Name: Dr. Princy Mittal Mentor Name: Dr. Amol Naik on April 08, 2020

Infertility is defined as failure to conceive even after 1 year of unprotected sexual intercourse.So it means if couple had been trying for at least 1 year and is not able to conceive they should meet doctor once for consultation.Cause can either be in male partner,female partner or in both.Infertility affects approximately 10 -15% of couples.Doctor will take history, examination of male and female partner will be done and some basic test will be advised to check for ovulation status, tubal patency test, assessment of uterus to know endometrial thickness, pattern, to rule out any structural pathology and finally semen analysis of male partner . If all reports comes normal and age of female partner is <35 years then couple can be advised to wait for some time so that they can conceive naturally.But if there is abnormality in any of reports or age of female partner > 35years then couple is advised treatment either in form of IUI, IVF or ICSI.

How to decide what is required IUI,IVF or ICSI?What is basic difference among these?

Let’s discuss them one by one.

IUI –INTRA UTERINE INSEMINATION

IUI i.e. intrauterine insemination is a process in which female partner is given specific medicines starting from period day 2/3 with an aim to develop 1-2 follicles and simultaneously ultrasound monitoring is done in order to know that follicle is growing and attaining appropriate size.When appropriate size is achieved ,trigger injection is given so that ovulation occurs and after its confirmation , husband’s semen sample is washed and through a thin sterile uterine catheter,processed semen sample is inserted directly into uterus.This gives little more assistance to sperms in order to reach egg and fertilise it, as compared to natural means.

Advantages of IUI:

• It bypasses cervical canal and semen sample is directly inserted into uterus which increases probability of reaching sperms to egg and hence pregnancy chances will increase.
• It is cheaper process than IVF
• less demanding
• less hormones are required
• Non-invasive process.

Disadvantage of IUI:

• Less success ratewhich ranges from 10-15% as compared to IVF.
• If hormones are used for regulating ovulation then chances of multiple pregnancy will increase.

Which couples can opt for IUI?

Couples with patent fallopian tubes,age of female partner <35 years and normal husband’s semen parameters i.e. total motile sperm count >10 million or couples who require donor sperm.
In couples with blocked fallopian tubes,age of female partner >35 years and abnormal husband’s semen parameters i.e.total motile sperm count <10 million or failed 3 -6 cycles of IUI , absence of menstruation IVF/ICSI procedure will be recommended.

IVF – IN VITRO FERTILIZATION

IVF i.e. in vitro fertilisation is a process in which female partner is given daily hormonalinjections starting from day 2/3 of cycles with an aim to grow maximum number of eggs .When these eggs attain appropriate size which occurs almost after 10 -12 days of stimulation, then under anaesthesia through ultrasound guidanceeggs are retrieved .On the day when eggs are retrieved husbands semen sample is taken and both eggs and sperms are placed in a dish overnight and allowed to fertilise each other which will result in embryo formation.In IVF sperm meets egg on its own.Embryo once formed is allowed to grow for 5 days in artificial media and good quality embryo(i.e. day 5 blastocyst)is then transferred into uterus of female partner.

Advantage of IVF

• Viable embryo is formed which gives better chances of conception.
• Success rate ranges from 60-70%.

IVF is done in cases where husband’s sperm count >1 million but in cases where count is < 1 million or female has low ovarian reserve or there is case of recurrent fertilisation failure,here comes the role of ICSI.

ICSI- INTRA CYTOPLASMIC SPERM INJECTION

Intra cytoplasmic sperm injection This process is a step ahead of IVF.It is more targeted method of IVF. The same procedure is followed i.e.hormonal injections are given to female partner to mature eggs.When female’s eggs arematured, they are retrieved, on same day husband’s semen sample is taken and it is processed and instead of waiting for fertilisation to occur as it happens in IVF, in ICSI the best sperms are selected according to their morphology .Each morphologically viable selected sperm is then directly injected into egg ,so that fertilisation occurs.

The benefit of ICSI over IVF is that

• Better quality embryo is formed.
• It also ensures that fertilisation will occur.

So to conclude ;

Appropriate treatment for couple will depend on multiple factors.Your fertility doctor can help and guide you to choose the best treatment option for you.

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