Fertility management

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The first thing to say about management of fertility problems is that if there is a cause, (e.g. PCOS) treat it. There are, four main treatments for infertility and they are outlined below.

Intrauterine Insemination (IUI)

Essentially, they put sperm directly into the uterus. Don't really know how else to describe it. If infertility is unexplained, due to low semen volume, otherwise rubbish sperm or a reaction between the cervical mucus and the sperm.

Gamete Intrafallopian Transfer (GIFT)

The oocytes are taken out of the ovary and then they do some magic to them. Well, they mix the recovered oocyte with sperm. After giving it all a good shake, the bag of fun that contains semen-ooctye mixture is transferred into one or both Fallopian tubes (the mixture rather than the bag - the latter would be incredibly painful). Slightly more complicated than IUI but it has different indications.

Can be used in unexplained infertility but also anovulation (obviously, you need to stimulate ovulation first), sperm-cervical mucus interaction or female autoimmune infertility.

In-vitro Fertilisation (IVF)

There are five basic bits of IVF:

  1. Ovarian stimulation: if this is necessary (i.e. part of the problem is they're not ovulating), clomiphene is used. This is an anti-oestrogen - as the levels of oestrogen drop FSH and LH start to rise eventually causing ovulation
  2. Egg retrieval: the eggs are taken from the ovaries and put in some fine China. Well, they'll actually put in a test tube. (In vitro is Latin for in glass. Clever, eh? No? Oh, just shut up and read the next bit.)
  3. Fertilisation: the sperm is put in the fine China with the oocyte and they leave it for a while to inseminate.
  4. Selection: they then decide which embryos look the most likely to get babies from.
  5. Embryo transfer: these embryos are put into uterus. Only 2 embryos can be used in women <40 years old and 3 in those >40. Really, if you want a baby, have it before you're forty.

How many free attempts you get at IVF is dependent on which trust hospital you're in. After that, you have to pay. It's £1732 in Australia, apparently. If anybody could find out the rates in Iran, that'd be useful as there's a 100% chance it's on the syllabus.

Intracytoplasmic Sperm Injection

ICSI, mothertruckers!

At the "fertilisation" stage of the IVF, a single sperm is directly injected into the ovum to produce an embryo. They're the cool pictures you see a lot, kind of like the one on the right. After his, IVF continues as outlined above.