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Female Infertility – Treatments

Several lifestyle changes can be adopted by women to increase their chances of becoming pregnant. Women are recommended to follow a proper diet, exercise in moderation, abstain from tobacco and alcohol and lead a stress-free life. Sleep and nutritious diet contribute significantly in alleviating several issues.

Medical Management

After thoroughly studying the patient and diagnosing the condition, medication is provided to rectify ovulatory dysfunction.

Surgical Management

Laparoscopy

It is a surgical procedure that involves making one, two or three very small cuts in the abdomen, through which the doctor inserts a laparoscope and specialized surgical instruments. A laparoscope is a thin, fiber optic tube fitted with a light and camera. Laparoscopy allows the doctor to see the abdominal organs and sometimes make repairs without making a larger incision that can require a longer recovery time and hospital stay.

Some causes of infertility like endometriosis can only be diagnosed with laparoscopy. It allows the doctor to not only see what is inside but also treat some causes of infertility allowing you to get pregnant naturally or with fertility treatments.

Laparoscopy is performed in hospital under general anesthesia. This requires you to fast for at least 8 to 10 hours before your scheduled surgery. Under complete anesthesia, a small cut is made around the umbilicus and carbon dioxide gas is used to fill up the abdomen, then the laparoscope is introduced to look at your organs and sometimes two or three more small cuts are made so that other thin surgical instruments can be introduced to make repairs and move the organs around for a better view.

The surgeon addresses the problem depending on the issue – adhesions, growths, cysts, and fibroids will be removed and the fallopian tubes, if blocked, may be opened, if possible. Based on findings during laparoscopy, doctor will decide on further fertility treatments.

Hysteroscopy is the visual examination of the canal of the cervix and interior of the uterus using a thin, lighted, flexible tube called a Hysteroscope. The device is inserted through the vagina. The Hysteroscope allows for easy visual access to the interior of the cervix and uterus to assess any abnormalities. Hysteroscopy may be used for both diagnostic and therapeutic purposes.

Diagnostic hysteroscopy is used to diagnose problems of the uterus and to confirm results of other tests like Ultrasound and Hysterosalpingography (HSG).

Operative hysteroscopy is used to correct an abnormal condition detected during a diagnostic hysteroscopy. An operative hysteroscopy is often performed at the same time avoiding the need for a second surgery. During operative hysteroscopy, small instruments are inserted through the Hysteroscope to correct the condition.

Anesthesia for hysteroscopy may be regional or general:

You will be seen by an anesthetist and prepared for receiving anesthesia.

The time it takes to perform hysteroscopy can range from less than 5 minutes to more than an hour. The length of the procedure depends on whether it is diagnostic or operative and whether an additional procedure, such as laparoscopy, is done at the same time. In general, however, diagnostic hysteroscopy takes less time than operative.

PGS – Pre-implantation Genetic Screening

Pre-implantation Genetic Screening involves analysing the genetic composition to determine an embryo with normal chromosomal content and transferring it. In this technique, embryos are checked individually for a chance of implantation by detecting abnormal chromosomes. This helps to select and transfer of genetically normal embryos.

Pre-implantation Genetic Screening can potentially benefit couples who present a majority of IVF indications, particularly couples where the age of the woman is advanced and families who have had recurrent pregnancy losses both naturally and through IVF.

A declining live birth rate is an increasing problem for families who choose to have children later in life and is strongly associated with late maternal age embryos showing greater levels of chromosomal abnormalities. Pre-implantation Genetic Screening utilizes the most sophisticated and scientifically validated technology for determining the chromosome compliment in a single cell.

Procedure
Pre-implantation Genetic Screening requires the woman to go through a regular IVF/ICSI cycle. The embryos created in the laboratory are then biopsied using highly specialized lasers and a single cell of an embryo is taken out for testing. These cells are subjected to identify chromosomally normal embryos.

These cells are subjected to identify chromosomally normal embryos.

Step 1. You undergo normal in vitro fertilisation (IVF) treatment to collect and fertilise your eggs.
Step 2. The embryo is grown in the laboratory for two to three days until the cells have divided and the embryo consists of around eight cells.
Step 3. A trained embryologist removes one or two of the cells (blastomeres) from the embryo.
Step 4. The cells are tested to see if the embryo from which they were removed contains the gene that causes the genetic condition in the family.
Step 5. The embryo unaffected by the condition is transferred to the womb to allow it to develop.
Step 6. Any suitable remaining unaffected embryos can be frozen for later use. Those embryos that are affected by the condition are allowed to perish or, with your consent, used for research.

The biopsy does not harm the growth of the baby or cause any abnormality in the baby, if proper equipment and trained personnel perform the same.

a) If you are over 35 years, the biological clock reduces the egg numbers as well as the quality with increasing age. These increasing egg abnormalities predispose elderly women (>35yrs) to have abnormal embryos. It is known that 40-60% of the embryos created through IVF are genetically abnormal (even in younger women).
b) Women who have had 2 or more pregnancy loss/abortions/ miscarriage.
c) Women who have had 2 or more failures with IVF especially when you were told everything was normal, but still it failed.
d) Women who have had abnormalities during pregnancy in the baby.
e) Men with severe male infertility factors such poor sperm movement, defective sperms or high DNA in sperm.
Theoretically, testing the embryos to see if they are genetically normal before transferring them into the uterus to implant will increase the probability of a pregnancy. By eliminating the abnormal embryos and selecting the normal ones for transfer, a successful pregnancy and a healthy child is ensured.

Some of the risks involved in PGS treatment are similar to those for conventional IVF.

Other challenges unique to PGS treatment include:
– Some embryos may be damaged by the process of cell removal but with the right expertise of trained doctors, this can be entirely avoided
– Possibility that no embryos are suitable for transfer to the womb after PGS

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