Human beings are social animals. We want to have a family and would like to have kids. Kids will make our lives so complete and also replace ourselves. If any couple, age under 36, lives together for more than one year and still not has a child will be defined as “sub fertile couple”. All of them need kids to fulfill their dream or their lives. Why? Some used to say “Without a kid, they don’t have goal in their lives. There seems not to have destination.” B.I.C provides various treatment plans to suit each couple’s problem.

The investigations and the medical history are required to find out if there is any condition which might affect fertility: such as

• Hormonal disorders of hypothalamus/pituitary or thyroid gland
• Medication affecting reproductive function
• Surgery of the abdomen affecting the reproductive organs
• Obesity or anorexia nervosa which may affect oocyte production/ovulation
• Alcohol, nicotine, drugs
• Life situation causes stress
• Difficulty with sexual intercourse

A full gynecological examination is required to evaluate the external and internal female reproductive organs: vulva, vagina, cervix, uterus, ovaries.

Ultrasonography allows the identification of potential abnormalities of the internal reproductive organs (uterus, fallopian tubes and ovaries) and monitoring of ovarian response to hormonal stimulation defined by counting the number and size of follicles which are contained of oocytes. To evaluate the ability of uterus to produce endometrial lining whether it’s thick enough for embryo implantation

Blood / hormone tests also required to evaluate whether ovulation occurs and the quality of ovulation, tests for infectious and immunological causes of female infertility. Included of Karyotype examination which is one kind of tests for chromosome abnormalities for example Turner’s syndrome is an abnormality of gender chromosomes.  

Hysterosalpingography

This is a radiological investigation where a dye is injected into the uterine cavity, any abnormality of the uterus and fallopian tubes can be seen on the X-ray. It particularly demonstrates any blockage of the tubes.

Hysteroscopy

This test visualizes the cavity of the uterus and demonstrates any abnormalities inside. A viewing instrument (a very thin, cold light fiber-optic tube) is inserted into the uterine cavity to see any abnormalities. It allows, if necessary, corrective surgery to be performed.

Laparoscopy

This is a surgical procedure under general anesthesia whereas a viewing scope is inserted into a small incision in the abdominal wall about one centimeter from the navel. The abdominal cavity is filled with gas allowing the viewing of reproductive organs including pelvis, ovaries, fallopian tubes and uterus. The passage of dye through the tubes can be checked at the same time. Scar tissue and endometriosis can be identified and certain abnormalities corrected by surgery.

Various diagnosis of female reproductive organ abnormality causes infertility e.g. vagina, cervix, uterus, fallopian tubes and ovaries. These abnormal incidences may be present at birth or be acquired later for example acidic cervical mucus, absence or insufficient mucus, cervical infection, cervical mucus with anti-sperm antibody, ovulation disorders, lack of ovulation, irregular or incomplete ovulation, luteal insufficiency, obstructive fallopian tubes, damage to fallopian tubes from any infection or surgery following an ectopic pregnancy.

Endometriosis

is a common medical condition characterized by growth beyond or outside the uterus of tissue resembling endometrial tissue, the tissue that normally lines the uterus. This condition can causes chronic inflammation with a subsequent adhesion development then obstruct pathway of egg and sperm to fertilize.

Unexplained infertility

This is infertility with no apparent cause being demonstrated after all the previous history taking, physical examination and investigation.

The treatments

Surgical treatment included surgery of fallopian tubes, removal of adhesions, surgery to the uterus to rectify any abnormality or remove anatomical abnormality e.g. fibroids, polyps, congenital malformation.

Hormonal treatment in order to re-establishing a normal ovulation cycle with the help of hormones: clomiphene citrate, gonadotropins (FSH, LH), progesterone which can help oocytes growing, maintain luteal phase and support during early pregnancy.

Assisted conceptions treatments

Natural conception following timed sexual intercourse with or without ovarian stimulation, ovulation can be predicted by the use of urine or blood ovulation prediction tests or by follicular ultrasound scanning to determine the exact day of ovulation. This allows a couple to have intercourse during their most fertile periods.

IUI- intrauterine insemination

After sperm preparation from the semen sample in laboratory to select the most motive and normal sperm, the preparation is injected with the aid of a catheter directly into the woman’s uterine cavity. The insemination may be made during a natural cycle or an ovarian stimulation cycle.

IVF- in-vitro fertilization

One or more eggs are retrieved from the ovaries following ovarian stimulation and these are mixed with the partner’s sperm collected by masturbation. If fertilization occurs, then development of embryos are expected and transferred into the woman’s uterine cavity on the 3-5 days after fertilization.

Counseling and psychological support

The emotional impact of IVF can be enormous. Counseling and psychological support are extremely important in helping couples dealing with their infertility and/or treatment. Especially, when treatment is not possible or the chance of success is poor. Other treatment options may be offered e.g. oocytes donation, when a woman is suffering from ovarian failure. Treatment for the patient is very similar to IVF except that oocytes are retrieved from the donor who should be under age of 35 years.
 

