New technologies for childless couples
Oladapo Ashiru
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 Reproduction
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.
Male assessment
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.
Super ovulation
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.
Intrauterine 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.
Assisted fertilisation
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.
Embryo development
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.
Holistic medicine
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.
BRAZIL
