Infertility Treatment Center 

The child has always been considered as one of the basic elements of the family and having it is one of the desires that human beings have never been able to ignore. The fertility process is a process that relies on many probabilities. The possibility of fertility is defined when a woman is perfectly healthy and her hormonal balance is normal and the man is perfectly healthy and there are no movement or structural problems in the sperm. Also sexual relationship should be performed at the time of ovulation. Infertility testing should be performed for couples who have been expecting a child for a year and have had regular sexual intercourse without using contraceptives. This test should be done after 6 months for women who are over 35 years old. According to the WHO, the prevalence of infertility in the world is reported to be between 12 and 15%. Fortunately, today, with increasing awareness and advancement in science, most infertile couples can fulfill their dream of having a child.

With the help of God Almighty and efforts of the authorities, the Infertility Center of Amir Al-Momenin Hospital, the diagnostic and treatment services of this center, in the form of a specialized clinic for infertility, recurrent abortion and RIF, has been started operating since 2000. From 1379 to 1389 until today, IUI and microinjection (ICSI) services and other services related to infertility, including freezing eggs, embryos and sperm, are also offered in this center.

Experienced and committed staff and specialists provide the latest and most complete diagnostic and treatment methods for clients.

Patient admission and process in infertility clinic:

  • -      Creating a file for couples (by midwifery consultants), requesting tests and diagnostic tests
  • -      First visit (initial examination of couples and requesting for necessary and diagnostic tests)
  • -      Second visit, checking of test results, requesting for hysterosalpingography, vaginal ultrasound and diagnostic tests of couples by gynecologists and referral to relevant consultants (in the fields of genetics, internal medicine, endocrinology, etc.) if necessary, based on the results of examinations
  • -      Checking and examination by consultants
  • -      Determining the treatment plan by a specialized team including gynecologists and men specialists
  • -      Announcing the treatment prescribed for the couple, answering the questions and getting acquainted with the treatment process prescribed for the couple (suggested treatment methods may be one of the methods of ovulation stimulation, IUI or intrauterine sperm insemination, microinjection or injection of sperm into the cytoplasm of the egg in the laboratory environment.

Induction of ovulation

Applications:

This operation is performed on patients who have problems in ovulation.

Steps of ovulation stimulation:

After the necessary examinations, routine tests, hormonal tests, and uterine x-rays to make sure the fallopian tubes are open, the woman will come in on the second or third day of menstruation. On this day, an ultrasound will be done to check the condition of the ovaries and uterus.

Then the necessary drugs to stimulate ovulation are prescribed by a doctor. The necessary ultrasounds eventually lead to ovulation. Complementary instructions are given by the doctor to the patient and only two weeks later the patient returns for the test.

Intrauterine insemination (IUI)

Applications:

IUI or intrauterine insemination is used in two cases:

First: In cases where the man has problems such as low sperm volume, low sperm count, low sperm motility or decreased libido.

Second: In cases where a woman has problems with cervical secretions or an immunodeficiency that leads to infertility or due to pain and special conditions such as vaginismus, natural intercourse is not possible.

 

Steps

This procedure is relatively simple, painless and can be done without anesthesia. In this method, the male sperm fluid is washed and in this washing, active and good sperms are separated. In normal intercourse, about ten percent of sperms reach the cervix from the vagina, but with IUI, more sperm of good quality enter the uterus.

 

Preoperative measures

Prior to surgery, necessary examinations, routine tests, hormonal tests, and uterine imaging should be performed to ensure that the fallopian tubes are open. The woman comes in on the second or third day of menstruation. On this day, an ultrasound is done to check the condition of the ovaries and uterus and, if necessary, she takes the medicine. The drug is prescribed to stimulate ovulation and increase the chance of fertility. After taking the medicine, several ultrasounds are performed on different days. When the follicle (the sac containing the egg in the ovary) has reached the proper size, HCG is injected intramuscularly, which causes the egg to mature and ovulate. 40-36 hours after the HCG injection, the patient returns and has an IUI operation.

