Fertility Treatment

Generally speaking, infertility can be defined as the inability to get pregnant after a year or more of regular unprotected intercourse. There are two types of infertility: primary and secondary.

Causes of infertility

Many factors can lead to infertility or reduce fertility overall in men and women. In 25% of the cases, a reason cannot be determined for the couples' inability to conceive.

Causes of infertility in men

Many factors need to work correctly to ensure sperm production and efficient delivery of the male reproductive cells into the vagina. Issues that hinder this process can be classified into three categories: pre-testicular, testicular, and post-testicular:

1. Pre-testicular problems are typically systemic illnesses that disrupt the Hypothalamic-Pituitary-Gonadal (HPG) axis.

2. Testicular issues refer to problems with sperm production or storage. They include genetic conditions such as Klinefelter syndrome (XXY), where the individual's cells have an extra copy of the X chromosomes and are unable to produce sperms. Another condition that can be placed under the testicular class of infertility is when the testicles fail to descend into the scrotum in the fetal period, also called cryptorchidism.

3. Post-testicular problems describe issues with sperm delivery. These include issues such as sterilization and erectile dysfunction.

Causes of infertility in women

Factors affecting fertility in women are classified into three main categories: ovulatory disorders, disorders of the uterus, and fallopian tube damage:

1. Ovulatory disorders include issues that disrupt the HPG axis and the release of reproductive hormones. Examples include polycystic ovarian syndrome (PCOS) and premature menopause (menopause before the age of 40).

2. Disorders of the uterus relate to physical reasons in the uterus that prevent the implantation of the embryo. They include conditions such as scarring after surgery and uterine fibroids.

3. Fallopian tube damage relates to conditions that specifically affect the uterine tubes and, hence, disrupt the transport of the egg cell from the ovaries to the uterus.

Fertility treatment, meaning and process

Fertility treatments can be categorized into three main types: hormone therapy, surgical procedures, and assisted conception.

Hormones to Treat Infertility

Extrinsic hormones or antihormone drugs can be used to treat infertility, especially when a woman is not generating enough eggs. This is often due to the anterior pituitary not secreting enough follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to promote egg maturation and release.

A key issue to consider with these types of hormone therapies is that several eggs can be released at the same time, which would increase the likelihood of having twins or triplets.

Surgical procedures

Several surgical techniques may be performed to evaluate reproductive issues and assist with fertility. In women, major surgical procedures that are used to improve fertility include the surgical opening of blocked or scarred fallopian tubes to allow egg release and the surgical removal of ovarian cysts in PCOS.

In men, surgical procedures can also be used to improve fertility in some cases. Surgical extraction of sperm is a viable option for those men who have obstructions preventing the release of sperm or those who would like to reverse their vasectomy.

Assisted conception

The use of medical interventions other than hormone medicines or surgery alone to help couples conceive and have a child is known as assisted conception. Artificial insemination and in vitro fertilization (IVF) are two of the most known assisted conception treatments.

Artificial insemination

Artificial insemination, also referred to as intrauterine insemination, is a procedure that involves delivering sperms into the uterus via a tiny plastic tube that is inserted through the vagina and the cervix. For this procedure, sperm is collected and only the top quality and the quickest sperm cells are chosen.

In vitro fertilization (IVF)

IVF is the process of fertilizing an egg outside the body ('in vitro' means 'in glass'). This is especially useful when both male and female counterparts have fertility problems. Reproductive hormones FSH and LH are injected into the mother to stimulate her ovaries to produce more eggs than normal. The eggs are then extracted from the ovaries, and the father's sperm is used to fertilize the eggs in a laboratory.

The fertilization of the egg cell by a sperm cell results in a zygote. The zygote is the first cell of the developing embryo, which starts to quickly divide by mitosis. The resulting initial cells are called blastomeres, which form a ball of cells termed morula at this stage. Several of these embryos are then artificially implanted in the uterus. The implantation of a single injected embryo yields a very low success rate, so implanting numerous ones raises the likelihood of at least one of them being successful.

According to the current UK national guidelines, IVF can be provided under the NHS to women under the age of 43 who have been attempting to conceive for two years using frequent unprotected intercourse or have had 12 rounds of artificial insemination.

Advantages and disadvantages of fertility treatment

There are advantages of fertility treatment, as it can provide couples with the opportunity to successfully conceive and have their own child. However, there are also disadvantages of fertility treatment as it comes with some serious potential issues that need to be considered.

Firstly, fertility treatments such as hormone therapy and IVF increase the chances of multiple embryos being implanted in the uterus. As a result, couples have to be financially and socially prepared for the possibility of having twins or triplets. Furthermore, the success rate of some treatment options such as IVF is relatively low, and IVF failure can have an emotional and psychological toll on couples.

During the IVF procedure, more embryos can be developed than are ultimately used. Who owns these embryos, and whether it's ethical to use them for research if they were going to be destroyed in the first place, are difficult and often controversial questions.

The use of genetic testing on embryos is also ethically debatable, since it could potentially be exploited by couples who may want to be able to choose embryos with certain desirable genetic traits. For example, a couple of may want to have a boy if they already have many girls. Such influence and manipulation remain controversial topics.