Infertility And Reproduction
What is Infertility?
Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.
Factors involved in infertility:
There are three main factors involved in infertility of a couple, male sperm, female eggs, female uterus. For a normal pregnancy these three factors should be available so that a couple may be able to conceive.
The first factor which is mostly evaluated in infertility is male sperm. Male sperm itself has many factors like amount of the sperm, motility of the sperm and morphology or general appearance of the sperm. Motility itself is divided in three categories, one is motility type “A” also known as rapid progressive sperms, its amount should be at least 20%. Second category is motility type “B” which is progressive and third type is motility type “C” which are non-progressive but alive. For a normal pregnancy A+B = 40% is needed. The minimal amount needed for normal pregnancy is 20 million sperms per ejaculation. Another factor is the morphology of the sperm which means the physical appearance of the sperm, for example the head and tail of the sperm should be normal and the normal morphological sperms should be at least 50%.
Another important factor involve in fertility is the female eggs amount and quality, both these factors are needed for normal pregnancy. By birth a female has fixed amount of eggs and after the age of 14 or 15 the maturation of eggs starts and in every cycle or menses a fixed amount of eggs become matured and are released. With the passage of time the amount of eggs decreases and after the age of 35 till 38 a female does not have appropriate amount of eggs or good quality eggs for normal pregnancy. Another factor is the uterus of the female, for a normal pregnancy the uterus should be of normal size and shape and free of any disease.
If a couple gets married and the female does not becomes pregnant after 12 months of regular unprotected intercourse we do some primary evaluations both for male and female. Which are as follow.
- A male should do a sperm analysis test, the sample should be provided maximum 3 days after the last ejaculation.
- A female should do hysterosalpingography (HSG) for the evaluation of the fallopian tubes and the uterine cavity as well. Hysterosalpingography is a simple radiology procedure in which a contrast media is injected inside the uterus through vagina and the x-ray images are taken. It should be noted that HSG should be done on eighth or ninth day of the menstrual cycle, exactly on the day when bleeding stops. HSG shows the anatomy of the fallopian tubes and the inside cavity of the uterus. If the fallopian tubes are blocked or are suffering from hydrosalpinx they can easily be evaluated by HSG and further treatment is advised depending on the condition. If a female is suffering from hydrosalpinx before I.VF. the tubes should be ligated through laparoscopy. If any irregularity is seen in the HSG the second step is hysteroscopy which is diagnostic and interventional as well. Before doing any procedure for fertility the uterus should be free of fibroids or septations and should be of normal size.
- The lab tests which a female should do before starting any treatment are LH, FSH, PROLACTIN, TSH and AMH ( anti mullerian hormone). Remember that these tests should be done on third day of the menstrual cycle. After completing these tests the file is sent to us and depending on conditions our infertility team takes decision that which procedure is appropriate for the couple.
WHAT SERVICES WE PROVIDE FOR AN INFERTILE COUPLE:
Our infertility center provide almost every facility which is present in any country of the world like advanced laparoscopy, hysteroscopy, I.V.F (in vitro fertilization), IUI ( in uterus insemination), ZIFT, PGD ( pre implantation genetic diagnoses).
WHAT IS IVF?
I.V.F is an abbreviation for in vitro fertilization. I.V.F is good for couple whose sperm count or motility is not good or the female eggs are not maturing because of any disease or are having any other problem. In this procedure a female uses certain types of injections for at least one month and then come to the infertility center on the exact day mentioned by the doctor. On the first day a transvaginal sonography is done to evaluate the general conditions of the eggs, then after 2 or 3 days the female undergoes a minor operation under mild general anesthesia known as EGG PUNCTURE. Through the vagina a probe is entered and the eggs are retrieved and kept in particular incubators, on the same day male sperms are taken and after washing and separating the good quality sperms, the sperms are injected in the cytoplasm of the eggs through an advanced machine. The fertilized eggs are then kept in incubator for three days and after three days the best embryos are selected and transferred to the uterus of the female without any anesthesia. The embryos which are remained are frozen for the couple and can be kept for hundreds of years and any time they can use the embryos again.
WHAT IS IUI?
IUI is an abbreviation for intra uterine insemination, this procedure is mostly used for the couples who are having problem in sperm amount and motility. In this procedure the good sperms are separated and then through a probe they are transferred to the uterus of the female.
WHAT IS PGD?
PGD is abbreviation for pre implantation genetic diagnoses, it is one of the most advanced techniques in genetics. PGD is mostly used for gender selection, if a couple wants a girl, through this procedure the female embryos are separated and transferred to the uterus and if they want a boy the male embryos are separated and transferred to the uterus. Another important aspect of PGD is the detection of different genetics diseases like turner syndrome, down syndrome and many other trizomies. So after doing PGD there is no danger of any genetic disease.
WHAT IF A FEMALE DOES NOT HAS EGGS?
There are certain conditions that the female does not has eggs herself, it can either be an age factor or may be because of any gynecologic or hormonal disorder so for such couples we provide EGG DONOR. Egg donor is a person who donates her eggs to the couple and then the eggs are fertilized with the sperms of the husband and transferred to the uterus of the mother not the egg donor. Before selection of egg donor they are evaluated by the medical team and certain specialized tests are done. A patient can even see the picture of her donor and can select donor by her own choice but because of ethical issues the patient is not allowed to meet the donor.
WHAT IF A MALE DOES NOT HAVE SPERM?
There are certain couple who are suffering from infertility because of the male factor like azospermia, azospermia is a condition in which there are no sperms even there are no spermatoids, for such couple we provide embryos from another couple who are willing to donate or if the couple accepts, sperm donation is also available.
WHAT IF THE MALE HAS SPERMATOIDS BUT NOT SPERMS?
Sometimes a male does not have sperm for the normal pregnancy but we have facility of testicular biopsy through which we can get even a single spermatoid if available and also for the patients who are paraplegic or quadriplegic.
WHAT IF A FEMALE UTERUS IS NOT APPROPRIATE FOR PREGNANCY?
There are many cases that both the sperm and eggs are perfect for natural pregnancy but the because of any reason the female uterus is not suitable for pregnancy. In such cases we advise SURROGATE MOTHER, Surrogate mother is a female who is legally hired for the couple and after doing IVF the embryo is transfer to the uterus of the surrogate mother, she carries the baby for nine months and on the day of delivery the child is given to their biologic parents, I would like to mention that it is completely legal in Iran and there is no worry that the surrogate mother will not handle over the child because before starting the procedure and affidavit is written in the court.
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