Assisted Reproductive Techniques

In-vitro Fertilization
In-vitro fertilization (IVF) is recommended for people who suffer from tubal illness and female infertility that does not have any certain reason. It is also used by men who suffer from male infertility. This method is applied for the fertilization of human ova that is concentrated of 20,000 to 100,000 motile sperm. IVF helps human sperm to get in the female reproductive tract. Fertilization is applied when there is male infertility. Gamete intrafallopian transfer (GIFT) is a method similar to IVF, the sperm combined with the ova gets into the fallopian tube for fertilization. Gamete intrafallopian transfer applied for fertilization can be conducted in the fallopian tube. Fertilization is successful when a pregnancy occurs. IVF and GIFT can be conducted under the names:  pronuclear stage tubal transfer (PROST), zygote intrafallopian transfer (ZIFT), tubal embryo transfer (TET) and tubal embryo stage transfer (TEST). These techniques demand the in-vitro fertilization of human eggs conducted after putting of the early-stage embryo again into the fallopian tube. These methods are successfully used for achieving pregnancy when men are infertile; their effectiveness is from 10-35%. Fertilization should be used for couples who have antisperm antibodies.

Therapy for Retrograde Ejaculation
Antegrade ejaculation is the result of alpha-adrenergic stimulation with Ornade, Sudafed or Tofranil. Alkalinization of the bladder urine conducted with oral sodium bicarbonate or polycitra and retrieval of sperm from the bladder after ejaculation have shown its effectiveness for artificial insemination.

Treatment of Infection
Patients, who have symptomatic or genitourinary tract infection, are recommended to take inside the appropriate antibiotics. Tetracycline can also be used.

Empiric Therapy
40% of infertile men belongs to patients who suffer from idiopathic male infertility. The patients are eager to be cured with nonspecific therapy. Arginine, bromocriptine, corticosteroids and thyroid preparations can not treat infertility applied empirically. Clomiphene citrate (Clomid or Serophene) considered to be the most widespread medicine for male infertility. GnRH becomes higher; estrogens circulate causing androgenous gonadotropin secretion’s stimulation. High LH and FSH lead to high intratesticular testosterone levels and make spermatogenesis better. The recommended dosage of comiphene citrate is 25-50 mg a day during 3-6 months. You should adjust to the dosage gradually during four weeks beginning from 25 mg per day. The medicine influences semen parameters and is effective for pregnancy rates.

Artificial insemination is the use of the husbands sperm for insemination. The method is applied when low semen volumes are observed or where repeated post coital tests have shown cervical hostility. Its effectiveness is not observed among patients who suffer from oligospermia or asthenospermia. Enlarging follicles are observed with ultrasound and the purpose of urine testing is the prediction of the LH surge’s timing. Ovulation makes the process successful. Therapeutic donor insemination has shown its effectiveness, especially for couples with male infertility.

There is one more technique used by patients whose concentration of functional sperm is very low. Micromanipulation of gametes and assisted fertilization are applied for the sperm and ova’s surgical manipulation. Micromanipulation demands partial zone dissection (PZD), subzonal sperm injection (SZI) and intracytoplasmic sperm injection (ICSI). Fertilization rates are 20-40%, clinical pregnancy rates are 30% and men’s factor is10%.