Treatment Options for Infertility Association of Reproductive Health

Treatment Options for Infertility Association of Reproductive Health Professionals www. 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 1. Educate on infertility causes and prevention 2. Conduct appropriate diagnostic workup 2. 3. Offer information on treatment options 4. Provide resources for counseling and emotional support Stewart GK. 1998

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 Impaired sperm motility Nelson AL, Marshall JR. 2004. Inject FSH and LH Reverse vasectomy Repair varicocele

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 more… Nelson AL, Marshall JR. 2004.

Treatments for Female Infertility (continued) • In vitro fertilization • With or without salpingectomy • Tuboplasty (tubal ligation reversal) more… Nelson AL, Marshall JR. 2004.

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 (h. MG) • Follicle-Stimulating Hormone (FSH) ▪ ▪ Stimulate ovary to develop follicles 75– 150 IU/day (with h. CG) 20– 40% possibility of multiple births May not be appropriate in cases of pituitary tumor, ovarian cysts more… Harkness C. The Infertility Book. 1992.

Ovulation-Inducing Drugs (continued) Gonadotropin-Releasing Hormone (Gn. RH) • 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 occurs Harkness C. The Infertility Book. 1992.

Endometriosis: Treatment with Surgery Pregnancy rates after surgery After Stage 1 or 2 Jennings VH, et al. 1998. Stage 3 Stage 4

Endometriosis: Drug Therapies • Gn. RH agonists • Birth control pills Jennings VH, et al. 1998.

Polycystic Ovarian Disease: Treatment Ovulation induction • Clomiphene • HMG, FSH, Gn. RH • Insulin sensitizers (e. g. metformin, rosiglitazone) Jennings VH, et al. 1998.

ART Treatments for Infertility IVF with embryo transfer Gamete intrafallopian transfer (GIFT) Zygote intrafallopian transfer (ZIFT) Cryopreservation Intracytoplasmic sperm injection (ICSI) American Society for Reproductive Medicine. 2003. American Society for Reproductive Medicine. 2001.

IVF with Embryo Transfer 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 Clapp DN. 2002.

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.

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.

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.