Treatment Options - in vitro fertilization

in vitro fertilization Overcoming Infertility: what are the treatment options?
Nearly 90% of all infertility cases are overcome through treatment, including surgical and medical techniques. The physicians at fertility clinic Olimed Medical Center, Varna are committed to developing a personalized treatment plan, specifically tailored to each patient in order to optimize their chances at conceiving a child. We treat our patients as partners, working together we determine the most appropriate option based on individual circumstances taking into account medical, financial, social, ethical and religious factors.

Treatment options include: assisted reproductive techniques such as in vitro fertilization and ICSI, ovulation induction to enhance the production of eggs, surgery to repair reproductive organs and intrauterine insemination to increase the chances for egg fertilization by the sperm.


Fertility Drugs & how they are used (Ovulation Induction Medications)
Ovulation induction medications, often referred to as fertility drugs, are used to stimulate the follicles in your ovaries resulting in the production of multiple eggs in one cycle. The medications also control the time that you release the eggs, or ovulate, so sexual intercourse, intrauterine inseminations, and in vitro fertilization procedures can be scheduled at the most likely time to successfully achieve pregnancy.

What are the Risks?
There are risks associated with the use of ovulation induction medications including an increase in the chance for ‘high order’ multiple births and the development of ovarian cysts. A rare side effect that can occur is ovarian hyperstimulation syndrome (OHSS); symptoms include severe pain in the pelvis, abdomen and chest, nausea, vomiting, bloating, weight gain and difficulty breathing.

What are the most commonly used drugs in fertility treatment?
The medications most commonly used in fertility treatment are Clomiphene Citrate, Gonadotropins, Metformin and Parlodel.

Clomiphene Citrate (Clomid, Serophene) – This medication comes in a tablet form and is used for women who have infrequent periods or long menstrual cycles. Common side effects include headaches, blurred vision and hot flashes.

Gonadotropins (Puregon, Gonal F, Meriofert, Fostimon, Repronex, Follistim, Bravelle, Pergonal e.t.c.). This is an injectable medication that is used to induce the release of the egg once the follicles are developed and the eggs are mature. Side effects may include abdominal distention/discomfort, bloating sensation, mood swings, fatigue or restlessness. In most cases, the side effects are relieved by follicular aspiration.

Glucophage (Metformin) – Metformin is given to patients as an insulin lowering medication. Most commonly used in PCOS patients, the medication has been shown to reverse the endocrine abnormalities seen with polycystic ovary syndrome within two or three months. The use of Metformin can result in decreased hair loss, diminished facial and body hair growth, normalization of elevated blood pressure, regulation of periods, weight loss and normal fertility.

Parlodel – Parlodel is a medication used to lower prolactin levels. It will also reduce pituitary tumor size, should one be present. An oral medication taken with meals, Parlodel has few side effects and is relatively inexpensive.

‘First Line’ Therapies
There are different levels of ovulation induction commonly used to treat infertility related to ovulation disorders, male factor or unknown causes. One method of treatment involves clomiphene citrate (Clomid or Serophene) taken in pill form for 5 days at the beginning of a cycle. For women whose only infertility problem is ‘anovulation’ the failure to release an egg, up to 80% of patients will ovulate using this medication and 50% of those will conceive. Clomiphene may be combined with intrauterine insemination to boost the success of the medication by placing the sperm and egg in closer proximity to each other.

Superovulation
The more aggressive level of ovulation induction is called superovulation. This treatment uses Gonadotropins or sometimes a combination of Clomiphene and Gonadotropins to stimulate the production of multiple eggs. Patients undergoing superovulation must be closely monitored by blood tests and ultrasounds. Monitoring ensures that the patient does not hyperstimulate and also helps the physician administer the correct dosage of medication so that only a few follicles develop. This is a critical step to keeping the multiple pregnancy rates low. At the end of the superovulation treatment process, a low dose HCG (human chorionic gonadotropin) may be prescribed to stimulate ovulation. Ovulation will occur between 24-36 hours after HCG. The patient is instructed to either have intercourse during this time or to come in for an intrauterine insemination. Depending on the cause of infertility, the success rate per superovulation treatment cycle is approximately 10-20% based on the woman’s age.

Ovarian Drilling
Ovarian drilling can be done during a laparoscopy and is a procedure in which a laser fiber or electrosurgical needle punctures the ovary 4 to 10 times. This treatment results in a dramatic lowering of male hormones within days and is often performed in women who have Polycystic Ovary Syndrome (PCOS). Studies have shown that up to 80 percent of patients will benefit from such treatment. Many women who fail to ovulate with Clomiphene or Metformin therapy will respond when these medications are reintroduced to the system after ovarian drilling. Side effects are rare, but may result in adhesion formation or ovarian failure if there are complications during the procedure.

