Fertility Treatment and Success Rates
In industrialised countries about 15% of couples are childless, inadvertently. This figure is expected to increase over the next few years due to the decreases in fertility amongst both men and women. While it is still not clear what causes infertility in males (possible reasons for this may be hormones found in meat and hydrocarbons in the atmosphere), the main cause of the decrease in fertility amongst women is the fact that an increasing number of female patients start planning for a family at a much later stage in their lives than was previously customary. Fertility in women is closely linked with age. A women in her mid thirties is significantly less fertile than she was 10 years earlier.
Besides the above mentioned causes of infertility, a number of physical disorders can account for fertility problems. Around 40% of female infertility is caused by hormonal problems or to be specific ovarian disorders. A further 40% of infertility is caused by damage to the fallopian tubes and other pelvic organs. The remaining 20% has various other causes.
All treatment of infertility is dependent on every individual couple’s situation.
Where the cause of infertility is damage to the fallopian tubes or uterus, the first option of treatment would be surgery to restore function. Should this not be possible or should there be other influencing factors e.g. age of the patient, male infertility or hormonal disorders, fertility treatment may become necessary. Treatment usually begins by using the least invasive method. Should this not be successful, then further treatment options are discussed with the couple.
Possible treatment schedule:
- Following the cycle to determine ovulation
- Intrauterine insemination (Introduction of sperm into the uterus) either with or without hormone treatment and the possibility of sperm preparation before insemination
- Hormone treatment to induce ovulation, possibly in combination with insemination
- Hormone treatment during the second half of the cycle to support the implantation of the embryo
- Fertilization outside the body = IVF (In Vitro Fertilization, “Test tube baby”)
- Combination of IVF and micro insemination = ICSI (Intra-cytoplasmic sperm injection)
- Combination of ICSI and sperm extraction from the epididymis (MESA) or the testes (TESE)
- Freezing of pronuclei and sperm for later use
- Special circumstances : Micromanipulation of the outer protective coating of the embryo (Zona pellucida) to assist embryos in ‘hatching’ = Assisted Hatching
Procedures followed in Assisted Reproductive Technologies (ART) put more strain on the body, as more hormones are used, therefore making it vital that ovulation is closely monitored.
In an average couple a woman has a 30% chance of falling pregnant naturally per cycle. This figure falls, depending on the cause of infertility, to nearly 0%. The success rate of fertility treatment should therefore be no different to that of an average couple trying to conceive.
In reality, success rates of 30% for fertility treatment are only achieved where specifically favourable conditions prevail. According to the “German IVF Register” the average pregnancy rate after IVF treatment is just below 20% per cycle. For ICSI treatment, success rates are slightly higher.