Treatment of Female Infertility

The aim of treatment of female infertility is to remove any of the factors identified during the tests for the diagnosis of the cause of infertility.

Thorough investigation of both the male partner as well as the female partner should be done and and a plan of treatment evolved accordingly.

Most couples appreciate a description of the process of fertilization and conception. A sympathetic hearing of their difficulties goes a long way in decreasing the stress involved in visiting a doctor for treatment.

General Measures

An improvement in diet and general health can relieve stress to some degree. Obesity should be brought under control.

On the First Visit

Both the male and the female partner is tested for all the causes of female infertility as well as male infertility . Since the main cause of female infertility is either a lack of ovulation or a block in the genital tracts, treatment is aimed at managing these two causes.

Treatment for Failure in Ovulation

Hormonal Imbalance: Failure of ovulation or anovulation is usually due to hormonal problems. A low thyroid hormone level, a high prolactin level, a high androgen (male hormone) level or a high insulin level will cause anovulation.

PCOD is a common cause of female infertility. It is a syndrome characterised by a high androgen and insulin level, anovulation, growth of male pattern hair, obesity and irregular menstruation. Ultrasound will show a number of small cysts in the ovary.

The different types of hormonal imbalance can be managed by medicines to supplement or bring down the hormones to a normal level.

Ovulation Induction : Even after the hormonal levels has been brought to normal, the ovaries may need to be stimulated to cause the growth of graaffian follicles and cause ovulation. Various methods of ovulation induction may be used:

Clomiphene Citrate is an anti-oestrogen that stimulates the growth of Graafian follicles in the ovary. It is given as 50 mg tablets from the 3rd day of mens for 5 days. USG examination from the 8th day is carried out to count the number of follicles, measure their sizes and note the day of ovulation. Normally, follicles rupture when they are 18 – 20 mm in size without clomiphene. With the drug however, they can grow up to 25 mm or even bigger. Higher doses of 100 mg or even 150 mg of clomiphene can be given depending on the response of the ovaries. Clomiphene citrate alone is the first line of treatment in cases of failure of ovulation.
Human Chorionic Gonatrophin (HCG) – If the follicles grow to a reasonable size but fail to rupture, HCG is injected on the 12th or 14th day. HCG stimulates ovarian steroids which trigger the LH-FSH surge and cause ovulation.
Gonadotrophin therapy - Gonadotrophins like FSH and LH should be given in cases of failure of the hypothalamic-pituitary system and only in centers with proper laboratory facilities to monitor the patient.
Thyroid hormones should be given where failure of ovulation is believed to be due to hypothyroidism.
Bromoergocriptine: is given to bring down the prolactin level in hyperprolactinaemia.
Metformin: Metformin is commonly used to decrease the insulin resistance seen in PCOD. Insulin resistance is associated with anovulation.

Treatment for Tubal Block

Laproscopic operation: Laparoscopy, combined with a hysteroscopy, whether operative or diagnostic, is sometimes carried out as the first line of treatment of infertility in many centers. It is possible to open up any fimbrial block and release peritubal adhesions with the help of a laparoscope. Blocks inside the tubes can be corrected with a salpingoscope.
Correction of the position of the uterus Retroverted or acutely retroflexed uterus is rarely a cause for infertility but should be corrected if suspected to be responsible.

Intra-Uterine Insemination (IUI) : This method involves collecting the sperm by masturbation and injecting it gently into the uterus, thus bypassing the cervix. It is carried out in cases where it is suspected that the female cervical mucus may be hostile to the sperm or where the number of male sperm is believed to be inadequate for fertilization. The procedure should be done within 2 hours of collecting the semen.

Insemination with husbands semen (AIH) is done in cases of impenetrable cervical mucous or when disease or deformity of the cervix makes it impossible for the sperm to enter the uterus. It is also carried out in cases of impotence or premature ejaculation.
Insemination with donor semen (AID) is usually carried out in couples where the husband suffers from azoospermia or complete absence of sperm.

In-vitro fertilization (IVF) : This method is more commonly known as the test-tube baby method. Ovum is collected from the wife and sperm from the husband and fertilization is allowed to occur in the laboratory. In the early experiments, fertilization was allowed to occur in a test-tube, hence the name, 'test-tube baby'. The fertilized ovum is cultured up to a 16-celled stage and replaced in the wife’s uterus. Success rate is about 25 – 30 %.

ICSI : In this method, a single sperm is injected into mature ovum. It is a part of the IVF procedure and the advantage lies in the fact that men with a very low count of sperm can also utilize this method. It has also been successfully used in men suffering from azoospermia (complete absence of sperm). In these cases, sperm has been aspirated from the testes directly.

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