Treatment procedure

1. Counseling:
         Initially, the infertile couples will have a complete interview with our specialist. The information of marriage, sexual relationship, contraception, menstruation, medical and surgical history will be interviewed. The physician’s assessment of the factors affected infertility and the outline of subsequent diagnostic and treatment plans will be summarized.

2. Analysis: 
         The Patient will be subjected to a thorough physical examination, with particular attention to pelvic examination of female partner.
         Additional blood tests are also important to the assessment of pregnancy risk, including complete blood count, thalassemia, blood group, immunity to German measles and screening for sexually transmitted diseases (hepatitis B, syphilis, HIV).
         The infertility cause can be related to both female and male partner. Semen analysis can show many issues that are related to sperms such as sperm qualities and quantities. In selected cases, additional hormonal assays might be considered (FSH, LH, and Testosterone).  
         For female partner, the following investigations such as hormonal assays (FSH, LH, Progesterone, Estradiol, Prolactin), transvaginal ultrasound and hysterosalpingogram are needed in order to look for female factors.

3. Consent document: 
         It is necessary that the patient understands and gives consent for the physician to perform the procedure that had been decided for the individual cases.

Assisted Reproductive Technology

Intrauterine Insemination (IUI)
        Among the methods of assisted reproductive technology, the Intrauterine Insemination (IUI) is one of the most favorable and effective treatment. Artificial insemination with a washed sperm concentrate avoiding of the potential reaction to bacteria, proteins and prostaglandins in seminal fluid, will be performed by depositing sperm directly into the uterus on the day of ovulation.

        This method is appropriate for females without occlusion of both oviducts. Artificial insemination has been used to overcome ejaculatory problem, abnormal sperm quality and female cervical factor.

                                                                        The intrauterine insemination is a comparatively less costly method, and in general, most women will be conceiving within 3-6 insemination cycles.

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In Vitro Fertilization (IVF)
      ConventionalIn VitroFertilization first took place in mammals more than 50 years ago. The first successful IVF baby was born on 1978.
      IVF is a method of assisted reproduction in which sperm and eggs are combined outside of the body in a laboratory dish. One or more fertilized eggs (embryos) may be transferred to the woman's uterus after 72 hours.

Treatment Procedures

1. Ovarian stimulation
   In assisted reproduction, the fertility drugs (almost injections) are used to produce multiple eggs, in order to have enough embryos for transfer. Ultrasound and serial hormonal analysis are monitored during egg developments.
   
2. Egg retrieval
   Egg retrieval, or so-called “ovum pick up”, is typically performed by transvaginal ultrasound aspiration under general anesthesia on an outpatient basis.
   
3. Sperm processing
   Sperm are collected and processed on the same day of egg retrieval in preparing for in vitro culture.
   
4. Fertilization and embryo culture
   The concentrated motile sperm are incubated overnight together with the eggs. Fertilization is documented 16 to 18 hours later on. Then embryos are cultured under the quality control condition.
   
5. Embryo transfer
   After being cultured for 3-5 days, the embryos will be transferred into the uterus, await for implantation.
   
6. Luteal support
   Vaginal progesterone supplementation is to prescribe routinely in order to strengthen endometrium for implantation.
7. Pregnancy testing
   The test will be performed within 10-14 days after the embryo transfer.

Intracytoplasmic Sperm Injection (ICSI)
     ICSI is an assisted fertilization technique. A single viable sperm is injected directly into the egg under magnification with high power microscope.

     This technique is appropriate for couples with bilateral tubal block male factor infertility with very low sperm count or prior failed or poor fertilization with conventional IVF.

Surgical sperm retrieval technique
      When there is no ejaculate or only rare or no sperm in the semen, a variety of surgical methods can be used to retrieve sperm for fertilization.

Percutaneous Epididymal Sperm Aspiration (PESA) and Testicular Sperm Extraction (TESE)
      PESA, a less invasive technique, can be performed under local or general anesthesia. The procedure is performed by using a needle insertion into epididymis to retrieve fluid which may contain sperm. On the other hand, TESE is an open minor surgical technique as testicular biopsy. In which tissues were extracted to look for sperm. ICSI will be the treatment of choice for this patients, a very small sperms with normal morphology, are retrieved by the surgical methods.์ พร้อมที่จะเจริญเติบโตอย่างปกติ

Laser Assisted Hatching (LAH)
      Laser assisted hatching is a technique for artificially thinning or opening of the zona to improve implantation potential if needed. This procedure would enhance the implantation rate in selected patients.

Benefits of LAH

• Increase chance of successful embryo hatching.
  
• Facilitate implantation of the embryo into the endometrium.
  
• Increase pregnancy rate

Pre-implantation Genetic Diagnosis (PGD)
      PGD is performed by extraction of 1 or 2 cells of the embryo, processed for genetic analysis.

Benefits of PGD

• Detection of chromosomal abnormalities and genetic diseases.
  
• Increase successful pregnancy of conventional IVF.
  
• Reduction of miscarriage rate.
• Reduction of fetal anomalies.

Sperm cryopreservation (sperm freezing)
      Sperm cryopreservation has become an available option to allow fertility preservation in young men who are faced with surgery, radiotherapy or chemotherapy for cancer treatment. Also, it is an optimal choice for male partner with ejaculatory problem. Sperm can be preserved for several years if the storage is in liquid nitrogen tank at suitable temperature (- 196 oC).

Embryo cryopreservation (embryo freezing)
      Embryo freezing permits the excess embryos after single transfer to be frozen for the couple’s later use in non-stimulated cycle.

Oocyte donation
      Oocyte donation is now becoming a popular option due to better success rate in selected cases. Donor oocytes should be considered for women with ovarian failure, genetically-transmitted disease, diminish ovarian reserve and inaccessible ovaries.

Sperm donation
      Sperm donation should be considered for male partners with extremely low sperm count, azoospermia (absent of sperm in the ejaculate) and genetically-transmitted disease.

Sperm Bank
      In general, sperm bank recruits healthy young donors having outstanding semen quality. All of sperm donors have been repeatedly screened for sexually transmitted infections before acceptance.
     Sperm specimens must be quarantined by storage in freezing tank and cannot be released for use unless the repeated HIV test is negative.