Treatments
There is no simple solution for male infertility.
Treatment will depend on the test results and the likelihood of success of
therapy. Depending on the severity of the disorder, doctors may choose from a
variety of treatments, which can be simple or complex. However, at present even
the most difficult causes of male infertility are likely to be medically - and
even more serious cases, in which the only solution few years ago was
artificial insemination from a donor (AID) or adoption they have been successfully
treated by the new techniques of microinjection of sperm.
Because there is a wide range of therapeutic options
and considering that some treatments have not widely available, both doctors
and patients face the need to take a number of significant decisions. If
treatment is deemed appropriate, the available options are pharmacotherapy
alone, fertilization in nitro (IVF), gamete transfer into the fallopian tubes
(GIFT), artificial insemination from a donor (AID or DI) , superovulation and
intrauterine insemination (IUI), and fertilization by the technique of
intracytoplasmic sperm injection (ICSI).
pharmacotherapy
There is no simple drug therapy to increase sperm
concentrations or correct the shape of the sperm. Some drugs have been used
successfully in cases of impotence, particularly when it is associated with the
male sex hormone testosterone.
Furthermore, when the man suffering from a disorder
known as hypogonadotropic hypogonadism - which is the inability of the testes
to produce sperm due to inadequate stimulation or complete absence of
stimulation of the testes by the hypothalamus or pituitary gland in the brain
-can substitution treatment administered hormones to stimulate the testes.
These hormones "reproduction" are known as gonadotropins, and can be
administered both men and women - to stimulate the development of eggs in women
and sperm in men.
* AID = Artificial Insemination by donor
In
vitro fertilization
IVF is the original technique of "test tube
babies" and the assisted conception procedure that is most frequently
practiced worldwide. In simple terms, IVF involves removing one or more eggs
from the ovaries to be fertilized with the man's sperm in the laboratory and
transferring a small selection of the output to the matrix for implantation and
development of embryos pregnancy. Although IVF was developed to treat couples
whose main cause of infertility is damage to the fallopian tubes, the technique
has also proven useful in cases of infertility caused by sperm count below
average or morphological defects of spermatozoa . Modern techniques of sperm
preparation (washing and culture) can improve the viability of sperm samples
and increase the chances of fertilization.
Insemination
from donors
Insemination with donor sperm is usually reserved for
cases of severe sperm abnormality and was carried out with the sperm of an
anonymous donor (AID or DI). However, with the recently introduced techniques
such as ICSI, fertilization and development of a successful pregnancy with
concentrations lower than average sperm can be achieved, which has increased
the chances of effecting treatment with the sperm of the partner.
The most favorable results are obtained when
insemination coincides with ovulation induced by fertility drugs. However, it
is important that physicians who apply this procedure performed ovarian
stimulation monitoring of drug therapy to make sure they are not developing too
many eggs in the ovary. The presence of an excessive amount of eggs can
increase the risk of a multiple pregnancy. Generally the aim of all artificial
insemination procedures is to generate three eggs at most. While this is a much
lower figure than in IVF, the risk of multiple pregnancy is minimized.
When approaching the scheduled time for ovulation, a
sample of fresh semen of man (produced on the same day) is prepared and placed
on top of the woman's uterus using a thin catheter for it. This procedure is
known as intrauterine insemination or IUI. Since fertilization takes place in
the natural environment (ie, in the fallopian tube), at least one of the tubes
of women must be open.
The success rate of IUI after ovarian stimulation is
10 to 15% per cycle, but can be up to 50% after several attempts in one year.
It is important that the sperm count in men is within a large "normal"
limit and fallopian women are healthy. Today almost all IUI procedures are
performed with the sperm of the partner.
The
IUI step by step:
Pharmacotherapy to stimulate maturation two to ten
eggs.
Gonadotrapinas are generally administered to
stimulate the growth of follicles and cause ovulation
Peer monitoring treatment measure growth £ oliculos,
individualizing drug dosage and prevent side effects seriosbr.
By transvaginal ultrasound examination (two or three
times during a treatment cycle). Sometimes by quantification of hormones in
blood samples.
The sperm sample obtained the day of ovulation, is
prepared and injected later that day.
Pregnancy test monitoring.
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