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Fertility Treatment

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Fertility Treatment

Generally speaking, infertility can be defined as the inability to get pregnant after a year or more of regular unprotected intercourse. There are two types of infertility: primary and secondary.

Primary infertility describes couples who have never been pregnant before and are unable to conceive after at least a year of having intercourse.

Secondary infertility describes couples who have previously been able to conceive (ectopic pregnancy and termination of pregnancy included) but are now unable to do so despite a year or more of unprotected sex.

Causes of infertility

Many factors can lead to infertility or reduce fertility overall in men and women. In 25% of the cases, a reason cannot be determined for the couples' inability to conceive.

Causes of infertility in men

Many factors need to work correctly to ensure sperm production and efficient delivery of the male reproductive cells into the vagina. Issues that hinder this process can be classified into three categories: pre-testicular, testicular, and post-testicular:

  1. Pre-testicular problems are typically systemic illnesses that disrupt the Hypothalamic-Pituitary-Gonadal (HPG) axis.

  2. Testicular issues refer to problems with sperm production or storage. They include genetic conditions such as Klinefelter syndrome (XXY), where the individual's cells have an extra copy of the X chromosomes and are unable to produce sperms. Another condition that can be placed under the testicular class of infertility is when the testicles fail to descend into the scrotum in the fetal period, also called cryptorchidism.

  3. Post-testicular problems describe issues with sperm delivery. These include issues such as sterilization and erectile dysfunction.

Causes of infertility in women

Factors affecting fertility in women are classified into three main categories: ovulatory disorders, disorders of the uterus, and fallopian tube damage:

  1. Ovulatory disorders include issues that disrupt the HPG axis and the release of reproductive hormones. Examples include polycystic ovarian syndrome (PCOS) and premature menopause (menopause before the age of 40).

  2. Disorders of the uterus relate to physical reasons in the uterus that prevent the implantation of the embryo. They include conditions such as scarring after surgery and uterine fibroids.

  3. Fallopian tube damage relates to conditions that specifically affect the uterine tubes and, hence, disrupt the transport of the egg cell from the ovaries to the uterus.

Polycystic ovarian syndrome (PCOS) is a disorder in which the ovaries generate an abnormally large quantity of androgens (male sex hormones) or oestrogen, disturbing the HPG axis and resulti in irregular and infrequent ovulation.

Fertility treatment, meaning and process

Fertility treatment refers to any type of therapy or medical procedure that increases a couple's chances of successfully becoming pregnant and conceiving a child.

Fertility treatments can be categorized into three main types: hormone therapy, surgical procedures, and assisted conception.

Hormones to Treat Infertility

Extrinsic hormones or antihormone drugs can be used to treat infertility, especially when a woman is not generating enough eggs. This is often due to the anterior pituitary not secreting enough follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to promote egg maturation and release.

Clomiphene is an estrogen-blocking medication that works by removing the negative feedback of oestrogen on the hypothalamus and anterior pituitary. As a result of clomiphene, these glands can release more hormones such as GnRH (gonadotropin-releasing hormone), FSH, and LH. Alternatively, these hormones (FSH and GnRH) can be directly injected to trigger the development of eggs in the ovaries.

A key issue to consider with these types of hormone therapies is that several eggs can be released at the same time, which would increase the likelihood of having twins or triplets.

Surgical procedures

Several surgical techniques may be performed to evaluate reproductive issues and assist with fertility. In women, major surgical procedures that are used to improve fertility include the surgical opening of blocked or scarred fallopian tubes to allow egg release and the surgical removal of ovarian cysts in PCOS.

In men, surgical procedures can also be used to improve fertility in some cases. Surgical extraction of sperm is a viable option for those men who have obstructions preventing the release of sperm or those who would like to reverse their vasectomy.

Vasectomy is a surgical method of sterilization in which the sperm tubes are severed or tied, preventing sperm cells from entering the penis and being released in the semen.

