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MANY PATHS TO A MIRACLE BABY

Infertility

Infertility is defined as a inability to conceive after one year of regular intercourse without contraception.

Causes

In Women:

  • Blocked or damaged Fallopian tubes: A woman can be born with a Fallopian-tube defect, or pelvic infection from sexually transmitted diseases can cause damage.
  • Endometriosis: Tissues that normally appear in the uterus are found in the pelvis instead. This is one of the most common causes of infertility in women. Symptoms vary from no pain to extreme pain usually tied to menstrual cramps.
  • Ovulation: Hormone problems are ovary failure may result in some women not ovulating (producing an egg) during their menstrual cycle.
  • Age: “Women’s fertility goes down, statistically, starting around age 35, at about nine per cent per year,” says Genesis Fertility Centre’s Dr. Albert Yuzpe.

In Men:

  • Low sperm count.
  • Low motility: In a normal sperm sample, 30 to 50 per cent of sperm are moving.
  • Abnormal sperm: In a normal sperm sample, 30 per cent of sperm look normal.
  • Varicocele: Veins in the scrotum may be enlarged, interfering with sperm production.
  • Failure of the testicles: Sperm development and testosterone production in the testicles are independent functions. It is common for abnormalities to exist in this complex system.

What are some of the early steps you can expect if you’re having trouble getting pregnant?

  • Menstrual history: A family doctor can take a menstrual history to help you understand how your cycles work.
  • Temperature charting: By regularly charting you temperature you’ll find out whether ovulation occurs regularly and on what day of your cycle.
  • Hormone check: A blood test can measure your progesterone level, which can confirm ovulation.
  • Tubal dye test (hysterosalpingogram or HSG): A special X-ray can tell whether Fallopian tubes are healthy and check for an abnormally shaped uterus, fibroids, polyps or other problems.
  • Laparoscopy: This allows a thorough look at your reproductive organs by means of a telescopic device placed through a small incision in your abdomen. It usually requires a general anesthetic and is done as day surgery.

Therapies

  • Ovulation induction: To increase the number of eggs released during menstrual cycle, women are first treated with oral medications and if this is unsuccessful, then with injections of follicle-stimulating hormone (FSH).
  • Superovulation therapy: Some infertility still cannot be explained. In such cases, women may opt for superovulation therapy, in which the number of eggs produced in each cycle is increased.
  • In vitro (literally, “in glass”) fertilization: Eggs are stimulated to grow in the ovaries, are “retrieved” to be fertilized by the sperm in vitro and, when fertilized, placed back in the uterus.
  • Assisted hatching (AH): Still controversial. It is something done here, but is not the norm. During IVF, a hole is made in the shell of the embryo to assist implantation in the uterine wall.
  • Intracytoplasmic sperm injection (ICSI): This is the newest treatment for male factor infertility, which accounts for about 30 per cent of all infertility. With ICSI, a single sperm is injected directly into an egg during IVF.
  • Microscopic epididymal sperm aspiration (MESA): For men who have conditions which prevent sperm from being released from the genital tract. MESA allows sperm to be removed from the male using surgery. The sperm is then prepared for ICSI.
  • Donor sperm: This is used when the male partner’s sperm is unavailable or is not capable of fertilization.
  • Donor egg: These may be used for women suffering ovarian failure or premature menopause. Donor eggs are fertilized by the male partner’s sperm using IVF, and the fertilized eggs are transferred to the uterus of the infertile woman. Emotional, psychological and social issues may arise from this, since the recipients must approach the donor. Anonymous egg donors, unlike anonymous sperm donors, are not available to clinics here, partly because eggs are so difficult to freeze and thaw successfully.
  • Donor embryos: Donor eggs are fertilized by donor sperm and transferred to the uterus of an unrelated woman. This procedure is available in some clinics in North America, but is not available in B.C.

The reproductive revolution: It all began with Louise Brown

Important Dates

1978: In vitro fertilization (IVF) becomes a reality. Louise Brown, the first “test tube baby,” is born in England.

1980s: Superovulation techniques are developed that involve injections of newer, more powerful hormones to stimulate the production of more eggs for use with fertilization methods outside of the body.

1988: Intracytoplasmic sperm injection (ICSI) is developed, which treats severe cases of male infertility. With this technique, a single male sperm can be injected into an egg retrieved from the ovaries and a resulting embryo re-implanted in the womb.

1998: The edge of the envelope: Freezing eggs.

The Future

The next step, one that only a few random clinics worldwide have thus far undertaken, is the successful freezing of eggs.

This procedure is right on the horizon. When it’s properly established, it will be an enormously important breakthrough. Eggs, or oocytes, are much harder to freeze and thaw successfully than sperm. They are fragile, and until now, attempts to preserve them this way have always failed.

Once we’re able to freeze eggs, women who face debilitating diseases or cancer treatment that can cause infertility can freeze their own eggs so that they can have children after they have recovered.

Women who must put off having children for other reasons can do the same.

Freezing eggs will also solve some ethical dilemmas. Many believe life begins at conception. Freezing a fertilized embryo, therefore, raises the question of how that microscopic life must be treated. What, for example, should be done with “leftover” embryos?

Since it’s the eggs, not the chromosomes, that age, another future technique may involve injecting the chromosome material from an older woman into the eggs of a younger woman from which the nuclei have been removed.