Any underlying medical condition that may be contributing to fertility problems should be the first focus of treatment. Drug therapy may be used to treat hypogonadism and other hormonally related conditions. Surgery is used to repair varicoceles and correct any obstructions in the reproductive tract.
Intrauterine insemination and assisted reproductive technologies such as in vitro fertilization should be considered if the fertility issues remain unresolved. Intracytoplasmic sperm injection is commonly used in combination with in vitro fertilization in cases of male factor infertility.
Choosing a good fertility clinic is always important. Those offering assisted reproductive techniques are not always regulated by the government and they may not have informed consent, may use the embryos without authorization and sometimes fail to screen donors for disease. A best clinic should always be open in providing the following information like live birth rate and not the pregnancy success rate and success percentages from high risk woman.
Any medical technique that helps couples conceive can be called as an assisted reproductive technology. These procedures either use a couple's own eggs or sperm or donor eggs, sperm, or embryos. Fertilization may occur either in the laboratory or in the uterus. Technically, the term ART refers only to fertility treatments, such as in vitro fertilization (IVF) and its variants, which handle both egg and sperm. Intrauterine insemination (artificial insemination) is not officially considered a form of ART.
Sperm retrieval: Sperm has to be collected before fertilization using intrauterine insemination (IUI) or intracytoplasmic sperm injection (ICSI) can take place, the sperm must be collected and prepared. When a man has no available sperm in the ejaculate due to blockage, vasectomy, or lack of vas deference, the sperm must be retrieved from the testes or the epididymis with Testicular Fine Needle Aspiration, Microsurgical Epididymal Sperm Aspiration, Percutaneous Epididymal Sperm Aspiration, Testicular Sperm Extraction or Testicular Sperm Aspiration.
Sperm Washing: Sperm is washed from the seminal fluid to improve the ability of sperm to move towards the egg. The swim-up technique is a useful diagnostic procedure for testing the ability of sperm to escape from the semen into the cervical mucus; in addition it also achieves the goal of removing sperm from semen.
Sperm can be fresh or frozen in advance. Frozen sperm provide excellent results and can be used confidently for fertilization procedures. Fresh sperm, however, are preferred by some centers for cases when low sperm count is not caused by obstruction.
Intrauterine Insemination (Artificial Insemination): This is the least complex of fertility procedures and the preliminary step tried in uncomplicated cases of infertility. The sperm is either placed directly in the cervix (called intracervical insemination) or into the uterus (called intrauterine insemination, or IUI). IUI is less expensive and have less risk for multiple births than the more advanced assisted reproductive technologies. This technique is used when a woman's cervical mucus is unreceptive or when donor sperm is required or when sperm count or motility is very low or when unexplained infertility exists in both partners. More advanced reproductive technologies are taken in to consideration when this fails.
Intracytoplasmic Sperm Injection (ICSI): When male infertility is the main factor for infertility, intracytoplasmic sperm injection is used. This technique is usually used in combination with in vitro fertilization (IVF). An egg obtained from IVF is injected with a single sperm. The chances for success are best for women younger than age 37. Multiple births are frequent in IVF/ICSI since several embryos are implanted to increase the chances for pregnancy success. Multiple pregnancies increase the risks for the mother and babies. In babies premature delivery can cause low birth weight which eventually result in heart and lung problems and developmental disabilities in children. The risks to the mother include ovarian hyperstimulation due to the fertility drugs used in the procedure. Ovarian hyperstimulation can cause dangerous fluid and electrolyte imbalances as well as increased blood pressure and higher risk for blood clots.
Not all IVF/ICSI cycles result in pregnancy, and not all IVF-achieved pregnancies result in live births. Success rates provided by fertility clinics are not always a reliable indicator as they depend on many variables, including the age of the patients.