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Infertility: what can you do

letto 6159 volte | autore: Claudio Manna, ginecologo specialista in fecondazione assistita (vai al curriculum)


The treatment of infertility normally begins with most simple therapeutic solutions and when this fails you resort to other possibilities, in some cases though  where there is evidence of a principal cause of infertility specialists direct the couple toward in vitro fertilisation. A quick zoom to widespread treatments.

The induction of ovulation
Often the attempt to have a high quality ovulation is the first proposal made to a couple after the doctor has ascertained the normality of the uterine cavity, of the tubes and of the sperm. Clomifene citrate and menotropin can be used to stimulate ovulation and are administered at the beginning of the menstrual cycle.  Secondary undesired side effects caused by these treatments is the possible  alteration of cervical mucus, which implies the complimentary assumption of  oestrogen or the addition of gonadotropine. The latter consist of FSH (follicle stimulating hormone), genetically obtained, or from a combination of FSH and LH (luteinising hormone), the hormones secreted by the hypophysis to stimulate the ovaries. The gonadotropines are taken for 6-12 days, during the first part of the cycle, the use of these requires constant ultrasound monitoring of the ovarian follicles  combined with hormonal dosages so as to avoid the multi-follicular stimulation which creates the risk of multiple pregnancy. When the abnormality responsible for ovulation disturbances is situated at the level of the hypothalamus it is possible to utilise a GnRH  injector (gonadotropine release hormone that stimulates the hypophysis) which is kept on the waist for several weeks and is programmed to release pulses  of GnRH hence reproducing almost physiological cycles.

Intrauterine insemination (IUI)
This technique can be necessitated by abnormalities in the number and/or mobility of the spermatozoa, or when the fertility obstacle is at the level of the uterine neck, for example, in the case of cervical mucus.  The principle of intrauterine insemination is to stimulate follicular growth and trigger ovulation with a HCG (human chorionic gonadotropine) injection.  Two days
after injection several specially selected spermatozoa, the most mobile, are transferred into uterus. This same technique is utilised with donor sperm also.

Fertilisation in vitro and embryo transfer (FIVET)
Initially developed to allow women without tubes to become pregnant, this technique of medical intervention for procreation has seen its reasons grow progressively. The principle on which FIVET is based consists in the stimulation of the ovaries with repeated injections of gonadotropine a (recombinant) form of  FSH which is genetically engineered or a mixture of FSH and LH of human origin.  These hormones, secreted by the hypophysis, naturally stimulate the development of follicles and in this case are used in high doses to obtain a multi-follicular response.  It is obligatory to monitor  this stimulation with ultrasound and assess hormone dosages.  When multi-follicular maturity has been reached the best moment for ovulation is determined and we proceed with an injection of HCG (human chorionic gonadotropine) The exportation of the follicles is carried out 36 hours later vaginally and using ultrasound guidance.  In the follicular liquid drawn there are many ova that are put in a specially prepared culture with the spermatozoa to achieve fertilisation.  Two to five days after this two (sometimes three) embryos are transferred into the uterus of the patient.

The micro injection (ICSI)
The micro injection or ICSI (Intra Cytoplasmic Sperm Injection) begins like classical FIVET, but instead of putting the ova and spermatozoa into a culture and waiting for fertilisation, the biologist, under microscope, directly introduces a mobile spermatozoa into each exported ovum.  The use of ICSI is indicated in grave cases of sperm abnormality (insufficient number of spermatozoa and/or very weak mobility).  The sperm obtained by testicular biopsy are therefore micro-injected.

Reproductive surgery
In men, surgery is common to correct limited retraction of the deferent channel or in the case of varicoceles. In women using a laparoscopic technique  it is possible to effect a saplingoneostomia, that is the opening of a blocked or narrow tubaric pavilion, and the elimination of adhesions. Laparatomically, that is via a cut in the abdominal wall, it is possible to perform tubaric surgery of for proximal obstruction, that is the rectification of the obstructed tube at the level of its entrance in the uterus (utero-tubaric re-implant), and the termino-terminal tubaric anastomosy, that is, tubaric re-channelling in women who have previously undergone sterilisation by tubal ligation. Lastly, using the hysteroscopic technique polyps of the endometrium and uterine adhesions can be operated.

Disclaimer: the information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician.

giovedì 20 marzo 2008

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