Treatment Options for Infertility

Association of Reproductive Health Professionalswww.arhp.org

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.

Basic Services for Infertile Couples

Stewart GK. 1998

2. Conduct appropriate diagnostic workup

3. Offer information on treatment options

4. Provide resources for counseling and emotional support

1. Educate on infertility causes and prevention

2. Conduct appropriate diagnostic workup

Fertility Treatments Can Work

“…With thorough evaluation and application of current treatments short of IVF, embryo transfer, or GIFT, 50–60% of infertility couples will conceive.”

Meldrum DR. 1998.

Meldrum DR 1998

Causes & Treatments for Male Infertility

Azospermia

Surgical sterilization

Inject FSH and LH

Impaired sperm motility

Reverse vasectomy

Repair varicocele

Nelson AL, Marshall JR. 2004.

Main Causes of Female Infertility

Nelson AL, Marshall JR. 2004.

Treatments for Female Infertility

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

Nelson AL, Marshall JR. 2004.

more…

Treatments for Female Infertility (continued)

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

reversal)

Nelson AL, Marshall JR. 2004.

more…

Treatments for Female Infertility (continued)

• Laparoscopic ablation• Intrauterine insemination with

controlled hyperstimulation• In vitro fertilization

Nelson AL, Marshall JR. 2004.

Ovulation-Inducing Drugs:Clomiphene

• 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

Harkness C. The Infertility Book. 1992.

more…

Ovulation-Inducing Drugs:Bromocriptine

• Reduces production of prolactin hormone• Dosage: 2.5 mg 1–3 times/day• Some side effects• May not be appropriate for patients with

pituitary tumors >1 cm

Harkness C. The Infertility Book. 1992.

Ovulation-Inducing Drugs

• Human Menopausal Gonadotropins (hMG)• Follicle-Stimulating Hormone (FSH)

▪ Stimulate ovary to develop follicles▪ 75–150 IU/day (with hCG)▪ 20–40% possibility of multiple births▪ May not be appropriate in cases of pituitary

tumor, ovarian cysts

Harkness C. The Infertility Book. 1992.

more…

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 1–2 weeks or until ovulation occursHarkness C. The Infertility Book. 1992.

Endometriosis: Treatment with Surgery

Pregnancy rates after surgery

After Stage 1 or 2 Stage 3 Stage 4

Jennings VH, et al. 1998.

Endometriosis: Drug Therapies

• GnRH agonists• Birth control pills

Jennings VH, et al. 1998.

Polycystic Ovarian Disease: Treatment

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

rosiglitazone)

Jennings VH, et al. 1998.

ART Treatments for Infertility

American Society for Reproductive Medicine. 2003.American Society for Reproductive Medicine. 2001.

IVF with embryo transfer

Gamete intrafallopian transfer (GIFT)

Zygote intrafallopian transfer (ZIFT)

Cryopreservation

Intracytoplasmic sperm injection (ICSI)

IVF with Embryo Transfer

Clapp DN. 2002.

Egg and sperm are retrieved from couple, donor(s), or both

Combined in a petri dish, incubated for 2–5 days

If fertilization and cleavage occurs, embryo is transferred through a catheter to uterus

Gamete Intrafallopian Transfer (GIFT)

Clapp DN. 2002.

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

Zygote Intrafallopian Transfer (ZIFT)

Combines techniques used in IVF and GIFT

Clapp DN. 2002.

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

Cryopreservation

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

Clapp DN. 2002.Photo source: http://www.dcmsonline.org

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

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.