Infertility treatment

Contents

1. Treating infertility and determining its causes
2. Education and awareness before infertility treatment
3. Treating the causes of male infertility
4. Treatment of the causes of infertility in women
5. Assisted reproductive technologies
6. Facts about fertility and sterility

Infertility treatment and causes

To treat infertility, the doctor begins his task by trying to reveal its causes, to choose the appropriate treatment according to it. The doctor may treat infertility with drugs or surgical procedures, and he can also recommend the use of one of the assisted reproductive technologies such as IVF and intrauterine insemination if he finds that treatment with drugs or surgical procedures may not be sufficient to treat infertility, or if it is not possible to identify a clear cause of infertility in both spouses, and it is worth noting that infertility treatment may require resorting to one or more of the available treatment options, and the selection of the appropriate treatment depends on several factors in addition to the cause of infertility, Such as the duration of suffering from infertility, the personal preference of the spouses, and the age of each.

As mentioned previously, problem of infertility is a relatively common health problem, and the problem of infertility or delayed pregnancy may be caused by one of the health disorders of the woman, the man, or both, and in many cases, the main cause of infertility cannot be determined, so it is worth Indicating the need for both spouses to undergo a medical evaluation to determine the factors causing infertility, and the tests used to determine the factors that cause infertility in women include blood tests to detect the level of certain hormones and imaging tests, and in some cases, some medical procedures may be resorted to, such as laparoscopy and hysteroscopy, which It provides an opportunity to examine the internal genital parts of women. As for men, a sperm analysis, blood tests to detect the level of some hormones, and some imaging tests may be performed.

Education and awareness before treatment

Infertility It is important to educate the spouses before starting treatment that infertility or delayed pregnancy may be linked to some wrong practices or factors that can be avoided without the need for treatment, and the timing and number of times of marital intercourse play an important role in the fertilization process, as the practice of marital relationship periodically Every 2-3 days increases the chance of conception, in addition to trying to determine the date of ovulation for a woman to practice the marital relationship during the fertile period, and the following is a statement of some of the factors that may affect the fertilization process and reduce the chance of pregnancy:

• Women suffering from overweight or underweight.
• Excessive exercise by women.
• Men or women drinking alcoholic beverages.
• Smoking, as may have an effect in reducing the number of sperms in a man, and impairing their motility.
• using a lubricant during intercourse; Some types of lubricants may affect impeding the sperm from reaching the egg.

Treating the causes of male infertility

The treatment of male infertility depends mainly on the cause of infertility, and infertility is often caused by a sperm disorder such as a decrease in its number than the normal rate, problems with semen, or suffering from one of the problems related to ejaculation, and this is due to four main reasons, Which:

• secondary hypogonadism; Which is caused by some disorders of the pituitary gland, or the hypothalamus in the brain, which is responsible for secreting hormones that stimulate the testicles to produce testosterone, and this type of disorder accounts for only 1-2% of male infertility cases.
• Primary disorders in the testicles, such as orchitis, varicocele, and some problems related to the growth and development of the testicles, constitute 30-40% of male infertility cases.
• Sperm transport disorder accounts for 10-20% of male infertility cases.
• Cases of unknown cause make up 40-50% of infertility cases.

Medical treatment of male infertility

There are a group of medications that a doctor may resort to treat male infertility, including:

• Gonadotropins:

There are a group of medications that a doctor may resort to treat male infertility, including:

• Alpha agonists:

Your doctor may prescribe pseudoephedrine, an alpha agonist if a man has retrograde ejaculation, which is retrograde ejaculation into the bladder instead of through the urethra and out of the body. These medications block the opening that leads to ejaculation toward the bladder.

• Medicines to treat premature ejaculation and erectile dysfunction:

Some medicines help solve the problem of premature ejaculation (premature ejaculation), and other medicines to treat erectile dysfunction (erectile dysfunction), such as: (sildenafil).

• Bromocriptine or Cabergoline:

  Treatment of cases of high milk hormone, or what is known as hyperprolactinemia in men, varies according to the cause, and medical treatments for this condition include: The doctor resorts to prescribing bromocriptine or cabergoline to help restore the natural hormone level in the body, surgery, or radiotherapy can be used in some cases.

