In line with the modern trend, the options available are:
- Conventional treatment methods
- Assisted reproduction technology (ART)
- Conventional Treatment Methods: The principle here is to facilitate and improve functions of the inner mechanism in both the man and woman responsible for conception without taking over the functions artificially. By this method, the processes leading on the release of the gametes (sperm or eggs) are facilitated using drugs or an surgical operations to correct the anomalics in the structures like the tubes, uterus, ovaries or tests which have been preventing conception an often backed up with drugs at the subsequent follow-up. Thus, essentially, the conventional infertility treatment method refers to the use of drugs or surgical operations either singly or in combination to improve the internal processes responsible for conception in structures and or functions. The methods are as follows:
- Conventional types of treatment methods in the woman: Ovulation induction: This is the use of very potent drugs (tables and pessaries, injections) to bring ovulation. It is often more successful in the younger women aged 34 years or less. A course of treatment is for 4-6 cycles.
- Repair of the damaged or blocked fallopian tubes: This is done surgically at the operation called tuboplasty. The success rate is low generally about (5-10)% worldwide but is higher in the young woman who is 32 years or less and much worse for the older woman of about 35 years or above.
- Removal of fibroid or myomectomy operation: This is done surgically at the operation done through the abdomen at which the fibroids are carefully removed in such a manner that the uterus or tubes or ovaries are not damaged. Great care is exercised at this operation to ensure particularly that the uterus remains and functions well normally at subsequent menstruation afterward. This is why we advocate at St. Augustine that this operation should be performed by the infertility like anovulation which may co-exist with the fibroid have been identified and treated or else the infertility will persist and the fibroid will usually re-grow.
However, removal of the fibroids in some situation came to be come with some special injections often administered once every month. It is used for smallish fibroids specially for these who are young. It is also used and actually preferred in women who have had previous operations on the abdomen especially when it is more than once, whether for fibroids or not. It is also used for women with moderate size fibroids who wish to be treated with IVF treatment soon after the drug treatment. Finally, injections are preferred to remove the fibroids in those women who form Kelloid to surgical incisions or any injury on the skin. The common duration for which the injections are used to melt fibroids is 4 to 6 months. The women are often informed that, when the drug is working effectively, the menstruation will stop but will return promptly again about 1-2 months after the drug is stopped. The fibroid may grow back again 6-8 months after the end of the treatment unless a pregnancy occurs. Hence we take steps at St. Augustine to ensure a pregnancy in our patient treated with the injections to melt the fibroids.
- Treatment of the intra-uterine adhesion: This is usually in the operating theatre, after anaesthetising the patient to reduce the pain using uterine sound or special instrument called the hysteroscope. After the adhesions are removed, the newly recreated uterine cavity is often kept patient with a device like foley catheter balloon which is kept insitu for only 10 days or any of th inert IUCD which is kept insitu for about three months. Some drugs are used after the adhesiolysis, to ensure regeneration of the inner lining of the uterus called endometrium and these drugs also ensures monthly menstruation while is being administered for some three consecutive months. In some women, the adhesion after this form of treatments as above may not fully clear the adhesion and the process may have to be repeated again on one or even two or more occasions.
CONVENTIONAL TYPES OF TREATMENT METHODS IN THE MALE
The conventional treatment of man includes the followings:
- Drugs
- Hormone imbalance: In the form of tablets or injections or very rarely implants are used for problems of hormone imbalance affecting the male hormone called testosterone. This has varying degree of success especially when the sperm count abhormalities re of a mild or moderate degree. The correction of hormone imbalance associated with severe sperm count anomalies is not commonly as successful in restoring the sperm count anomalies to normal.
- Treatment of other disease: Other disease like diabetes, thyroid disease etc may be responsible for the low sperm count and other anomalies on semen examination, the treatment of which commonly will reverse the anomalies and restore full normal functions. This is why at St. Augustine ART Unit we do screen for the other disease and it is important to do this because in most cases the treatment restores normal function to the joy of all surgical operations.
- Surgical operations: These are arranged in collaboration with the urological surgeons in the following situations.
- Restoration of obstruction to the sperm production: This is done to correct azoospemia which is caused by obstruction to the discharge of the spermatozoa. When this operation is successful, the sperm parameters are often restored to normal and pregnancy may easily occur particularly where this is the only cause of the infertility in the couple.
- Ligation of the testicular varicose veins: This operation which is called Varicoselectomy is only performed at St. Augustine Medical when oligospermia or other semen anomalies is found in the man of aga 25 years or less who is found as well to have testicular varicose veins on one or both testes. This is because, of studies which have revealed very poor responses in performing the operation as treatment for semen anomalies in men who are elder than 26 years. Our experience confirms this fact, but additionally that the operation commonly is associated with further deterioration of the semen parameters particularly when done in the older man.
- Adjunctive treatment in the man: These include advises on improved exercise; vitamins with essential elements and anti-oxidants and avoidance of alcohol etc. In general alteration in life styles with emphasis on reduced stress, help quit considerably in enhancing functions for male human reproduction.
