INTRA-UTERINE INSEMMINATION AND GONADOTROPHIN THERAPY

This is an infertility treatment suitable for couples with:-

1. Unexplained infertility
2. Mild male factor problems
3. Immunological infertility
4. Cervical factor infertility
5. Some forms of sexual dysfunctions

Techniques of Treatment

1. The female partner will be given fertility treatment to ensure that she has at least 2 or 3 really good eggs. This comprises:

a) clomiphene tablets 50-100 mg daily for 5 day and,/or
b) gonadotropin injections

2 Ultrasound scans are performed to ensure that the response of the ovaries is adequate

3 Provided that the follicles are of appropriate size, an injection of HCG (10,000 units) will be given by intramuscular injection This injection causes maturation of the follicles and ovulation.

4 24-36 hours later, the male partner will be asked to provide a sample of seminal fluid which will be prepared by a special technique, to select out the healthiest and strongest swimming sperm.

5 The specially prepared semen sample will then be gently injected, using a very fine plastic tube, through the cervix (mouth of the uterus), into the upper part of the uterus, close to the opening of the tubes. This procedure does not require any anaesthetic and causes minimal discomfort.

6 This sperm will swim along the tube to meet the eggs, and hopefully fertilisation of one or more of the eggs will occur.

7 The fertilized eggs then travel back along the tube and into the uterus. Hopefully implantation will occur, leading to pregnancy.

Risks and Side-Effects

The use of fertility injections is associated with a small risk of causing too many follicles to grow (hyperstimulation). This may result either in multiple pregnancy, or in a condition called Ovarian Hyperstimulation Syndrome (OHSS).

With OHSS the ovaries become swollen, form cysts and very rarely, the women may become very ill. In an attempt to minimise the risks of causing these problems, it is usual to begin treatment with a low dose of gonadotrophin therapy and always to count and measure the follicles before giving the HCG (egg releasing) injection. If the scan suggests that there may be too many very large follicles, the HCG injection will NOT be given and you will be advised not to have sexual intercourse.

Contra-Indications

This treatment is not suitable for couples who are infertile due to:

a) damage or blockage of the fallopian tubes
b) severe male factor problems (very low sperm counts)
c) significant endometriosis

This form of treatment will not be effective if :

a) there are not enough good quality eggs in the ovaries
b) if there are any adhesions which may cause the eggs to be trapped
c) if the fimbrial ends of the tubes are damages and are therefore unable to collect the eggs after ovulation
d) if there is any significant damage to the tubes so that sperms and eggs cannot travel freely along the tubes
e) if the sperm are very weak, and either not strong enough to swim along the tube to meet the eggs, or are not strong enough to burrow their way through the outer covering of the egg in order to bring about fertilisation.

In all these cases other forms of Assisted Reproduction would be the treatment of choice.

Success Rates

1. 1 pregnancy out of every 9 treatment cycles.
2. It is usually offered for 3-6 treatment cycles. If you fail to become pregnant within the first 6 attempts, the likelihood of becoming pregnant if you continue treatment, is very small, and should then go ahead with other forms of Assisted Reproductive Techniques. (ART)

OTHER OPTIONS ?

IUI ? IVF ? GIFT ? ICSI ? Blastocyst Transfer ? Assisted Hatching? PGD ? Adoption ? DI ?