fertility treatments

Most In Demand Infertility Treatments for Couples with high success rates

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Medically Reviewed by Dr. Deepika Tiwari - MS, MBBS on 30 May 2019 - Written by Dr. Neha Gupta - MS, MBBS, DNB - Grammatically Approved by Dr. Kavita Jaggi Agrawal - MS, MBBS

The most in-demand infertility treatments for couples with high success rates include Intrauterine insemination (IUI), In vitro fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI) and surrogacy. The IVF success rates depends on age, quantity, quality of sperms and a woman's health to hold a pregnancy.

IVF success rates largely depend upon the male and female body's capacity to adapt to different Assisted Reproductive Technology (ART) treatments. There is an abundant number of reasons for the failure of certain infertility treatments like IUI, IVF, and ICSI procedures. Infertility in couple commences with many factors like male infertility, female infertility and some unknown reasons for infertility which are termed as unexplained infertility. Some big reasons for the failure of infertility treatments such as  IUI and IVF are age, pregnancy history, Body Mass Index (BMI), and lifestyle. Natural health issues like uterus size, poor quality of spermatozoa, and sexually transmitted diseases lead to low success rates. 

The top male infertility treatments depend on the values of certain factors as mentioned below: 

  • Sperm concentration (oligospermia) - 15 million sperm/ ml. 
  • Total sperm movement or motility (asthenospermia) - 40 percent. 
  • Normal formation (teratozoospermia) - 4 percent.

Considerably, male partners in several couples face infertility issues and this graph is on an increasing rate. Male infertility is approximately 30 to 40 percent on average in total infertile couples around the world. In different scenarios, different treatments are suggested for example-

  • For couples with mild oligospermia which counts at 10-15 million sperm/ml, it is suggested to opt for IUI treatment, as the treatment improves the chances of conception in such cases.
  • The infertile couples with moderate oligospermia counts between 5-10 million/ml are suggested for  In Vitro Fertilization (IVF) treatment.
  • Whereas couples with severe oligospermia count below 5 million/ml and poor sperm motility, an IVF along with Intracytoplasmic Sperm Injection (ICSI) is suggested.

Different causes of infertility in a woman belong to their age, menopause, presence of Polycystic Ovary Syndrome (PCOS) and other problems within the uterus. These problems require proper medical care before obtaining a pregnancy. Otherwise, these health issues may hinder pregnancy anytime during its term period. Generally, the menstruation cycle plays an important role in achieving pregnancy and balancing many hormones. If a woman does not have regular periods means, either she is pregnant or there is the presence of infertility problems in the woman. A part of the brain hypothalamus triggers nearby pituitary glands to discharge hormones, which stimulates the ovaries to produce eggs. Many women suffer from blockages in their fallopian tubes and uterus due to overgrown tissues. These additional tissues need to be removed through surgery first, to obtain ART treatment. Many of these tissue removal surgeries are known as infertility treatments. Infertility in women can be treated by the following treatments most in-demand treatment:

  • Ovulation induction (hormone therapy)
  • Surgery 
  • Assisted Reproductive Technologies (ART) through In Vitro Fertilization (IVF)

In women, the IVF procedure is the most useful and successful treatment to deal with infertility issues and effectively treat them. In IVF treatment, the female partner is injected with certain hormonal injections preparing her body to adapt to pregnancy. Later, fertilizing eggs and sperms outside the body forming an embryo is implanted inside her uterus. A woman has to take extra care to achieve a success rate in pregnancy treatments. A healthy body helps a woman to sustain a pregnancy. However, a chance of miscarriage is reduced by the first trimester of pregnancy. (2)

In this useful article we will be discussing the below questions and analyze the most in-demand treatments for infertility:

ART treatment success rates depend on numerous factors of patients and which type of treatment the patient is considering for their case. The different ART treatment possesses different costs and certain requirements. As per age, the requirement of eggs or sperm and treatment techniques, the prices of these infertility treatments vary. Costs of IUI, IVF, and ICSI also includes a certain number of cycles, which are required as per the success rate. Whereas, the success rate considers the history of pregnancy and some other body factors. (3)

Major treatments, which are useful in treating infertility are mentioned below:

  • IUI Treatment 
  • IVF Treatment 
  • IVF ICSI Treatment  
  • Surrogacy

Intrauterine insemination (IUI):