• Antibiotics:

Antibiotics may be prescribed if the man has a reproductive tract infection. It should be noted here that antibiotics are used if a man has a sexually transmitted infection that can affect fertility, but is often not sufficient to treat infertility. A genital infection may cause a blockage in the tubes that carry semen or sperm and require surgery to remove the blockage.

Surgical treatment of male infertility

Several surgical treatments may be used to treat male infertility as well, including:

• Operations to remove the blockage that obstructs the exit of semen:

In the event of suffering from a blockage that hinders the exit of sperm or semen in the man, a surgical procedure may be performed that helps to remove this blockage, which may be caused by an injury, infection in the reproductive system, or others.

• Surgical treatment of varicoceles:

Surgical treatment of varicoceles is usually not recommended, except in severe cases in which a person suffers from the formation of large varicose veins in the testicles, and the presence of other factors that impair a man's fertility; Where the veins causing the problem in the testicle are removed, and it should be noted that this process may not help restore the natural fertility of the man in some cases, especially in the case of suffering from varicocele for a long period and not obtaining appropriate treatment; In the event of permanent damage to the testicles.

• Surgical sperm extraction:

Sperm may be extracted from the man surgically for use through assisted reproductive techniques, and this surgical procedure is done in some cases, such as: suffering from a blockage in the reproductive system, or the presence of a congenital malformation since birth, such as males who are born with a reproductive system that lacks the presence of the vas deferens; It is the tube responsible for transporting sperm from the testicles.

Treating the causes of infertility in women

Infertility treatment in women depends on the main cause of infertility, and infertility may be caused by several different reasons, such as advancing age, ovulation disorders such as: caused by polycystic ovary syndrome, in addition to blockage of the fallopian tubes, which may be caused by the previous infection with a sexually transmitted disease such as Gonorrhea and pelvic infection, where the blockage leads to the inability of sperm to reach the egg or the egg not reaching the uterus for implantation, and uterine fibroids may also lead to In some cases, suffering from infertility, and it should be noted that there are three different types of uterine fibroids, and the risk of infertility does not increase except in the case of submucosal fibroids, in which the fibroids grow inward from the lining of the uterus, and among the causes of infertility in women are also the growth of endometrial polyps, and endometriosis, which is known among the people as endometriosis

Medical treatment of female infertility

The drug treatment represented by fertility drugs is the main treatment used to restore normal fertility in women who suffer from infertility as a result of a disturbance in the ovulation process, and most of these drugs work in a similar way to the body’s natural hormones responsible for stimulating ovulation.

• Clomiphene drug:

Clomiphene stimulates the production of follicle-stimulating hormone and luteinizing hormone from the pituitary gland, which in turn stimulates ovulation.

• Gonadotropins:

It is the same drug used in some cases of male infertility, which when used for women stimulates the ovaries to produce more eggs directly (instead of stimulating them indirectly by stimulating the secretion of stimulating hormones from the pituitary gland).

• Metformin:

If a woman suffers from polycystic ovary syndrome accompanied by insulin resistance, metformin may be prescribed to help get rid of the problem of hyperinsulinemia and the problem of insulin resistance, which in turn works to regulate the woman’s menstrual cycle, regulate ovulation, and Tamoxifen may also be used in some cases to stimulate ovulation in women with PCOS.

• Aromatase inhibitors:

In some cases, an aromatase inhibitor, such as Letrozole, may be used if treatment with clomiphene is unsuccessful.

• Bromocriptine or cabergoline:

If a woman’s infertility is caused by hyperprolactinemia, bromocriptine or cabergoline may be prescribed.

• Surgical treatment of female infertility:

Some cases of infertility in women may need to resort to some surgical treatments, and it is worth noting that resorting to surgical treatment is usually rare due to the high chance of pregnancy success through assisted reproductive techniques such as IVF. In any case, the available surgical options can be described as follows:

• Transabdominal or uterine surgery:

This type of surgery aims to get rid of disorders or problems in the uterus or pelvis, and to help increase the chance of childbearing and fertility in women, and is often performed through simple endoscopic surgery, according to the health problem that the woman suffers from, and the health problems that may be performed Treatment through this type of surgery is as follows:

• Endometriosis.
• Removal of submucous uterine fibroids.
• Polycystic ovary syndrome.
• Uterine polyps.
• Correcting some congenital anomalies in the uterus.
• Removal of adhesions formed in the pelvis or uterus.

