For the initial evaluation of the infertile couple,besides a semen analysis and an estimation of the Anti-Mullerian Hormone (AMH) for her egg reserve, a transvaginal ultrasound scan is also required for diagnosis
Dr Jatin Shah
Infertility often creates one of the most distressing life crises a couple has faced. Coping with the multitude of medical decisions and the uncertainties that infertility brings can create great emotional upheaval for most couples. Many couples experience anxiety, depression, and feelings of being out of control or isolated. Modern techniques of assisted reproduction have offered these couples a realistic chance at parenthood.
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For the initial evaluation of the infertile couple,besides a semen analysis and an estimation of the Anti-Mullerian Hormone (AMH) for her egg reserve, a transvaginal ultrasound scan is also required for diagnosis.
IVF is recommended for patients with blocked tubes, previous tubal pregnancies, resistant PCOS and endometriosis.ICSI (Intracytoplasmic sperm injection) is very useful for patients with poor sperm counts, reduced sperm motility, abnormal sperms and even zero sperm counts (where sperm can be directly retrieved from the testes).
There are also very successful techniques using third party reproduction. Egg donation is recommended for patients with premature ovarian failure or menopause, repeated IVF failures due to poor egg quality, unexplained IVF failures, patients with a reduced egg reserveand those of advanced age
Sperm donation might be a viable option for patients with zero sperm counts where ICSI is not possible and patients with poor sperm who have failed repeated ICSI cycles.
Embryo donation is recommended for couples withlong standing infertility and repeated IVF failures.
Gestational Surrogacy is indispensable for patients who are born without a uterus or where the uterus is damaged owing to tuberculosis, congenital defects or after a previous miscarriage or abortion and also for patients with repeated unexplained IVF failures.
The commonest causes of a failed IVF cycle are suboptimal sperm/poor egg quality oran unreceptive uterus
What are the options after failed IVF?
It is important to remember that a full trial of IVF often entails 3-5 cycles with a proactive change of protocols for ovarian stimulation and other measures such as frozen instead of fresh embryo transfer, further testing of sperm DNA fragmentation, genetic studies, dual stimulation, endometrial scratching, intrauterine Platelet rich plasma, vaginal sildenafil, heparin, blastocyst culture, Preimplantation genetic testing (in indicated cases) and finally third party reproduction. These “add-ons” need to be judiciously selected and applied as per the individual patient for optimal outcomes. “Individualized patient care and protocols” and “evidence based practice” are essential to optimize the time to pregnancy for every patient.
Is female infertility preventable? A principal limitation to human reproduction is the natural loss of healthy eggs as a woman ages. At birth, a woman is born with her fixed total reserve of eggs of which almost 80-90% are lost by the age of 30. Women who are planning to marry at a later age have the option of egg freezing when they are young so that they still retain the option of having their own biological offspring.
Dr Jatin Shah, MD, DGO (gold medallist) is the Director of Mumbai Fertility Clinic & IVF Centre, a clinic of international repute, consistently high success rates and well known for treating patients with repeated IVF failures
https://drjatinshah.com/
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