Faith and Science Ministries,Dr.Tamale and Kate Sali,Watch Faith and Science

The treatment for infertlity includes but are not limited to the following;procedures ;

1. IVF (Invitro Fertilisation)
2. IVF/ICSI (Intracytoplasmic sperm injection)
3. Egg Donation
4. IUI (Intra Uterine Insemination)
5. HIV sperm wash (for HIV discordant couple)
6. Laboratory Tests (Hormoinal tests, Seminal analysis)
7. Counselling
8. Laparoscopic surgery
9. Fertility treatment
10. Ultra Sound scan
11. Family Planning
11. Myomectomy Operations
12. Antenatal Care

In vitro fertilization (IVF)

In vitro fertilization (IVF) is a technique in which egg cells are fertilised outside the woman's body. IVF is a major treatment in infertility where other methods of achieving conception have failed or is preferred by the couple based on their individual circumstances.

The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman's ovaries and letting sperm fertilise them in a fluid medium. The fertilised egg (zygote) is then transferred to the patient's uterus with the intent to establish a successful pregnancy. "In vitro" is Latin for "in glass", referring to the test tubes; however neither glass nor test tubes are used, and the term is used generically for laboratory procedures. Babies that are the result of IVF have been called "test tube babies".

The preconditions for In Vitro Fertilisation
Treatment with in vitro fertilisation implies that:

IVF step by step
Below you get a short overview of the steps of the IVF treatment:

1. Preliminary consultation with the doctor.

Here we can make sure that you are well informed about your treatment.

2. Examination for infertility

The couple is examined for causes of infertility.

3. Hormone stimulation

The woman gets a hormone stimulation to regulate the egg production and the egg maturation.

4. Ultrasound scan of the follicles

The right time for egg removal is determined.

5. Egg aspiration (aspiration)

The eggs are aspirated from the ovaries. Aspiration is performed with a thin needle through the vagina wall. The doctor will administer a local anaesthetic in the vagina wall. Egg aspiration is illustrated below:

6. Sperm cell sample

The man hands in a sperm cell sample on the day of the egg aspiration. If donor sperm cells or frozen sperm cells are to be used, these are thawed.

7. Fertilisation of the eggs (fertilisation)

The aspirated eggs are fertilised with the sperm cells in the laboratory.

8. Egg transfer (transfer)

The fertilised egg/eggs are transferred to the woman’s uterus for normal growth.

The endometrium is stimulated to prepare it for receiving the egg.

The pregnancy test is made 14 days after the egg transfer.

Look at our IVF Calendar

Hormone Stimulation

Hormone stimulation can be used if the woman has irregular ovulation.
At hormone stimulation we try with medication to influence the woman’s hormone system, so that she regains a normal ovulation.
The hormonal stimulation we use aims to increase the proportion of eggs that are ready to ovulate from 1 in 20 to perhaps 8 to 10 in 20 – (NB. therefore we don't 'use up' more eggs so women undergoing treatment do NOT go through the menopause earlier). This allows us to collect more ‘rescued’ eggs and therefore we have a higher chance of achieving fertilisation and subsequent pregnancy but we need to be cautious to avoid over-stimulation.

Intrauterine Insemination (IUI)

In an IUI procedure, the practitioner inserts specially treated sperm through the cervix into the woman?s uterus. IUI increases the likelihood of fertilization. This procedure is performed around the time of ovulation. In some cases, particularly if low sperm count is a concern, two IUI procedures can be performed several hours apart. IUI may use the partner's sperm, or if indicated, sperm from a donor.

Intrauterine insemination with partner's sperm can be used as a potentially effective treatment for infertility of all causes in women under about age 45 except for cases with tubal blockage, severe tubal damage, very poor egg quantity and quality, ovarian failure (menopause), and severe male factor infertility. In vitro fertilization with the woman's eggs or IVF with donor eggs are alternatives for couples that are not candidates for artificial insemination.

It is most commonly used for infertility associated with endometriosis, unexplained infertility, anovulatory infertility, very mild degrees of male factor infertility, cervical infertility and for some couples with immunological abnormalities.

It is a reasonable initial treatment that should be utilized for a maximum of about 3-6 months in women who are ovulating (releasing eggs) on their own. It can be reasonable to use it for somewhat longer than this in women with anovulation that have been stimulated to ovulate.

It should not be used in women with blocked fallopian tubes. Tubal patency should be demonstrated prior to performing insemination. This is usually done with an x-ray study called a hysterosalpingogram.

It has very little chance of working in women that are over 40 years old, or in younger women with a significantly elevated day 3 FSH level, or other indications of significantly reduced ovarian reserve.

If the sperm count, motility or morphology is more than slightly low, insemination is quite unlikely to be successful. In that situation, IVF with ICSI is indicated and has high success rates.

How is insemination performed?

1. The woman usually is stimulated with medication to stimulate multiple egg development and the insemination is timed to coincide with ovulation.

2. A semen specimen is either produced at home or in the office by masturbation after 2-5 days of abstinence from ejaculation.

