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Health Dictionary

Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Infertility other therapies

Introduction

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

Intracytoplasmic sperm injection

Others

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.