Infertility treatment depends in principle on the cause(s) of infertility, the duration of infertility and the age of the female partner. The more precisely these causes are known, the more specifically they can be treated.

Please remember: The following are general descriptions of treatments. As each patient's condition is different, treatment(s) are recommended according to the cause(s) and individual circumstances. Please consult your doctor about the most suitable treatment, or if you have any questions.

General Measures before Infertility Treatment

Some simple modifications of life style can help to improve fertility or infertility treatment outcome. These include reduction or cessation of smoking and alcohol intake. For a female partner who is obese (BMI > 30kg/m2), weight reduction may help to resume ovulation and improve spontaneous and assisted pregnancy rates.

Women who are susceptible to Rubella infection should have Rubella vaccination before attempting any infertility treatment. Patients who have other medical illnesses such as diabetes or kidney problems should only attempt fertility treatment after consulting their physicians. It is also advisable that women take folic acid 0.5mg daily during the peri-conception period as recent evidence suggests that taking folic acid in a small dose may reduce the incidence of neural tube defects in the baby.

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Treatment of Ovulation Disorders

There are a number of disorders which may prevent the female partner from having regular ovulation as mentioned in the Causes section. Usually these are not serious and can be easily treated.

In the most common disorder with failure of ovulation, hormonal tests may be normal, and the problem is treated by switching on the ovulation mechanism with specifically designed drugs (The procedure is called ovulation induction, and is explained in the Assisted Reproductive Technologies section). This type of ovulation disorder is known as "hypothalamic anovulation". The most frequently prescribed treatment is a drug called "clomiphene citrate", which is usually taken each day from days 2 to 6 of the menstrual cycle. This drug causes mild stimulation of the ovaries, and in most cases will induce ovulation, although occasionally it may be necessary to give more than 1 tablet each day. Monitoring of the effect of treatment is by the use of a basal body temperature chart (BBT) and, if necessary, a blood test (mid-luteal phase progesterone assay). There are few side effects from this treatment. The risk of multiple pregnancy with clomiphene citrate is around 8%.

For cases resistant to clomiphene citrate, a series of ovarian stimulation injections may be necessary. If this is needed, your doctor will discuss of this with you. IVFHK patients will receive a more detailed information booklet when they start this treatment.

Polycystic ovarian syndrome (PCOS) is another common cause of anovulation. Patients with PCOS who are found to have an abnormal blood sugar or insulin test may be prescribed a blood sugar lowering drug (Metformin) to correct the sugar abnormality and at the same time correct ovulation. Other treatment options may be offered which include "laparoscopic ovarian drilling" (drilling small holes in the ovaries via the laparoscope). Bromocriptine (a type of hormone) may be prescribed in patients with a condition called hyperprolactinaemia to suppress the prolactin level and return ovulation to normal.

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Treatment of Male Factor Infertility

For a borderline male factor problem, the semen sample can be processed in the laboratory so that a more concentrated sample with better motilility and greater numbers of normal sperm can be prepared. The semen sample is transferred into the uterus just before the time of ovulation. This procedure is called intrauterine insemination (IUI).

For a severe male factor problem, a type of assisted reproductive technology (ART) called intracytoplasmic sperm injection (ICSI) is often used to assist fertilization. It involves direct injection of the sperm into the egg under microscopic guidance.

When no sperm are present in the semen sample, another group of specialist doctors called urologists may be involved in getting the sperm from the male partner via small incisions in the testes (Testicular surgical extraction, TESE) or epididymis (Microsurgical epididymal sperm aspiration, MESA).

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Treatment of Tubal Damage / Obstruction

Mild degrees of tubal disease and adhesions may be treated by either laparoscopic, hysteroscopic or conventional surgery. However, when the disease is more serious, the only alternative is in-vitro fertilization (IVF), which bypasses the damaged tubes. Laparoscopic reversal of previous tubal ligation may be performed in selected cases after detailed discussion with the reproductive surgeon.

In some patients with markedly damaged and swollen tubes (hydrosalpinges), removal of the tubes (salpingectomy) may help to improve the IVF outcome as the fluid in these damaged tubes may be toxic to the embryos and reduce the chance of success. Removal of the tubes can usually be performed via a laparoscope and this form of treatment should be discussed with you when needed.

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Treatment of Endometriosis

Endometriosis, even of a minor degree, can be a cause of infertility. Surgical ablation of mild endometriosis has been shown to improve fertility. In patients with mild endometriosis, ovulation induction (OI) together with intrauterine insemination (IUI) is also a useful treatment.

In patients with moderate to severe endometriosis, surgery can be performed to repair the damage. However, endometriosis usually recurrs and in cases where surgical correction cannot be performed or has failed, in-vitro fertilization (IVF) may be performed.

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Treatment for Unexplained Infertility

For couples where no obvious cause can be identified, expectant management (the "wait and see" approach) is sometimes the best approach especially if the female partner is young and the duration of infertility is short. However, for couples who have waited longer or when the age of the female partner is more advanced, ovulation induction (OI) together with intrauterine insemination (IUI) has been shown to be a useful primary treatment.

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Other Fators

Couples with coital problems may be referred to our sexual rehabilitation team for further assessment and treatment. Ovulation induction (OI) together with intrauterine insemination (IUI) may also be used. Certain types of congenital uterine anomalies (such as uterine septa) can be corrected via a hysteroscope.

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