Intrauterine insemination (IUI) is a primary treatment in ART. Under the high success rate of pregnancy, IUI is suggested by the infertility experts. IUI is a comparatively less expensive treatment than other infertility treatments. Many experts consider IUI treatment for infertility issues in couples depending on the case of the respective couple. When sperms of the male partner have poor motility or less count, then the fertilization of the eggs in a natural manner becomes difficult. In this treatment, semen comprising of sperms are retrieved from man's reproductive parts with a thin needle. With the washing technique, good quality sperms is separated for fertilization. Through a catheter, these good quality sperms are inserted into the woman's vagina. The purpose of the entire process is to give a head start to sperm in reaching the eggs to perform fertilization naturally in fallopian tubes of the woman.

1. When is IUI used?

IUI is likely to be used in the case of low sperm count or less motility. (4) However, IUI is also helpful in certain woman infertility cases:

  • The reason for infertility is unknown.
  • An unreceptive medical condition of cervix or problems with cervical mucus.
  • A scar on the cervical tissues due to past surgeries, which is hindering the ability of the sperm to enter the uterus.
  • Dysfunctioning of female ejaculation.

Generally, problems in women's reproductive organs are either treated with surgery or IVF is suggested. Sometimes, pregnancy is achieved after 3-4 cycles of IUI without moving to IVF treatment. IUI is a less expensive process than any other ART treatment. Below are the few cases where IUI is not suggested:

  • Presence of severe complications in woman's fallopian tubes
  • A history of pelvic infection in a woman
  • A woman with medium to the extreme stage of endometriosis 

Under the intrauterine process, medicines to generate the stimulation of hormones are given to the patient. During this step close monitoring of eggs reaching the maturity stage is observed. IUI procedure has to be performed at the time of ovulation to obtain desired results. Approximately after 24-36 hours, when Leutinizing Hormone (LH) hormone is surged indicating the occurrence of ovulation, IUI is performed. With minimum discomfort process of IUI is completed in the patient. Washed sperms are inserted into the uterus to maximize the possibilities of conception. IUI sometimes involves a small risk of infection or the possibility of multiple birth gestation. The success rate depends upon certain variables like patients age, infertility reason and usage of drugs. Around 20 percent of chances increase in achieving pregnancy if IUI treatment is taken every month till gestation. However, as per statistics, IUI has less success rate in comparison to the IVF procedure. IUI is a simpler and less expensive process than other ART treatments.

IVF Treatment:

If one is seeking for the most effective treatment giving a high success rate, then IVF is the correct treatment to try. Usually In vitro fertilization (IVF) treatment is recommended after the failure of several IUI treatment cycles. IVF depends upon the condition of a patient and what are the factors, which will increase the chances of an IVF treatment. IVF proves to be the most helpful Infertility treatment in case of both male and female. Sometimes, experts combine other infertility treatments with IVF treatment to acquire a high success rate. IVF is a huge concept of treating numerous infertility problems. In fact, in many cases, IVF is directly recommended by the fertility experts knowing that other treatments will be unhelpful. In these cases, skipping other ART treatments saves money and time of the patient.

IVF treatment process:

In IVF procedure, the infertility expert injects the patient with several artificial stimulants. These stimulants balance the hormones of the woman's body and boost other useful hormones to obtain mature eggs. Primarily, medicines to prevent natural ovulation are given to the woman. Then an additional stimulating hormonal injection is given to the woman. These injections indicate the ovaries to produce eggs which are used in the IVF procedure. This step is carefully monitored by the experts so that they can collect the mature eggs from the ovaries. Similar to the IUI procedure, IVF also includes the step where sperms are taken out from male's reproductive parts. The best quality of sperms are separated through the washing technique and injected directly into the egg. The whole process is performed in a special IVF laboratory. The embryo is fertilized outside the body and then inserted into the uterus of the woman. If an embryo implants itself in the endometrium lining of her uterus means pregnancy is successful. (5) 

The best part of the IVF procedure is that it includes several options to boost pregnancy success rates. These procedures are known as ancillary procedures. Looking at the history of past infertility treatments, an IVF doctor may suggest opting for donors to provide eggs, sperms, and even embryos. In some cases, premature eggs are also collected known as the Egg Hatching process. In this process, premature follicles are matured to eggs in the IVF laboratory only. A medical test such as Preimplantation Genetic Diagnosis (PGD) is also performed before IVF treatment in some of the complicated cases of patients. PGD test is performed, when there is a high chance of transmitting genetic diseases to the baby. With the help of the PGD test, the risk of miscarriage and the transferring of genetic diseases is significantly reduced.

