To understand how infertility diagnosis and treatment are improving, we first must understand a bit about infertility itself. About one in six couples will experience infertility, meaning they have not conceived after trying for a full year. The underlying cause is attributable to the female partner 30% of the time, to the male partner 30% and a mutual problem in 30%. About 10% of infertile couples have no obvious cause. These causes may be abnormal sperm or an inadequate number of sperm, ovaries that do not ovulate regularly, such as in women with polycystic ovarian syndrome, endometriosis, Fallopian tube blockages or anomalies of the uterine lining, or obstructions in the uterus such as fibroids. Most evaluations begin with a careful history, looking for cycle abnormalities or other underlying medical problems, a semen analysis for the male partner, an ultrasound to look at pelvic structures and an evaluation of the uterus and tubes.
PARRYSCOPE REPLACES PAINFUL TESTING
One of the exciting improvements is the ability to evaluate the uterus and tubes differently. Traditionally, this has been done with an X-ray test called a hysterosalpingogram. This procedure puts dye through the cervix to see if it fills a normally shaped uterine cavity and spills out the end of the tubes. This frequently is accompanied by severe cramping and abdominal pain.
A new approach, pioneered by Dr. Preston Parry while he was chief of reproductive endocrinology and infertility at the University of Mississippi Medical Center, is called the Parryscope and involves an in-office scope using a very slim, flexible camera to assess the uterus’s interior and the condition of the Fallopian tubes. This allows for the diagnosis of problems that may have been missed on X-ray like endometritis (inflammation or infection of uterine lining), adhesions or retained products of previous conceptions. The process also uses water and air bubbles to see if the tubes are open.
THE RISE OF ROBOTIC PROCEDURES
The widespread availability of robotic surgical procedures also allows better infertility treatment. Robotic procedures are minimally invasive, which often means less postoperative pain. Robotic procedures are an excellent surgical treatment of endometriosis, and, in some cases, even fibroids can be removed with minimally invasive robotic techniques. Reconstructing Fallopian tubes (tubal reanastomosis) with robotic surgery results in more accurate suture placement and improved success rates. Ultimately, this leads to less downtime and pain.
TECHNOLOGY IS IMPROVING IVF SUCCESS RATE
Though most people with infertility will not need in vitro fertilization to conceive, those who do can benefit from new technology. Preimplantation genetic testing (PGT) tests the genetic material in an embryo before it is transferred to the uterus. This is especially helpful for patients who carry genes for certain diseases, those of advanced maternal age or those who have miscarried repeatedly due to chromosome abnormalities.
Identifying an embryo with the correct complement of chromosomes helps reduce the risk of miscarriage and improves IVF success rates with transfer of a single embryo, also reducing the risk of complications related to the birth of multiple babies.
PROMISING ADVANCES ON THE HORIZON
Even more exciting advances are on the horizon, but they may not be clinically available yet.
Microfluidic technology uses very small channels and wells of fluid to create an ideal environment to nourish embryos as they grow and to prepare eggs or embryos for cryopreservation. Newer tests suggest that healthiest embryos may be selected by the metabolites they produce, with a goal of choosing an embryo in a non-invasive manner. Robotic techniques may be used to improve intracytoplasmic sperm injection (ICSI), a procedure sometimes used in IVF to help sperm fertilize an egg.
All these procedures show great promise but need more testing to ensure they offer consistent and successful results while remaining affordable.
All these great developments should encourage couples needing help with fertility. On the Coast, in particular, patients have greater access than ever. Over time, several reproductive endocrinology/infertility specialists have opened in our area and continue to do so. Additionally, area hospitals have increased their robotic surgical capabilities. All these factors reduce the time, travel and expense of infertility treatments and allow for greater access and success.
