Since the pioneering conception of the first in vitro fertilisation (IVF) baby in 1977, the treatment mode has been a boon to a multitude of infertility patients. Transfer of fertilised product of mature egg and healthy sperm into the uterus has made life easier for patients as well as clinicians. Nonetheless, the inhibitions of patients leading to lacunae in their case-study along with the sheer popularity of this procedure has been driving couples to resort to despite that there are other simpler, safer and economic assisted reproductive techniques (ARTs) available to enhance one’s chances of conception.
Alternatives to IVF
- Fertility Drugs
Fertility Drugs may be prescribed to women with slight hormonal imbalances. Disruption in hormonal levels result in irregular ovulation associated with polycystic ovary syndrome (PCOS), obesity, hyper/ hypo-thyroidism or eating disorders. Hormonal manipulation can help restore the follicle stimulating hormone (FSH) levels to stimulate egg production.
Doctors may prescribe fertility drugs to male partners also in order to improve sperm quality or quantity.
Common Fertility Drugs
Clomiphene – It modulates the level of estrogen receptors which in turn tricks the brain into producing increased FSH and the brain is stimulated to produce more eggs.
Bromocriptine and Cabergoline – These drugs are suggested to females suffering from hyperprolactinemia or high prolactin levels which prevent ovulation.
Gonadotropins – The other alternative is direct administration of gonadotropins which would stimulate single or multiple ovulations.
Human chorionic gonadotropin (hCG) – hCG injections are usually administered for up to a period of six months to boost testosterone levels and consequently, sperm production. In certain cases, human menopausal gonadotropin (hMG) or recombinant human follicle stimulating hormone (rhFSH) may be administered in combination with hCG when the latter is not effective alone.
Gonadotropin releasing hormone (GnRH) – This treatment is opted in case of males suffering from hypothalamic disease which causes hypogonadotropic hypogonadism.
- Risk/ Side effects
Side Effects – Nausea, heat flashes, mood swings, mild depression, headache, breast tenderness, blurred vision, thick and dry cervical mucus, ovarian cysts
Risk – Since most of the fertility drugs target at inducing multiple ovulations, the chances of multiple conceptions also increase and so does the probability of accompanying complications like miscarriage or premature delivery.
Side Effects – Problems with vision, breast enlargement/ tenderness, weight gain, nausea, acne, changes in sex drive
2. Intra-Uterine Insemination (IUI)
It is an artificial insemination procedure suggested for couples with poor sperm motility in males or cervical mucus problems in females. It is also opted by potential single mothers or same sex female couples to get pregnant with a donor sperm.
The method involves semen testing and washing of sperms for selection of quality sperms free of seminal fluid and other chemicals. Washing also boosts sperm activity, hence enhancing the chances of pregnancy. Ovulation would be monitored in females to ensure the reproductive health of egg as well as uterus. Finally, sperm is injected into the uterus in conjunction with timing of female ovulation.
- Enhancing the chances of conception
IUI regimen comprising of with two inseminations per cycle
Usage of frozen sperm for insemination
Combination of the regimen with administration of ovulation-inducing fertility drugs
- Risks/ Side effects
Side effects – Mild cramping/pain, sexually transmitted disease (STD) / infection (very rare)
Risks – Side effects of IUI are very limited except in cases where the procedure is implemented in combination with fertility drugs, hence risks and side effects associated with the drugs may be observed.
3. Gamete intrafallopian transfer (GIFT)
GIFT is a subtle variation of IUI, varying in terms of location of injection of sperm and egg mixture. Following induction of ovulation using fertility drugs, the combination of eggs and sperms are delivered via a catheter into the fallopian tubes. The fertilisation occurs in vivo unlike IVF where fertilised embryo is placed into the uterus.
- Risks/ Side effects
Side effects – Reaction to anaesthesia, side effects associated with fertility drugs,
Risks – Multiple pregnancies, complications associated with pregnancy like miscarriage and ectopic pregnancy
Surgery may be considered in patients with diagnosed clinical conditions or anatomical abnormalities. Not only does it enhances the probability of conception, but also relieves the patient of pain associated with the disease. Reversal of sterilisation procedures may also be achieved via laparoscopic or microsurgical treatments.
- For Women
Conditions like fibroids, endometriosis or scarring associated with the uterine tissue may be surgically treated to overcome fertility problems in women
- For Men
Surgical treatment of varicocele (abnormal enlargement of scrotal veins) in males may also resolve conception issues for a couple.
- Risks/ Side effects
The decision of surgery should be made only after consulting with a fertility specialist with regard to factors like invasiveness, recovery and cost of procedure.
5. In vitro maturation (IVM)
IVM is a recent, improvised version of IVF wherein eggs are collected from ovary in the immature state and conditioned to maturity in vitro. It is preferred to conventional IVF as it does not require a prolonged usage of fertility drugs, hence eliminating the risks of multiple pregnancies and hormone-related side effects. It is not only a safer and cheaper alternative but also customises the approach of treatment for each individual. After collection and induced maturation, intracytoplasmic sperm injection (ICSI) may be carried out for fertilisation followed by transfer of fertilised embryos to the uterus.
- Risks/ Side effects
Side effects – Reaction to anaesthesia (Since the technique is recent, very few IVM cases have been studied and more investigation is required for assessment of its safety and risks)
Any of the ARTs including IVF must be selected after intensive consultation with a specialist as the selected mode of treatment varies from individual to individual. The pros and cons of each procedure should be well assessed to ensure a healthy life for both parents and child. Apart from the above listed procedures, one may also opt for adoption which is not only a way for fulfilment of one’s wish for a child but also a contribution to society as a whole.