IVF definitely provides the best results depending on the case of the patient. In many cases, IVF also fails because of reasons like the age of a woman, choice of fertility centers, and a past history of recurrent miscarriages.

2. How IVF is effective in Infertility?

The best part of IVF treatment is that it includes several options to boost the pregnancy success rate. These procedures are known as an ancillary procedure. Looking at the history of past infertility treatments performed on a patient, an IVF doctor may suggest opting for donors to provide eggs, sperm, and even embryos. In some cases, the most eminent egg hatching technique is used. In this process, premature eggs or premature follicles are accumulated from the ovaries in women. These follicles are developed as matured eggs in an IVF laboratory only.

Ovulation induction is one of the most effective treatments for infertility due to irregular periods depending upon oligomenorrhea and amenorrhea. The basic treatment leads to an increase in the natural chances of conceiving a baby by balancing the hormones only. Major cases like tubal or pelvic infections and damages require surgery first and then consider IVF treatment as a primitive choice to attain pregnancy. IVF treatment is mostly recognized as the most convenient and cost-effective treatment in unknown fertility. Whereas, the male-factor for infertility is dependent on critical diagnoses of sperms. Although, it is reported in many infertile couples that more than ICSI or any other treatment, IVF generates the maximum results and with high as well as minimal success rate couples.

3. How IVF and ICSI work together?

Intracytoplasmic Sperm Injection (ICSI) has restructured infertility treatment by improving the prognosis of an infertile men sperms. ICSI procedure is very helpful in analyzing severe oligospermia, asthenospermia, teratozoospermia, and even azoospermia (no sperm count). In ICSI, sperm are extracted through injection from male's reproductive parts such as epididymis or testis. These sperms are then analyzed and inserted into the vagina of a woman to accomplish a natural process of fertilization. (1)

ICSI is used in a few major fertilization aspects of eggs and sperms:

  • Poor quality of semen 
  • Thick Eggshell (zona)

Under ICSI, eggs are directly injected with sperm in an IVF laboratory. Basically, the formation of an embryo is performed outside the body in a petri dish. In case, a woman's eggs have a thick shell and do not allow the sperms to enter it. These sperms stick to the outer covering of a female egg. Sperms sticking to the outer lining could not pass the shell to fertilize it. Through laser hatching, the thinning of the outer covering of zona is performed. In this case, the success rate is provided to the patient by using treatments like IVF, ICSI, and laser hatching simultaneously. Similarly, ICSI is one of the best ART treatments in achieving success for pregnancy. (6)

Many infertility experts suggest ICSI in the following cases:

  • Insignificant sperm quality and quantity
  • Morphology or irregular shape of sperms
  • During a past IVF cycle, none or very few eggs were fertilized
  • Vasectomy or blockage which hinders the sperm in an ejaculation
  • If frozen sperm is not of good quality to fertilize an egg
  • Genetic testing of an embryo and sperm sticking to the outer lining of the eggs

If the reason behind the failure of an IVF cycle is a poor quality of sperm, then ICSI treatment will be unhelpful. ICSI procedure provides high success rate in the fertilization procedure. ICSI itself it is very successful in helping sperms and eggs in fertilization. However, similar to IVF there are exceptions to ICSI also like the age of the woman and the history of pregnancy in the couple reduces its success rate. (7)

4. Surrogacy, the final option to have a baby:

In surrogacy, an embryo is implanted in the body of a surrogate or a child carrier. When a woman is incapable of bearing a child in her womb or male infertility is prominent, then with the help of donor surrogacy is opted. Surrogacy is the final option under ART to have a baby. An IVF expert advises surrogacy in the following specific cases:

  • A woman with hysteroscopy or a missing part in her uterus.
  • A woman with a certain health condition, which disables her to carry a pregnancy.
  • A couple of the same sex who wants to have an infant by using sperms from either of the 2 partners.
  • A man who wants to have a baby with his sperm who is single and does not want to get married.
  • A man whose partner is deceased who had her embryos frozen at the time of IVF procedure can go for surrogacy to have a baby.