3. The semen is "washed" in the laboratory (called sperm processing or sperm washing). By this process, the sperm is separated from the other components of the semen and concentrated in a small volume. Various media and techniques can be used to perform the washing and separation, depending on the specifics of the individual case and preferences of the laboratory. The sperm processing takes about 20-60 minutes, depending on the technique utilized.

4. The separated and washed specimen consisting of a purified fraction of highly motile sperm is placed either in the cervix or high in the uterine cavity using a very thin, soft catheter.

Most programs have the woman remain lying down for 5 minutes following the procedure, although this has not been shown to improve pregnancy rates. Since the sperm is above the level of the vagina, it will not leak out when she stands up.

This procedure, if done properly, usually seems similar to a pap smear for the woman. There should be little or no discomfort.

Success rates for intrauterine insemination vary considerably and depend on the age of the woman, type of ovarian stimulation (if any) used, duration of infertility, cause of infertility, number and quality of motile sperm in the washed specimen, and other factors. Rates for women over 35 drop off, and for women over 40 are much lower. For this reason, we are more aggressive in "older" women.

Pregnancy rates are lower when insemination is used:

The rates are slightly higher for women that do not ovulate on their own (anovulation) that are stimulated to ovulate with medication and then inseminated. This is because it is likely that the sole cause of their infertility is their ovulation disorder - which is overcome with the use of the ovulation stimulating medicine.

For a couple with unexplained infertility, the female age 35, trying for 2 years, and normal sperm - we would generally expect about:

5% chance per month of conceiving and delivering with clomiphene and intrauterine insemination for up to about 3 cycles (lower after 3 attempts)
8% chance per month of conceiving and delivering with injectable FSH (e.g. Follistim, or Pergonal) and insemination for up to about 3 cycles (lower after 3 attempts)
50% chance of conceiving and delivering with one cycle (month) of IVF treatment (at our center - pregnancy rates vary greatly between IVF clinics)

Our IVF pregnancy and delivery rates

Ovarian stimulation with clomiphene citrate versus stimulation with injectable gonadotropins (Pergonal or Follistim)

Although there is not universal agreement in published studies or among infertility experts, intrauterine insemination with partner's sperm in conjunction with ovarian stimulation seems to provide higher pregnancy rates than insemination in natural menstrual cycles (without ovarian stimulation).

Insemination combined with ovarian stimulation with injectable gonadotropins provides better pregnancy rates (and higher multiple pregnancy rates) as compared to insemination combined with clomiphene. Injectable gonadotropins usually stimulate more mature eggs to develop than does clomiphene. More mature follicles and eggs leads to more chance for a pregnancy. However, more follicles and eggs also entails more risk for multiple pregnancy. It is a double-edged sword...

How many insemination cycles should be done?

Most pregnancies with insemination using partner's sperm occur in the first 3-4 attempts. The chances for success per month drop off after about 3 attempts and considerably more after about 4-6 unsuccessful attempts. Therefore, this therapy is not usually recommended for more than a maximum of 4-6 cycles. If the reason for infertility is lack of ovulation (anovulation) then it may be more reasonable to try several more cycles (6-12 cycles total).

In vitro fertilization is the next step in treatment after inseminations - and has a much higher success rate per cycle.

Intra-cytoplasmic sperm injection (ICSI)

ICSI (intra-cytoplasmic sperm injection) is an assisted conception technique which may be used where a male has only a few live sperm or where sperm quality is poor or lacking motility

It can overcome problems in which a sperm cannot drill a hole through the egg to fertilise it (for example, because of abnormalities affecting the sac of enzymes on the sperm head), and where anti-sperm antibodies are present. It can also be used where a male undergoing cancer treatment has previously frozen a sample of his sperm, and wants to maximise their potential use. ICSI has been used where there is a blockage preventing release of sperm, as the sperm can be obtained from the epididymis (the tube leading from a testis) or from the testis itself using a fine needle.

During ICSI, a single sperm is injected directly into the white (cytoplasm) of a mature egg using an ultra-fine glass needle (pipette). The fertilised egg is then observed until it has undergone a certain number of divisions before being transferred into the woman's reproductive tract.

A fertilisation rate of 50 per cent is usual, with 80 per cent or more fertilised eggs starting to divide as normal. Factors such as the woman's age (and therefore the age of her eggs) affect the success rate. The average live birth rate is 22 per cent, per embryo transfer, but the success of ICSI depends on the skill and experience of its practitioners.

Counselling offers you a forum for discussion which may assist you in making decisions about treatments and help you explore all options available. Talk to a counsellor about your concerns, and find out how others cope and how normal your reactions are.

For some patients, counselling is mandatory, for example, those donating or receiving donated gametes or embryos during fertility treatment. For most patients, it is service which we highly recommend to assist you to understand the range of emotions you and your partner may typically experience.

"It is important not to wait until you are overwhelmed before seeking counselling support ."

