- Ovulation Induction / home plan
- Artificial Insemination / Intrauterine Insemination
- In Vitro Fertilization (IVF) / Intracytoplasmic Sperm Injection (ICSI)
- Embryo Cryopreservation and Storage
- Fertility Preservation (cryopreservation and storage of oocytes / sperm)
- Embryo Cryopreservation and Storage
- Oocyte Donation
The initial approach consists of a consultation, physical examination and ultrasound. The problem of infertility is discussed with specific reference to causes, treatment options and lifestyle changes, which can improve the prognosis for a pregnancy. Patients and their partners are encouraged to ask questions. Planning is done regarding further investigation, which usually involves taking some blood samples and possibly a semen analysis, if not done before.
1. Ovulation Induction & Timed Intercourse
This is the most basic form of treatment. To consider this there should not be a severe male factor or a tubal factor present. Ovulation induction is done using oral medication or a combination of oral medication and injections. The aim is to ensure ovulation and possibly aim for two to three follicles per cycle in order to improve success rates. The follicles are monitored with ultrasound scans from day eight of the cycle. When the follicles have reached the ideal size, ovulation is either triggered with HCG injection or blood is taken to determine the LH peak.
Once a patient’s response has been determined in a cycle and the ovulation has been pinpointed the patient can follow this ‘recipe’ at home for two to three months.
The success rates for timed intercourse are 5-8% pregnancy rate per cycle.
2. Artificial Insemination
This is a step up from timed intercourse. Again to consider this there should not be a severe male factor or a tubal factor present. Ovulation induction is done using oral medication or a combination of oral medication and injections. The aim is to ensure ovulation and possibly aim for two to three follicles per cycle in order to improve success rates. The follicles are monitored with ultrasound scans from day eight of the cycle. When the follicles have reached the ideal size ovulation is triggered with HCG injection.
Thirty-six hours after the trigger the patient should ovulate and the insemination is done on that day. The male partner takes his sample to the fertility laboratory where it is prepared. The preparation takes approximately 2 hours. The prepared sample is brought to Dr. Slabbert’s rooms and the insemination is done. A small catheter is put into the uterine cavity, which allows the sperm sample to be deposited in the cavity. The patient remains supine for 30 minutes.
Artificial insemination can be repeated for up to nine cycles.
The success rates are 15% pregnancy rate per cycle.
In Vitro Fertilisation or IVF as it is commonly referred to is a technique where fertilization takes place in the laboratory. The patient is stimulated with follicle stimulating hormone (FSH) and /or luteinizing hormone (LH) in the form of injections. The stimulation is more intensive and aims at producing 8-10 follicles and in some cases even more. The follicles again are monitored using ultrasound. When the follicles reach the required size an HCG injection triggers the final maturation of the oocytes and aspiration is scheduled before ovulation takes place.The follicles are aspirated under a light anesthetic in a small theatre adjacent to the IVF lab. The embryologist picks up the oocytes from the follicular fluid. The male partner’s semen is prepared in much the same way as for artificial insemination and then added to the oocytes in the lab. On day one fertilization is seen and from day two the embryo divides and can be evaluated in terms of the quality.The transfer of embryos is possible from day two. If there is a lot of embryos transfer is postponed to try and determine which embryos are the best quality and, therefore will give the best possible pregnancy rate.
The success rate of IVF can be as high as 40% depending on factors such as the age of the patient and the number of follicles.
Intracytoplasmic sperm injection (ICSI) is used in patients where there is a severe male factor or recurrent non-fertilisation in previous cycles.
The process is similar to IVF. The only difference is that instead of allowing the sperm to fertilise the oocytes in much the same way as it would happen in the tube, with ICSI for each oocyte a normal looking sperm is selected and injected into the oocyte. In this way the fertilization rate is improved.
The success rate is similar to IVF, can be as high as 40% depending on factors such as the age of the patient and the number of follicles.