The surrogacy procedure involves many legal, medical, and emotional complexities. This is a chance for infertile couples, who are unable to have a pregnancy. It is the most expensive treatment out of all ART treatment but gives a significant success rate.

As per research despite the widespread sex education and reproductive awareness in people, many women are still incapable of understanding the way their body works. In New Zealand, it showed that approximately 74 percent of women heading to an infertility clinic possess an inadequate infertility awareness. Due to the upgraded lifestyle, it is seen in many surveys that the age of a woman being pregnant has changed from the 30s to 40s. In these cases sometimes it becomes difficult for infertility treatment to give proficient success results. (8)

It is known that young couples have a high success rate in achieving pregnancy than old couples. When a woman wants to get pregnant, it becomes essential for her to maintain a healthy lifestyle. A healthy body adapts fertility treatment much faster than an overweight body with an unhealthy diet. Also, if a woman does not have any problem in her reproductive organs, then it becomes easy to get positive results with the minimum number of infertility treatment. Repeating the same IUI cycle for a few months is still inexpensive for a couple with a high success rate rather than moving to another ART treatment called IVF procedure. The success of an IVF treatment majorly depends on costs and success rate of infertility treatment. Usually, couples with low success rates are considered for IVF treatment. One thorough research will help them find a well-known fertility center with a high number of success rates. IVF treatment has a wide variety of other sub-treatments, which helps in attaining pregnancy in maximum cases. When nothing works, then surrogacy is the last option provided to the couple to have a baby.

Written by

Dr. Neha Gupta

MS, MBBS, DNB, MRCOG
Infertility Specialist, IVF Specialist
Gurgaon
Dr. Neha Gupta is an Obstetrician and Gynaecologist in Gurgaon. She has been practicing for many years now. Her rich experience in Normal Vaginal Delivery, Intrauterine Insemination (IUI), In-Vitro Fertilization (IVF), Hysterectomy and Tubectomy makes her the most preferred names in Gurgaon. She has acquired MBBS in 2004, DNB from National Board of Examinations in 2009 and MS - Obstetrics and Gynaecology from Maulana Azad Medical College in 2009. She is a member of the Royal College of Obstetricians and Gynaecologists, London. Dr. Neha Gupta has an expertise in Intrauterine Insemination and is practicing at Fortis Memorial Research Institute in Gurgaon. You can get the contact details of Dr. Neha Gupta at elawoman.com
 

SOURCES AND REFERENCES:

  1. ^ Outcome of Assisted Reproductive Techniques among Couples Ncbi.nlm.nih.gov, 21 May 2019
  2. ^ Causes of Female Infertility Nichd.nih.gov, 21 May 2019
  3. ^ Assisted Reproductive Technology - Cdc.gov, 21 May 2019
  4. ^ Intrauterine Insemination - American Pregnancy Americanpregnancy.org, 21 May 2019
  5. ^ What is IVF - Planned Parenthood Plannedparenthood.org, 21 May 2019
  6. ^ IVF treatment - Business Standard Business-standard.com, 21 May 2019
  7. ^ Intracytoplasmic sperm injection Hfea.gov.uk, 21 May 2019
  8. ^ Top doc reveals 8 fertility misconceptions Cnn.com, 21 May 2019
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5 Comments

Chitra Rao

You can really go for these treatments to kill infertility problems. For the required information regarding IVF clinics and doctors, you can choose Ela.

Oct. 4, 2018, 6:59 p.m. 5.0

Banira Chawla

GIFT and ZIFT are the new technology I came to know about in this article. It was fun reading it. Thanks for sharing!

Sept. 28, 2018, 4:47 p.m. 5.0

Lalita Koirala

Medical science has really evolved in the field of fertility treatments. The treatment looks effective and convenient to the needed couples.

Sept. 3, 2018, 1:15 p.m. 5.0

Shrabani Saha

There are several cases where ICSI is recommended. Your doctor may ask for the treatment if the male partner has a very low sperm count or higher percentage of abnormally shaped or slow sperm. Males having issues with erection and ejaculation due to spinal cord injuries or diabetes, can also go for…

Nov. 1, 2017, 3:46 p.m. 4.5

Varsha Gautam

I know that IVF is an intricate and costly procedure and I have read somewhere that just around 5% of couples with infertility issues search it out.

Nov. 1, 2017, 3:41 p.m. 5.0

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