• An operation to correct a blocked fallopian tube:

Whether or not the procedure is performed depends on the severity of the condition and whether the blockage is in one or both fallopian tubes. If the blockage is only in one of the fallopian tubes and is accompanied by a buildup of fluid in the tube known as a hydrosalpinx, laparoscopy or hysteroscopy is done to remove the tube, or to separate it from the uterus, but if the tubes are blocked, assisted reproductive techniques are usually used.

Assisted Reproductive Technologies

Several assisted reproductive techniques can be used to treat infertility and are very common in infertility treatment, including:

Intrauterine injection

In the process of intrauterine insemination, semen is obtained from the man, then the semen is washed with a suitable solution that does not affect the integrity of the sperm or the egg, then the healthy sperm are separated from the weak sperm and injected into the woman’s uterus using a special needle directly to increase The chance of fertilization of the egg and pregnancy, and this process may be resorted to in some cases, such as a decrease in the number of sperm cells in the man or a disturbance in this process. Movement, erectile dysfunction in a man, a man who suffers from retrograde ejaculation, or a woman who suffers from scarring or deformation in the cervix, and it should be noted the use of artificial insemination in some cases in conjunction with the use of fertility drugs or augmenting ovulation to increase the chance of pregnancy.

IVF baby

The process of test-tube baby, or what is known as in vitro fertilization (IVF), takes place in several stages, where ovulation is stimulated in the woman using the ovulation-stimulating drugs mentioned earlier, then the man’s semen is extracted, and several eggs from the woman during a period Ovulation, then isolating healthy sperm and healthy eggs, to be collected in the laboratory under conditions suitable for insemination to occur, or insemination may be done by injecting the sperm into the egg directly in some cases, in what is known as a microscopic injection (Intracytoplasmic sperm injection), and after the occurrence of ovulation. Insemination takes 1-6 days. The fertilized egg is re-implanted in the uterus, to facilitate pregnancy.
This type of treatment is used for many different reasons, such as fallopian tube disorders, endometriosis, and severe infertility in men. It should be noted that other auxiliary techniques can be used in cases of IVF, such as Assisted hatching. After 5-6 days from the time of fertilization, the embryo emerges or hatches from the surrounding membrane known as the zona pellucida (Zona pellucida) and implants In the endometrium, the hatching technique is represented by medical assistance by puncturing the transparent area of ​​the fertilized egg in the laboratory before transferring the embryo to the uterus, which facilitates its implantation in the endometrium. Or the woman's age and this technique are useful in cases where the woman's eggs are frozen for use at a later time, as freezing the eggs can cause the transparent area to harden.

Other techniques

Another technique that is used in cases of infertility is what is known as gamete intrafallopian transfer and zygote intrafallopian transfer. Fertilization of the egg and sperm outside the uterus, then the fertilized egg is transferred to the woman’s fallopian tube within twenty-four hours.

Facts about fertility and sterility

To understand the causes of infertility and how to treat each case, it is necessary to clarify what happens in the normal fertility situation in both men and women:

Female fertility:

The hypothalamus area in the brain stimulates the pituitary gland to secrete hormones known as gonadotropins or gonadotropins, which in turn stimulate the release of a mature egg from one of the ovaries in each menstrual cycle, and if this egg is fertilized By one of the man’s sperm, the fertilized egg is transmitted to the lining of the uterus and implanted in it. Therefore, any problem in the process of ovulation or the ability of the egg to move to the uterus and implant in it after fertilization may cause a woman to suffer from infertility.

male fertility:

The hypothalamus in the brain stimulates the pituitary gland to secrete gonadotropins, which in turn stimulates the production of testosterone in the testicles, which is necessary for the production of sperm. Vas deferens) to the vas deferens, where the semen is formed by the seminal vesicles and the prostate. Usually, and therefore it can be said that a man’s fertility requires the testicles to produce healthy sperm that can pass into the semen, that the semen contains good amounts of it, and that the sperms are effective and able to move and fertilize the ovum.