Postoperative care

The patient is discharged shortly after IUI with medication and counseling. There is no need for absolute rest and the patient can have normal activities. Obviously, peace of mind and avoidance of anxious situations can be effective in the success of the operation. Usually two weeks after the IUI operation, the patient goes to a hormone lab to measure the BHCG level in the blood. An increase in this hormone is the first sign of pregnancy.

 

Microinjection or intraocular sperm injection (ICSI)

Applications

It is mainly used in cases where the male sperm does not have the required quality in terms of number, motility or shape, or the woman is old or has already used other therapies. In some cases, when several IVF operations have been performed and have not been successful, microinjection surgery is used.

Steps

In this procedure, a sperm is injected into an egg in laboratory environment, followed by fertilization and cell division, and the embryo is formed. Microinjection, like IVF, involves several stages of ovarian stimulation, ovulation, sperm injection into the egg, fertilization and embryo transfer. In the first stage, hormonal drugs are used to stimulate the ovaries. In the second stage, ovulation is possible with ultrasound observations through the vagina, which can be performed with a short-term anesthesia. Using an ultrasound device, the doctor observes the follicles and pulls the follicular fluid with special needles, which is called a puncture. In the third stage, the cells around the egg are first separated by an enzyme, then the sperm is injected into the egg. Microinjection fertilizes several eggs to increase the success rate, so the number of formed embryos may be high. If these embryos are of good quality, some of them are frozen and stored for future pregnancies, if needed.

In the fourth and final stage, there is no need for general anesthesia. The fetus is transferred into the uterus through a catheter and one or two hours after the transfer of the patient, the patient is discharged with the necessary medication and consultation.

Advantages and limitations of this practice

One of the advantages of microinjection is that it can be done with the least amount of healthy sperm. Another advantage of microinjection is that if the patient does not have fallopian tubes, there is no problem in performing this operation. However, the pregnancy rate in women over 40 years decreases due to the low quality of female eggs.

Preoperative measures

After routine tests, hormonal tests, and couples' visits by specialists, if ICSI treatment is suggested, the following steps will be taken:

  • -      On the second or third day of menstruation, an ultrasound is done to check the condition of the ovaries and uterus.
  • -      After ultrasound, the drug is prescribed by a specialist to stimulate ovulation.
  • -      During the drug administration phase, five to six ultrasounds are performed based on the rate of ovarian reaction.
  • -      When the follicles reach the suitable size, HCG is injected and the patient is ready to ovulate.
  • -      About 36 hours after the HCG injection, the eggs are punctured by a gynecologist under short term anesthesia.
  • -      Simultaneously with receiving sperm samples from a man, the egg is fertilized in laboratory by an embryologist.
  • -      3 to 5 days after the puncture, if suitable embryos are created, the embryos are transferred to the patient.

 

Post-embryo care

The patient is discharged one to two hours after the embryo transfer operation. It is recommended not to do strenuous activities that lead to excessive fatigue for 3 to 4 days after the operation. Obviously, peace of mind and avoidance of anxious conditions can be effective in the success of the operation. The patient usually goes to a hormone laboratory 10 to 12 days after the embryo transfer to measure the BHCG level in the blood. An increase in this hormone is the first sign of pregnancy.

The success rate of the IUI method is about 20% and the microinjection method is about 35-40%. The costs of each of the above methods are very different according to the side diagnostic tests, the number of required ultrasounds, and the necessary drugs to stimulate ovulation, which the patient can receive the necessary information after determining the treatment method.

 

Tel : +98 (0) 33460055

Fax : +98 (0) 33461580

Website: en.amirhos.semums.ac.ir

Email : amir.hospital@semums.ac.ir

 Address: 9771 No., Amir-al-Momenin Medical-Educational & Research Center, Shaheed Mostafa Khomeini Blvd. Imam Hossein Sq. Semnan. Iran.