Women’s fertility analysis

 Fertility tests

When a woman is having problems conceiving a child, a number of tests can be carried out in order to determine what the problem is. These tests are usually carried out after the man has undergone testing (semen analysis) because these are much more complicated procedures and more expensive. After seeing a fertility specialist, there are a few basic tests that can be carried out:

  • An ultrasound scan can be carried out to check the ovaries and womb (uterus).
  • Blood tests can be done to check for levels of hormones involved in ovulation (i.e., egg production), such as the follicle stimulating hormone (FSH), luteinising hormone (LH) and progesterone.

If these basic tests give no indication to the doctor as to what the problem is, more tests can be carried out:

  • A Hysterosalpingogram involves a special dye being injected into the neck of the womb. As the dye travels into the fallopian tubes it is viewed by an X-ray – so they can be checked to see if there are any blockages.
  • Hysterosalpingo-contrast sonography involves a vaginal ultrasound, again to examine the fallopian tubes for any blockages.
  • In a Laparoscopy a small incision is made near the navel and a small telescope (called a laparoscope) is inserted so that the womb and fallopian tubes can be inspected. A dye can then be injected to see if it runs into the fallopian tubes. This procedure can be used to check for scar tissue or again, any blockages of the fallopian tubes.
  • A Hysteroscopy involves a small microscope called a hysteroscope which is passed through the vagina and the cervix in order to view the womb; to check for fibroids (small round lumps) or any other abnormalities.

 

 The effects of ovarian stimulation on normal ovulation patterns and egg collections for IVF

 IVF Fertility treatment

In vitro fertilisation treatment or IVF treatment is carried out once other fertility treatments have failed, or following many months of trying to conceive a child without success. IVF treatment is the very first treatment tried when an egg donor is being used, when there are severe cases of male infertility or a woman’s fallopian tubes are blocked. However, IVF treatment is usually only carried out following a very long time period of the woman trying to get pregnant, followed by various methods of fertility testing.

IVF treatment has a very good success rate, although it may take more than one attempt in order for this to be achieved. Studies show that the potential for success with IVF treatment is the same for up to four cycles. Generally, the live birth rate for each IVF cycle is 30 to 35 per cent for women under the age of 35, 25 per cent for women between the ages of 35 and 37, 15 to 20 per cent for women between the ages of 38 and 40 and 6 to 10 per cent for women after 40. When an egg donor is used, however, success rates remain high even at age 40, with a 45 per cent success rate.[1]

IVF treatment is quite a long process which includes ultrasounds, blood work, injections, etc.

Before a women actually begins IVF treatment, in some cases, she may be put on birth control. This may seem very odd but the use of birth control pills before starting an IVF treatment cycle has been shown to decrease the risk of ovarian hyperstimulation syndrome (which could be caused  because of the possible side effects of fertility drugs) and ovarian cysts (small cysts that could be found on the ovaries) and may even improve the odds of success of the treatment.

The doctors and laboratories carrying out the fertility treatments and analysis may give patients a basal body temperature charting kit or provide them with an ovulation predictor kit. This is so that as soon as ovulation is detected, the doctor can be notified, who may then give the patient a GnRH antagonist (hormone antagonist) or a GnRH agonist such as Lupron. This is so that the doctors are able to have complete control over ovulation once the patient’s treatment cycle has begun (so that they know the woman’s ovulation patterns). The doctors may also get the patient to take the progesterone hormone which would cause a cycle to occur and cause the women to have her period.

Once the woman has her period, the treatment begins. A baseline blood work and a baseline ultrasound would be ordered by the doctor (just blood work and an ultrasound carried out on the second day of the woman’s period). The blood work is carried out in order to look at oestrogen levels (whether or not they are at the correct amounts for a woman) and the ultrasound is done in order to check the size of the ovaries and if there is anything else present on the ovaries (such as cysts). If there are cysts present, it is not that big of a problem, as cysts are likely to resolve on there own so the doctor may just choose to delay the treatment for about a week, or the doctor may use a needle to suck the cyst.

Once the patients blood work and ultrasounds are normal, ovarian stimulation is then carried out. Ovarian stimulation is carried out in conjunction with fertility drugs, which are administered by injections, which can be quite frequent. If so, the drugs may have to be injected into the patient about four times a day for up to two weeks. The injections can be administered in a clinic, however many women often inject the fertility drugs themselves (with correct training and guidance).

Some commonly prescribed fertility drugs that are used in ovarian stimulation are:

  • Clomid, serophene
  • Femera
  • Follistim
  • Bravelle
  • Lupron

During the process of ovarian stimulation, the patient’s blood work would continuously be monitored and ultrasounds would take place to monitor the growth and development of the follicle (fluid-filled sac that contains an immature egg; oocyte) and oocyte growth. These tests would help the doctor in deciding whether or not to administer more medication/drugs in the dosage.

The oocytes are then triggered to go through their last stages of maturation before they can be retrieved. This is triggered by human chorionic gonadotropin. This has to be injected at the right time (which is why ultrasounds are continuously carried out) because if the injection is administered to the patient at an early stage of the ovulation stimulation cycle, the eggs may not have matured enough, and if it is injected too late, the eggs may be too old and would therefore not fertilise properly. ‘Usually, the HCG injection is given when four or more follicles have grown to be 18 to 20mm in size and your estradiol levels are greater than 2,000pg/ML’.[2]

The egg collections/retrieval can then take place. This involves a special type of ultrasound called a transvaginal ultrasound which involves a needle, which is guided through the back wall of the vagina and up into the ovaries. The needle is then used to aspirate the follicle, or to gently suck out the fluid and oocyte from the follicle into the needle. There is one oocyte per follicle. These oocytes will then be transferred to a specialised laboratory called the embryology laboratory, for fertilization to then occur. Then, the follicles that are retrieved can be searched for any oocytes or eggs. If these are found (not every follicle would contain an oocyte or egg) they are then examined, and if they are thought to be mature enough, they are used in fertilisation.

The fertilisation has to occur about 14-20 hours after the oocyte has been retrieved, using a fresh semen sample provided by the woman’s partner. The semen sample is then cleaned; the sperm are separated from the rest of the substances in the ejaculate. The sperm are then examined, with the best looking sperm (with the best morphology, motility etc.) being chosen and placed into a culture dish with an oocyte. These dishes are kept in a special incubator for about 20 hours, and they are then examined for signs of fertilisation. There is a 70 per cent chance that the oocytes become fertilised. If the eggs do become fertilised, about four days later the eggs can be transferred. During the transfer of the embryo, a thin tube (catheter) will be passed through the cervix. The embryos are transferred through the catheter.

Progesterone supplements are then taken as a form of supplementation via injections. Then about two weeks later, more blood tests and progesterone tests are taken (in order to determine if the woman is pregnant).

Risks of treatment

Drugs

As with the use of any drugs, there are risks that come with fertility drugs. A large risk is that of a multiple pregnancy. Multiples, either twins, triplets, or higher-order, can occur when using fertility drugs.

Another potential side effect of fertility drug use is ovarian hyperstimulation syndrome, or OHSS. OHSS occurs when the ovaries are overly stimulated, becoming dangerously large and filled with too much fluid. This fluid, which is released with ovulation, can lead to serious complications. OHSS is rarely life-threatening, but it can be.

 

Sources:

[1] http://infertility.about.com/od/infertilitytreatments/ss/ivf_treatment.htm

[2] http://infertility.about.com/od/infertilitytreatments/ss/ivf_treatment_5.htm