It is important not to wait until you are overwhelmed before seeking counselling support. Our team of fertility specialists, nurses and scientists all provide counsel to patients. However our specifically trained fertility counsellors can help at any time to:

For those patients undergoing donor cycles or surrogacy counselling, a number of counselling sessions are required for all parties involved in prior to commencing any form of treatment.

You do not need to spend time and money on an outside egg donation agency
We do it all here.

Who should be treated with egg donation?

How is egg donation performed?

1. An appropriate egg donor is chosen by the infertile couple and thoroughly screened for infectious diseases and genetically transmissible conditions. Donors are generally given some monetary compensation for going through the treatment.

2. Consents are signed by all parties.

3. The donor is stimulated with injected medications to develop multiple egg development. This allows us to perform in vitro fertilization with her eggs and the sperm of the infertile woman's male partner.

Fibroid (Myoma)
Also known as a myoma or leiomyoma, a benign (noncancerous) tumor found in the wall of the uterus. Fibroids are extremely common; more than 40% of all women develop fibroids, and most do not cause symptoms or require treatment. Some fibroids, however, may cause problems with fertility and should be removed. They may also be removed if they are growing large enough to cause pressure on other organs, such as the bladder, or are causing abnormal bleeding.

Uterine fibroids, also known as myomas, are non-cancerous tumors of the lining or muscular walls of the uterus. More than 40% of all women develop fibroids, and most fibroids do not cause symptoms or require treatment. However, fibroids may require treatment in the following circumstances:

Fibroid tumors can often be removed in a surgical procedure called a laparoscopic myomectomy. For patients who are candidates, this surgical approach allows a woman to avoid a large incision in her abdomen, which is the way traditional myomectomies are performed.

Laparoscopic surgery
Laparoscopy allows physicians to view the internal pelvic organs without requiring major surgery. The procedure is minimally invasive, and most patients can be discharged a few hours after their surgery.

Laparoscopy is employed in two levels of complexity:

Diagnostic Laparoscopy
Diagnostic laparoscopy can be performed in the office or in the operating room and is utilized mainly for observation and diagnosis. Some minimal corrective procedures can be accomplished in this setting.

Operative Laparoscopy
Operative laparoscopy is always done in the operating room while the patient is under general anesthesia. This approach will enable the physician to correct any abnormalities that are encountered during the surgical procedure.

The laparoscope enables the physician to examine the external surface of the uterus tubes and ovaries. The surrounding organs can be viewed as well. This could include the liver, gall bladder, intestines, cul de sac, and anterior surface of the bladder. Often the appendix can be seen.

Conditions that impair fertility may not have symptoms that a woman notices in her daily life. These conditions include endometriosis, uterine fibroids, and damage from prior infection, tubal disease resulting from ectopic pregnancy, and pelvic adhesive disease. Once encountered through the laparoscope many of these conditions can be treated at the time of their diagnosis, which would save the patient from having to return for a second procedure.

Duration of Laparoscopic Surgery

Diagnostic laparoscopy usually takes between 20-30 minutes. Operative laparoscopy can last from 1-3 hours, depending on the complexity of the procedures that are required. On rare occasions, an operative laparoscopy is converted to a laparotomy in order to complete the excision or repair.

Tubal factor (or diseases of the fallopian tube) account for infertility in about 20-25 percent of all couples that are having difficulty getting pregnant. Couples have a couple options available for the treatment of tubal factor infertility.

Tubal surgery may be utilized to repair the damage in certain cases

In vitro fertilization is another option
You should consult with your doctor to determine which solution is best for you. Each has very specific pros and cons, which vary from patient to patient. Occasionally, women may have had a history of previous infection such as appendicitis. This can lead to damage and scarring of the fallopian tubes. Other conditions, which are known to damage the fallopian tubes, include endometriosis, prior surgery and previous ectopic pregnancy. Patients who have used the intrauterine device in the past may also be at risk. Most physicians will take a careful history for prior infections such as cervicitis or pelvic inflammatory disease. Non-invasive tests, such as a hysterosalpingogram, are often employed to provide information about the extent of damage of the tube prior to the decision to have surgery.

HIV sperm wash (for HIV discordant couple)

The development of highly active antiretroviral therapy has transformed the prognosis of patients infected with human immunodeficiency virus type 1 (HIV) living in the developed world and increased the demand for reproductive care for these patients. The primary aim is to ensure that infected individuals do not put their uninfected partner or unborn child at risk. Centres offering assisted-conception treatment to HIV couples need to provide risk-reduction options such as sperm-washing, and reproductive counselling, and ensure the safety of uninfected patients and healthcare workers in the centre. Where the man is HIV-1 positive and the women HIV-1 negative, sperm-washing is a well-established, effective means of reducing HIV transmission risk compared with timed, unprotected intercourse. If a couple have additional fertility issues, sperm-washing can be combined with ovulation induction, in vitro fertilization or intracytoplasmic sperm injection. In HIV-positive women trying to conceive, reducing risk lies primarily after conception in preventing mother-to-child transmission, achieved through the use of antiretroviral medication during pregnancy and delivery, caesarean or managed vaginal delivery and an avoidance of breast-feeding.