The investigations and the medical history are required to find out if there is any condition which might affect fertility: such as

• Endocrine disorders e.g Diabetes mellitus
• Infectious diseases
• Genetic conditions
• Medication affecting reproductive function
• Alcohol, nicotine, drugs
• Life situations causes stress
• Contact with a toxic environment e.g. work in the chemical industry, contact with X-rays, heat
• Difficulty with sexual intercourse

Clinical examination

• Male external genitalia: testes, penis, scrotum, epididymis, vas deferens
• Presence of varicoceles
• Presence of phimosis
• Semen analysis: to examine for: volume / concentration of sperm, sperm motility and physical appearance (Morphology)

Additional investigations:

If there is any concern regarding medical history, clinical examination or poor result of semen analysis then proceeds to these additional tests such as biochemical examination of semen, bacteriological testing hormonal analysis, chromosome analysis via a blood karyotype, absence of the epididymis or vas deferens, maldescended or undescended testes (cryptorchidism), prostatic abnormality (effecting to ejaculatory ducts), a varicocele (an enlargement of veins surrounding testicular artery and vas deferens), testicular failure resulting in small, poorly or non-functioning testes.

Diagnostic classification of semen analysis

Azoospermia - An absence of sperm in an ejaculate: cryptospermia or an absence of sperm in an ejaculate on routine testing but small numbers seen after preparation.

Oligozoospermia  -  Low sperm count

Asthenozoospermia – Poor sperm mobility

Teratozoospermia - Abnormal sperm shape and size

Oligo-astheno-teratozoospermia - Abnormal sperm numbers, movement and appearance

Other diagnosis

Genetic abnormality, infection, hormonal imbalance, immunological problems e.g. anti-sperm antibodies, endocrine abnormality e.g. diabetes mellitus or thyroid disease

Unexplained infertility

This is infertility with no apparent cause being demonstrated after all the previous history taking, examination and investigations. In certain cases, psychological factors may cause or influence infertility.

The treatments

Surgical treatments: for example removal of varicoceles, reconstructive surgery to correct blockage of sperm ducts or anatomical abnormality

Medical treatments:

Hormonal treatments: in cases of hormonal imbalance or shortage which are successful in only 1 % of cases.

Antibiotic treatment: in cases of seminal infections

Assisted conception treatments for male sub-fertility/infertility 

IUI- intrauterine insemination

After sperm preparation from the semen sample in laboratory to select the most motive and normal sperm, the preparation is injected with the aid of a catheter directly into the woman’s uterine cavity.

IVF- in-vitro fertilization

One or more eggs are retrieved from the ovaries following ovarian stimulation and these are mixed with the partner’s sperm collected by masturbation. If fertilization occurs, then development of embryos are expected and transferred into the woman’s uterine cavity on the 3-5 days after fertilization.

ICSI- intra-cytoplasmic sperm injection

This treatment is identical to IVF except that in cases of poor sperm quality. A single sperm is injected directly into each oocyte to aid fertilization. This has revolutionized the treatment of male infertility.         

Other treatment options   

DI – donor insemination

This treatment is identical to IUI but sperm is provided by a donor. IVF/DI in vitro fertilization with donor sperm IVF is performed as previously described but donor rather than partner is used.
 

When a man and a woman fell in love to each other and decide to live together, love is a bonding between them and keeps them together. As time passes, they desire to fulfill their family by creating a representative of their love called “baby”. This unique “baby” shares the couple’s genetic materials and nothing in this world can imitate this uniqueness.

How can this happen? (Fertilization and implantation of a fertilized oocyte)

When a man and a woman have sexual intercourse, after ejaculation, around 40-300 million sperms are released. The sperms will travel from cervix through cervical canal into uterine cavity and finally into fallopian tubes where an oocyte may be waiting.

The lifespan of an oocyte is about 24 hours after ovulation and sperms can live about 2-3 days inside fallopian tubes after ejaculation. Only few hundred sperms manage to find their ways to the oocyte at distal part of fallopian tube. It is a miracle, isn’t it?

When sperm meets the oocyte, it must penetrate through zona pellucida which surrounds the oocyte in order to fertilize with the oocyte. If fertilization happened, the chromosomes content in the male and female nucleus will fuse and become one first cell which immediately divides in two. This fertilized oocyte will keep on dividing and become “embryo”. The embryo continues to multiply while traveling down the fallopian tube to uterine cavity.

When embryo multiplies up to about 100 cells so-called blastocyst stage, it will snuggle into the uterine lining and called “Implantation”. Only small percentage of embryo will successfully implant and that is the beginning of pregnancy. The chances of natural conception are only 10-30 % per cycle