Intrauterine Insemination
Intrauterine insemination (IUI) is a procedure in which sperm are placed directly into the uterine cavity through a catheter near the time of ovulation. This procedure is most commonly performed when there are problems with the sperm, such as low count or low motility, or an incompatibility between the sperm and the cervical mucus. It can also be performed to overcome problems associated with a man’s inability to ejaculate inside the woman’s vagina due to impotence, premature ejaculation or other medical conditions. IUI increases the chances of pregnancy because the sperm are placed directly in the uterus, bypassing the cervix and improving the delivery of the sperm to the egg.
IUIs can be performed either with the partner’s sperm or with donor sperm. It is recommended that the patient abstain from sexual intercourse for two to three days before the procedure. In some cases, it may be necessary for the female to take medication to induce ovulation if her cycles are not regular. The male will provide a semen sample one to two hours before the procedure is to be performed. The semen will be washed, a procedure in which the sperm is separated from the seminal fluid and the quality of the sperm is analyzed. Following the wash, it is time for the insemination procedure, which only takes a few minutes and does not cause much, if any, discomfort for the female. The doctor will insert a small catheter into the uterine cavity through the cervix and inject sperm directly into the uterus. The patient is able to resume normal activity immediately following the IUI procedure. If pregnancy does not result from the initial IUI, the procedure may be repeated during the following cycles.

Sperm Banks: Spermatozoa can be stored in a containers filled with liquid nitrogen at minus 196 degrees Celsium. After a sample is taking from a man, sperm undergoes special handling, mixing it with a nutrient media. This is necessary to protect the sperm cells from damage, when put it into the liquid nitrogen. This way the cells can survive years around 10. The method is proposed to people, who are going to undergo a chemotherapy or surgical procedures on their testicles. Also the sperm can be stored this way, when husband/partner is not available in the day of fertilization during performing Assisted Reproductive techniques. This is a way to store the sperm samples from legally chosen donors and use it in cases of azoospermia.

Surgery
In some situations, the condition causing infertility may not be treatable through the use of medication or procedures including intrauterine inseminations and ovarian drilling. For these cases, surgical options will be explored to treat the condition in either the female or the male.

Female surgical options
Hysteroscopy – A hysteroscopy is an outpatient procedure in which your doctor will use a narrow fiber-optic telescope inserted into your uterus through your cervix, to look for and where necessary, remove adhesions inside your uterus.

Laparoscopy – A laparoscopy is an outpatient surgical procedure in which your doctor will use a narrow fiber-optic telescope inserted through an incision near your navel to look for and where necessary, remove adhesions in your pelvic cavity, remove ovarian cysts or remove or repair a fluid-filled hydrosalpinx.

Fallopian Tube Sterilization Reversal (reanastomosis) – A tubal reversal is a surgical procedure performed to reconnect the two ends of the fallopian tubes in an effort to reverse sterilization.
Hydrosalpinx removal – A hydrosalpinx is an obstructed fallopian tube that leads to an accumulation of fluid. Removal of the affected tube can increase IVF success rates.

Male Surgical Options
Testicular biopsy – Testicular biopsy performed as an ‘in-office surgical procedure in which several small pieces of testicular tissue are removed and examined for sperm which can be used in fertility procedures.
Testicular sperm aspiration (TESA) – A TESA procedure involves a needle biopsy of the testicle in which a sample of tissue is taken directly from the testis and used to extract sperm for IVF or ICSI.
Percutaneous sperm aspiration (PESA) – PESA is a procedure involving a needle inserted into the epididymis in an effort to locate and aspirate a pocket of sperm.

Vasectomy reversal – A vasectomy reversal is often performed as an outpatient procedure and is done to reverse a previous vasectomy and restore the male’s ability to release sperm into his semen from the testicles.

In Vitro Fertilization

The IVF Program
Many couples faced with infertility are still unable to conceive after first line therapies such as ovulation induction, intrauterine insemination, or reproductive surgery. For these couples, the next logical step is to explore the possibility of Assisted Reproductive Technologies (ART).

These treatments include In Vitro Fertilization and other assisted laboratory techniques designed to improve fertilization. The medical team at “Olimed” Medical Center is dedicated to identifying and developing the most successful ART treatment plan for each patient. Compared to simpler treatments, ART procedures typically have very high success rates but are more complex as they involve a well-coordinated, perfectly timed effort between the medical team, laboratory staff and the patient.

We encourage you to learn as much as you can about the IVF program at the Olimed web site. This section of the Website offers information on medications, procedures, success rates and financial issues relating to IVF. For more information, read our IVF Patient Informed Consent or contact us at +35952600027 to schedule an initial consultation with a physician.

Each month, the physicians at Olimed MC host a free seminar “IVF … After Hours”. During this, we cover issues related to the diagnosis and treatment of infertility through in vitro fertilization including the emotional, scientific, medical and financial aspects. You will also have the opportunity to tour our state-of-the-art medical facilities, ask any questions you may have related to infertility and IVF, plus you can schedule a free, private mini-consultation with an Olimed physician and psychologist..

Read more in our patient informed consent. You may also contact us with any questions you have.