Assisted conception

The use of medical interventions other than hormone medicines or surgery alone to help couples conceive and have a child is known as assisted conception. Artificial insemination and in vitro fertilization (IVF) are two of the most known assisted conception treatments.

Artificial insemination

Artificial insemination, also referred to as intrauterine insemination, is a procedure that involves delivering sperms into the uterus via a tiny plastic tube that is inserted through the vagina and the cervix. For this procedure, sperm is collected and only the top quality and the quickest sperm cells are chosen.

In vitro fertilization (IVF)

IVF is the process of fertilizing an egg outside the body ('in vitro' means 'in glass'). This is especially useful when both male and female counterparts have fertility problems. Reproductive hormones FSH and LH are injected into the mother to stimulate her ovaries to produce more eggs than normal. The eggs are then extracted from the ovaries, and the father's sperm is used to fertilize the eggs in a laboratory.

The fertilization of the egg cell by a sperm cell results in a zygote. The zygote is the first cell of the developing embryo, which starts to quickly divide by mitosis. The resulting initial cells are called blastomeres, which form a ball of cells termed morula at this stage. Several of these embryos are then artificially implanted in the uterus. The implantation of a single injected embryo yields a very low success rate, so implanting numerous ones raises the likelihood of at least one of them being successful.

According to the current UK national guidelines, IVF can be provided under the NHS to women under the age of 43 who have been attempting to conceive for two years using frequent unprotected intercourse or have had 12 rounds of artificial insemination.

Advantages and disadvantages of fertility treatment

There are advantages of fertility treatment, as it can provide couples with the opportunity to successfully conceive and have their own child. However, there are also disadvantages of fertility treatment as it comes with some serious potential issues that need to be considered.

Firstly, fertility treatments such as hormone therapy and IVF increase the chances of multiple embryos being implanted in the uterus. As a result, couples have to be financially and socially prepared for the possibility of having twins or triplets. Furthermore, the success rate of some treatment options such as IVF is relatively low, and IVF failure can have an emotional and psychological toll on couples.

During the IVF procedure, more embryos can be developed than are ultimately used. Who owns these embryos, and whether it's ethical to use them for research if they were going to be destroyed in the first place, are difficult and often controversial questions.

Stem cell research is, for example, one of the scientific research fields that could greatly benefit from access to these embryos due to the presence of human embryonic stem cells (ES cells) in early-stage embryos. ES cell clinical research could have massive implications in regenerative medicine, but many would argue that it's unethical to use spare cells from embryos to help cure others. If you want to learn more about ES cells, check out our article on Stem Cells!

The use of genetic testing on embryos is also ethically debatable, since it could potentially be exploited by couples who may want to be able to choose embryos with certain desirable genetic traits. For example, a couple of may want to have a boy if they already have many girls. Such influence and manipulation remain controversial topics.

Fertility Treatment - Key takeaways

  • Infertility can be defined as the inability to get pregnant after a year or more of regular unprotected intercourse.
  • Fertility treatment refers to any type of therapy or medical procedure that increases a couple's chances of successfully conceiving a child and becoming pregnant. There are three types of fertility treatment: hormone treatments, surgical procedures, and assisted conception (IVF and artificial insemination).
  • Fertility treatment has some disadvantages that need to be considered, such as the low success rate of IVF.

Frequently Asked Questions about Fertility Treatment

Fertility treatment refers to any type of therapy or medical procedure that increases a couple's chances of successfully conceiving a child and becoming pregnant.


Fertility treatments can be categorized into three main types: hormone therapy, surgical procedures, and assisted conception. 

The first step is to book an appointment with your doctor. In the first consultation, the doctor will ask questions in order to identify the underlying cause of subfertility and determine what type of treatment is best suitable. 

