Struggling with infertility – A common issue among couples

For married couples struggling with infertility, having tried various methods without success, there may be many questions about infertility—how to treat it, what methods are available, how to track ovulation, and whether one can take ovulation-stimulating medication on their own. Let’s address these concerns.

Q&A on Infertility Consultation

Q : When should one consult about infertility?

A : Infertility is defined as a couple having regular sexual intercourse (about 2-3 times a week) for one year without conceiving. Couples in this situation should consult about infertility. However, there are cases where early consultation or treatment is needed, such as couples over 30 years old, women with pre-existing conditions, irregular menstrual cycles, or severe menstrual pain. These cases might warrant consultation before the one-year mark. Sometimes, preliminary screening is done to find causes in both partners before marriage or conception

Q: What tests are necessary for diagnosing infertility before treatment?

A : To diagnose infertility and find the cause, which leads to appropriate treatment, doctors will review the couple's history, perform physical exams, and conduct laboratory tests such as blood tests, genetic screening for thalassemia, urine tests, and screening for hepatitis B, among others. Additional specialized tests include:

• For men: Semen analysis to assess sperm count, motility, size, shape, and overall quality.
• For women: Pelvic ultrasound to check for abnormalities in the uterus and ovaries, and hormone tests such as:
  • AMH (Anti-Müllerian Hormone) to evaluate ovarian function.
  • TSH (Thyroid-Stimulating Hormone) to check thyroid function.
  • PROLACTIN to assess its impact on ovulation.
  • FSH (Follicle-Stimulating Hormone) to evaluate egg development and menstrual cycles.

Q : How can someone with infertility improve their chances of conceiving?

A : It depends on the cause of infertility. Generally, couples should maintain good health, eat nutritious foods, avoid alcohol and cigarettes, exercise regularly, and get enough rest. Consulting a fertility specialist is crucial for appropriate treatment.

Q : How do you track ovulation?

A : Tracking ovulation is suitable for those with regular menstrual cycles, typically about 28 days. Ovulation usually occurs around the middle of the cycle, approximately day 14 from the first day of the last period. However, it can vary. It’s recommended to have intercourse every other day during the expected ovulation period.

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Q&A on Infertility Treatment

Q : What are the methods for treating infertility?

A : Initial methods may include tracking ovulation and timing intercourse, possibly combined with ovulation-stimulating medications or injections to increase egg production. Technology-assisted methods include intrauterine insemination (IUI), where sperm is injected into the uterus, and in vitro fertilization (IVF) or ICSI (intracytoplasmic sperm injection), where eggs and sperm are combined in the lab to maximize pregnancy chances. The choice of method depends on the specific circumstances of the patient.

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Q : How much does infertility treatment cost?

A : Costs vary based on the patient's condition. Some may only need ovulation tracking and hormone tests, which may be relatively inexpensive. Others might require surgery or expensive medications, particularly for stimulation. IVF is more costly and can range in the hundreds of thousands, depending on the hospital. Not everyone needs IVF, so treatment costs depend on individual conditions.

In vitro fertilization (IVF) tends to be more costly, depending on the hospital, and can range in the hundreds of thousands of baht. However, not everyone needs IVF, so the overall cost of infertility treatment varies based on each individual’s condition.

Q : Are babies born from infertility treatments healthy?

A : Studies show that the rate of birth defects from IVF and ICSI is similar to natural pregnancies, except for twin pregnancies. Advances like Preimplantation Genetic Diagnosis (PGD) can help screen embryos for genetic abnormalities, reducing the risk of birth defects.

Q : How should one take ovulation-stimulating medication?

A : Ovulation-stimulating medication should be prescribed by a fertility specialist and is not available over the counter. It is typically taken for 5 days during the menstrual cycle to increase the number of eggs. This may sometimes be used with IUI.

Q : What are the effects of frequent egg stimulation?

A : Frequent stimulation might decrease the number of eggs and affect hormone balance. Taking breaks between stimulation cycles might help restore normal menstruation. However, irregular periods might have other causes and should be evaluated by a specialist.

Q : What is preimplantation genetic diagnosis (PGD)? Is it necessary for everyone?

A : Preimplantation genetic diagnosis (PGD) is a method used to analyze the genetic material from some cells of an embryo, either at the gene or chromosome level, to select embryos with normal genetic makeup for transfer into the woman’s uterus.

PGD may not be necessary for every couple, but it is required for those with specific indications, such as:

• Couples experiencing infertility issues.
• Couples who have had more than two miscarriages due to chromosomal abnormalities in embryos or unknown causes.
• Couples who have undergone IVF with good-quality embryos but failed to achieve pregnancy, where the issue may be chromosomal abnormalities not previously tested.
• Couples with chromosomal translocation.
• Couples where the woman is over 35 years old.
• Couples with known genetic disorders.
• Couples with a history of pregnancies involving genetic abnormalities.
• Couples where the male partner has abnormal sperm
• Couples with genetic disorders linked to severe cancers, such as breast or ovarian cancer, that are hereditary.

Q: If we want a healthy baby free from chromosomal abnormalities, is it possible, and what is the most suitable method?

A : Yes, it is possible to increase the chances of having a healthy baby free from chromosomal abnormalities. One effective method is preimplantation genetic diagnosis (PGD), which allows for the analysis of the chromosomes of embryos before they are implanted into the uterus. This ensures that only embryos with normal chromosomal patterns are selected for transfer.

A newer and recommended technique is Comparative Genomic Hybridization (CGH). This method allows for the analysis of all 24 chromosome pairs, offering higher accuracy and better success rates compared to the older technique, Fluorescence In Situ Hybridization (FISH).

Q : What risks do older women face when it comes to having a baby with abnormalities, and are there any preventive measures?

A : As women age, the number and quality of their eggs decrease, leading to a higher chance of chromosomal abnormalities during cell division. This results in difficulties conceiving, a higher risk of miscarriage, and an increased likelihood of chromosomal abnormalities in the baby, such as:

• Structural chromosomal abnormalities: Such as translocations and inversions.
• Numerical chromosomal abnormalities: Such as Down syndrome (Trisomy 21) and Turner syndrome (Monosomy X).