Ovulation Induction (OI)
The simplest form of fertility treatment designed to help women who do not ovulate naturally, or who ovulate infrequently. Medication is given to stimulate egg production. Tablets and injections are given shortly after the commencement of the period and the growth of the follicle (bags of fluid which contain eggs) are monitored by serial ultrasound scanning. Once the follicles have reached the appropriate size, an hCG injection is given to stimulate final egg maturation and release of the eggs from the follicle. At this time, the couple is advised natural intercourse.

Intra uterine insemination (IUI or AIH)

Intra uterine insemination or Artificial Insemination is done using the husband’s sperm. Where no cause of infertility is found i.e. unexplained infertility, this treatment may be used. It can also be used in situations, when semen quality is slightly sub optimal. This is the simplest form of assisted conception treatment. The ovaries are stimulated with tablets and Gonadotrophin injections as described for Ovulation induction. At the time of ovulation, the husband’s sperm is prepared in the IVF laboratory and then gently placed into the uterus. This procedure increases the chance of pregnancy to about 19-22%. This treatment is appropriate for couples where the husband’s semen has normal parameters or mild abnormalities, and the wife has open fallopian tubes.

Surgical Sperm Retrieval Techniques
These are used when no sperm is found in the semen.

Two techniques exist:
1. Percutaneous Epididymal Sperm Aspiration (PESA)
If a blockage in the epididymis or congenital absence of the vas deferens (the drainage tube for sperm from the testis to the penis), is the cause for Azoospermia (no sperm in the semen), then this procedure is indicated for obtaining sperm.

A very fine needle is inserted into the Epididymis (the sperm collecting tube outside the testis) and sperms are aspirated. This procedure is performed under local anaesthesia, requires no incision, and the patient can get back to work the same day.

2. Testicular Sperm Aspiration (TeSA)
In some men, the production of sperms in the testis is very low and no sperms are seen in the semen. TeSA is a way of obtaining the few sperms that are available in the testis. Using local anaesthesia, a needle is inserted into the testis to obtain some tissue. This tissue is carefully dissected in the laboratory and the few sperms obtained may be used for ICSI or frozen for later use.

Assisted Reproductive Techniques (ART)
These are sophisticated laboratory based infertility techniques for couples who require advanced treatment to be able to conceive.

In vitro Fertilization (IVF) or test tube baby treatment
When a woman has blocked or damaged fallopian tubes, but her husband’s sperm is healthy, IVF is the way for her to conceive. The woman's ovaries are stimulated by Gonadotrophin hormones in order to get the ovary to develop more eggs. When the follicles containing the eggs have developed adequately, the eggs (oocytes) are collected and mixed with a sample of the husband’s sperms. The mixture of eggs and sperms is incubated in a suitable environment in the laboratory. The procedure of egg collection involves a small operation (ultrasonographically guided transvaginal oocyte retrieval) performed under sedation on an outpatient basis. The operation is virtually painless and the patient can go home approximately four hours later. The eggs fertilize in the laboratory and divide over 2-3 days. The resulting embryos are then gently replaced into the uterus by a simple and painless procedure. If the embryos implant into the lining of the womb, a pregnancy occurs. This treatment can also be used for couples with unexplained infertility.

Intra Cytoplasmic sperm injection
When the husband’s sperms have poor movement or the count is very low, IVF will not work, as the sperms will not be able to enter the eggs. In these situations, ICSI is the only option. In this technique, each egg is injected with a single sperm. If fertilization and cleavage occur, the embryos are then replaced into the uterus as in IVF. ICSI is the only treatment for severe male factor infertility. In this procedure, even sperm obtained by TeSA or PESA i.e. testicular sperm or epididymal sperm can be used successfully. This procedure has helped couples who in the past had no hope of becoming parents.

Frozen Embryo Replacement (FER)
When embryos are left over from the initial IVF/ICSI procedure, the extra embryos can be frozen and transferred during a subsequent natural cycle.

Assisted Embryo Hatching
Where the shell covering the embryo is opened so as to allow the embryo to hatch and implant easily. This technique helps patients with repeated failure with the IVF or ICSI technique, women over the age of 38 and women undergoing FER.

Blastocyst Transfer
This involves the culture of embryos for 5 days in the laboratory to a stage called Blastocyst. This helps in the selection of embryos most likely to implant.