Extrinsic hormones or antihormone drugs can be used to treat infertility, especially when the female is not generating enough eggs. This is often due to the anterior pituitary not secreting enough follicle-stimulating hormone (FSH) and luteinising hormone (LH) to promote egg maturation and release. Alternatively, hormones such as FSh and GnRH can be direcly injected to trigger the development of eggs in the ovaries. 

The four types of fertility treatment are hormone therapy, surgical procedures, artificial insemination, and in vitro fertilisation (IVF)

Final Fertility Treatment Quiz

Question

What is infertility? 

Show answer

Answer

infertility can be defined as the inability to get pregnant after a year or more of regular unprotected intercourse. 

Show question

Question

what are the types of infertility?

Show answer

Answer

There are two types of infertility: primary and secondary. 

Show question

Question

What factors can lead to infertility in men?

Show answer

Answer

Kilenfelter syndrome (XXY) , sterilisation and erectile dysfunction  

Show question

Question

What factors can lead to infertility in women? 

Show answer

Answer

Ovulatory disorder, Fallopian tube damage, and Disorders of the uterus 


Show question

Question

What is PCOS? 

Show answer

Answer

Polycystic ovarian syndrome (PCOS) is a disorder in which the ovaries generate an abnormally large quantity of androgens, male sex hormones, or eostrogen that disturb the HPG axis and result in irregular and infrequent ovulation.  

Show question

Question

What is fertility treatmen?

Show answer

Answer

Fertility treatment refers to any type of therapy or medical procedure that increases a couple's chances of successfully conceiving a child and becoming pregnant. 

Show question

Question

What are the types of fertility treatment?

Show answer

Answer

Fertility treatments can be categorized into three main types: Hormone therapy, surgical procedures, and assisted conception.  

Show question

Question

How hormones can be used to improve fertility?

Show answer

Answer

Extrinsic hormones or anti hormone drugs can be used to treat infertility, especially when the female is not generating enough eggs. This is often due to the anterior pituatry not secreting enough follicle stimulating hormone (FSH) and leutenising hormone (LH) to promote egg maturation and release.  

Show question

Question

What issue should be considered with regards to hormones to treat infertility? 

Show answer

Answer

several eggs can be released at the same time which would increase the likelihood of having twins or triplets. 

Show question

Question

How can surgical procedures be used to improve fertility in women?

Show answer

Answer

In women, major surgical procedures that are used to improve fertility include the surgical opening of blocked or scarred fallopian tubes to allow eggs to be released, and surgical removal of ovarian cysts in PCOS.  

Show question

Question

How can surgical procedures be used to improve fertility in men? 

Show answer

Answer

Surgical procedures in some cases can be used to improve fertility in men as well. Surgical extraction of sperm is a viable option for those who have obstruction preventing the release of sperm or those who would like to reverse their vasectomy.  

Show question

Question

What is assisted conception and what are the two main methods it includes?

Show answer

Answer

The use of medical interventions other than hormone medicines or surgery alone to help couples concieve and have a child is known as assisted conception. Artificial insemination and in vitro fertilisation (IVF) are two of these methods.


Show question

Question

What is artificial insemination?

Show answer

Answer

a procedure that involves delivering sperms into the uterus via a tiny plastic tube that is inserted through the vagina and the cervix. For this procedure, sperms are collected and only the top quality and the quickest ones are chosen. 


Show question

Question

What is IVF?

Show answer

Answer

IVF is the process of fertilising an egg outside of the body ('in vitro' means 'in glass'). 

Show question

Question

Why does the mother need to receive FSH and LH injections for IVF?

Show answer

Answer

for the purpose of stimulating her ovaries to produce more eggs than normal so they can be extracted from the ovaries 

Show question

Question

Why is the use of genetic testing during IVF debatable?

Show answer

Answer

The use of genetic testing is also ethically debatable since it can potentially be exploited to by couples since they may be able to choose embryos with certain desirable genetic traits. For example, a couple may want to have a boy if they already have have many girls. 

Show question

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