Sperm analysis: Normal
If: Hormone testing, ultrasonography and hysterosalpingogram are normal.
The fertility doctor may recommend Intrauterine Insemination (IUI) in combination with the subcutaneous injection that triggers ovulation. IUI involves placing prepared sperm (“washed” sperm) inside the woman’s uterus, using a catheter. IUI success rates may reach 10-15% per cycle.
Additionally, medication pills (anti-oestrogens) may be given from the first day of menstruation, to stimulate the production of more oocytes. Alternatively, hormone injections (gonadotropins) may be administered. Low doses of hormones are used, to trigger the production of maximum 2-3 oocytes avoiding multiple pregnancies.
If: The woman has an irregular or absent menstrual cycle.
Ovulation is triggered with the administration of hormones (in some cases the menstrual cycle is prepared using oral contraceptive pills for 2-3 months prior to hormone administration).
After treatment the fertility doctor may recommend either sexual intercourse or intrauterine insemination. If endocrine disorders co-exist (e.g. thyroid abnormalities), the woman is advised to refer to an endocrinologist.
If: The woman has genital tract anomalies.
If the genital tract abnormality can’t be treated (e.g. absence of both fallopian tubes), the fertility doctor will recommend IVF.
If the genital tract abnormality can be treated (e.g. one fallopian tube is blocked, but the other is patent), there are still good chances for the couple to conceive either with sexual intercourse or intrauterine insemination.
Sperm analysis: abnormal
If: Sperm parameters are slightly abnormal (e.g. concentration 5 – 10 million spermatozoa per ml) and the woman has a normal reproductive system and hormone profile.
The fertility doctor may advise the couple to continue trying with timed sexual intercourse for a few more cycles. In some cases, treatment (hormones) is administered to the male for almost two months, to temporarily increase sperm count and motility.
If: Sperm parameters are far lower than normal values (e.g. 10% motility and very low sperm count).
A. If the woman has a fertility problem (e.g. blocked fallopian tubes), then IVF is recommended.
B. If the woman doesn’t have a fertility problem, then intrauterine insemination is recommended even every month – exceptional circumstances exist when the ovaries of the woman have been stimulated with hormone administration. In these cases, the female reproductive system needs a “rest” period of 1 – 2 months before starting a new stimulation cycle.
C. If: No spermatozoa are found (azoospermia).
1. If the testes produce sperm, but none are in the ejaculate, the man is treated surgically by a surgeon urologist and fertility is restored. However, this is not always possible and sperm is surgically extracted from the testes (testicular biopsy). Testicular sperm is then used in an IVF cycle.
2. If there are a few areas of sperm production in the testes, then a tissue sample is surgically removed. If mature spermatozoa are found, they are used for IVF. Otherwise, the couple should decide to use donor sperm from a sperm bank.