There are several potent injectable hormonal drugs that cause superovulation—the stimulating of several follicles in the ovary during the same cycle. They are used in preparation for IVF, but they can also be effective for women who don’t ovulate and for those with unexplained infertility. These medications include genetically engineered versions of FSH (Gonal-F and Follistim), and a combination of LH and FSH called Repronex which is made from the urine of menopausal women. Since the drugs “override” the natural hormonal messages from the pituitary gland and reproductive organs, they must be combined with other hormonal drugs such as hCG (a form of LH that triggers ovulation) and natural progesterone to stimulate the growth of the uterine lining. The injections are given for seven to 12 days, and the follicles are carefully monitored with ultrasound to help reduce the odds of multiple births
Surgical Repair for Women:
“Tubal ligation [‘tube-tying’ to prevent pregnancy] can be successfully reversed with laparoscopy in almost all cases,” says Dr. Silber. Laparoscopy—done in the hospital under anesthesia—involves inserting a narrow tube containing a tiny video camera through a small incision in the abdomen. Once the surgeon has examined the pelvic organs, additional small incisions are made so surgical instruments can remove the scar tissue. “Laparoscopy can also remove ovarian cysts,” adds Dr. Stadtmauer. However, if the tubes are blocked by natural causes such as scarring from surgery or past infection, laparoscopy is only about 15 percent effective. In these cases, IVF is the best option.
Surgical Repair for Men:
“Vasectomy [male surgical sterilization] can also be reversed with microsurgery, which succeeds 90 percent of the time,” says Dr. Silber. Microsurgery can also be used to remove blockages of the epididymis (the long tube connecting the testicles and sperm duct).
Fertility Tests for Men
Semen Analysis or Sperm Count
“This is the single most important test for men,” says Dr. Silber. It detects the number of sperm, the motility (speed and quality of the movement) and the shape. Ironically, a low number is less important than good motility and shape. The test also measures the total volume of semen (the fluid containing the sperm). A very low volume can indicate a reproductive tract blockage, while a high volume can signal an infection.
This test, to detect STDs or other harmful organisms, is also recommended.
Super-Tech Ways to Conceive
The Future is Here
If you’ve made it to this point and still aren’t pregnant, it may be time to harness the vast powers of high-tech medicine to help you. These are the techniques that make the news, and the techniques that are helping more and more couples to become pregnant.
An adjunct to in vitro fertilization, PGD (pre-implantation genetic diagnosis) allows embryos to be tested for genetic problems before they are implanted. The technique is usually offered to women over 35, and to couples who know they carry the gene for a specific disorder. New advances in PGD are helping to identify the best embryos to implant in any couple undergoing IVF.
Ovarian Tissue Freezing and Egg Freezing:
These new treatments are still being researched for women whose ovaries must be removed after a diagnosis of cancer, or whose eggs may be damaged or destroyed by cancer treatments such as chemotherapy and radiation. “Although ovarian tissue freezing has proven successful, it is considered too drastic for healthy women at this point,” says Dr. Silber. Egg freezing is still in the experimental stage.
In Vitro Maturation of Immature Eggs:
This experimental technique for women with polycystic ovaries—who produce multiple immature eggs in a single cycle—is currently being attempted at The Jones Reproductive Institute at Eastern Virginia Medical School. “If the technology and success rate improve, it will be the first technique that makes IVF possible without fertility drugs,” says Dr. Stadtmauer.
In Vitro Fertilization:
IVF is the treatment of choice—and the final fertility treatment option—for a variety of patients, including women with total fallopian tube blockage. It leads to childbirth in about 30 percent of cases. In IVF, the follicles are stimulated with superovulation drugs, but the eggs are retrieved from the ovaries before ovulation so they can be joined with sperm in a lab dish. To reduce the chances of multiple births, most doctors today transfer only two embryos into the uterus at a time; the rest can be frozen.
Intracytoplasmic Sperm Injection:
An adjunct to IVF, ICSI can help men with extremely low or even zero sperm count to become fathers. In this technique, doctors retrieve a single sperm from testicular or epididymal tissue and then microsurgically inject it into the egg.