The following processes of Assisted Reproductive Technology are not necessary for every couple. A proper evaluation should be conducted by the specialist to ensure that the most efficient and cost effective procedure is used to help the couple become pregnant. Each individual is different.
Assisted Reproductive Technologies (ARTs) now go beyond in vitro fertilisation (IVF) and intracytoplasmic sperm injection. In Nigeria there are a number of clinics giving these services.
Patient preparation and counseling
Good infertility clinics recognise that dealing with infertility or high risk pregnancy can be very stressful. Patient preparation and counseling services were established to provide a range of mental health services to patients needing emotional support and guidance during difficult times. It includes a thorough evaluation of a detailed questionnaire, which has been prepared to bring all the possible factors that could cause infertility in couples. Patients are made to realise that they are not alone with their problem.
Endocrine management of infertility
The evaluation of the endocrine panels and the treatment of any abnormal hormone is very helpful in some cases of infertility.
The male sperm is thoroughly evaluated for its fertility potential.
Sperm improvement technique
Several methods are available for the improvement of sperm to facilitate fertilisation.
The fact that many patients find it difficult to ovulate create a need for giving additional hormones to such patients to increase ovulation. A good number of patients would become pregnant after intercourse at ovulation without any additional procedure. Some would require other procedure such as Artificial Insemination.
A number of patients become pregnant with intensive cycle monitoring and super ovulation with the gonatrophins as well as intrauterine insemination or fallopian tube sperm perfusion,
In Vitro fertilisation (IVF)
In IVF, the female is inseminated with approximately 3 drops of sperm solution from the male partner. Usually the patient is given fertility drugs to increase the number of eggs that are produced at ovulation. The eggs are isolated from the aspirated follicle and allowed to rest in the incubator for a while before insemination. The inseminated eggs are kept in the incubator in the IVF laboratory for about 3 days. The fertilised embryo will rapidly divide into the 2-cell,4-cell and 8-cell stages at which point about 3 or 4 good embryos are selected and transferred into the uterus through the cervix. IVF is a good treatment option when the fallopian tubes are blocked or in endometriosis and when the male partner has low sperm count.
In some couples, fertilisation during IVF does not come easily. Consequently, there are several techniques that would ensure fertilisation based on the laboratory assessments of the sperm and egg. They include high concentration sperm insemination, micro-drop insemination, media enhancements and more.
Several culture techniques have been developed to ensure that fertilisation takes place in an IVF laboratory. There are also several gamete manipulations that can be utilised for the fertilisation process. They include embryo development with a blastocyst culture and cytoplasmic transfer.
Micro Manipulation (ICSI)
When the infertility in the couple is due to very low sperm count, the technique of intracytoplasmic sperm injection provides a solution to getting pregnant. Under a very specialised microscope one sperm cell is aspirated from the very few ones, and it is injected directly into the egg cytoplasm. This ensures fertilisation in significantly high numbers.
Assisted development/assisted hatching
The procedure is usually reserved for patients over the age of 38, as well as patients with prior unsuccessful IVF attempts. Patients in this category would normally produce eggs at stimulation in IVF cycle and could have some embryos transferred at the 4-cell or 8-cell stages. However, they would not get pregnant after the transfer. This is because the embryos will stop dividing at this stage as it has refused to hatch.
Using micromanipulation techniques enables the doctor to drill a small hole in the zona pellucid lining. Now, the embryo that would originally have ceased to grow at the hatching stage has a better chance of further development in the uterus. There are a number of patients who are able to carry their pregnancies to term by using this procedure.
Cryopreservation of oocytes and embryos
The excess embryos can be preserved for years by freezing the embryos in straws and then storing them in liquid nitrogen tanks. They can be thawed when needed.
Pre-Implantation Genetic Diagnosis
Patients who have genetic disorders like sickle cell can now have the disease gene eliminated from the children at conception. When embryos are fertilised, the process of pre-implantation genetic diagnosis can eliminate genetic disorders. One or two blastomeres can be removed from the fertilised embryos. The technique of Fluorescence In-Situ Hybridisation (FISH) is employed to analyze the chromosomal abnormalities, while another technique, the Polymerase Chain Reacting is used to detect sickle gene disorder. Simply put, a couple with genotype HbAS would expect to have offspring with AS, SS, and AA. With PGD we can select just the AA embryos for insemination, thereby producing AA babies.
Transplantation and cryopreservation of ovarian tissue
This is still one of the areas that is still under research. Some clinics now freeze the ovaries for patients who need to undergo radiotherapy or chemotherapy. Once they have finished treatment they can have the ovarian tissues grafts transplanted and then conceive if they wish.
Oocyte and embryo donation
This procedure is available for patients with premature ovarian failure. Many clinics encourage a number of their successful patients to donate their embryos. Some also have the embryo polling association where patients join to help each other for such assistance.
Uterine receptivity and embryo transfer
One of the areas that some ART clinics have made significant change in pregnancy rate is the devotion to the problem of implantation defects and uterine receptivity. Patients are evaluated to ensure that they eliminate several implantation defects, increase the receptivity of the uterus for the embryos and support the early phase of placental development.
In the last decade the American Society for Reproductive Medicine, and the European Society for Human Reproduction and Embryology; have witnessed scientific presentations and publications on the beneficial effect of holistic medicine, detoxification, acupuncture and the use of orthomolecular supplements (like vitamins and minerals) in improving fertility or increasing success rate in IVF. Consequently some IVF centers in USA like San Francisco, New York and in London as well and the MART center in Lagos and added the use of this type of therapy to their IVF unit to improve the success rate. This process in our own experience have shown a highly significant correlation between food intolerance, environmental stressors such as oil fumes, petrochemicals and heavy metals such as mercury and arsenic from fish eating with the elevated level of some blood immunoglobulins such as IgE and IgG with the attendant infertility. We discovered that once the patients go through a 7-10 days Mayr therapy their pregnancy rate is enhanced.