The goal of ovarian stimulation is to achieve ovulation in anovulatory women like PCOS patients. Sperm test should be normal. Stimulation can be done by letrozole, clomiphene citrate and gonadotropins. Couple tries to obtain pregnancy by sexual intercource.
Artificial insemination is fertility treatment when sperm (partner’s or donor’s) is placed in uterus and fallopian tubes, often in couples with unexplained infertility and light male factor. Donor artificial insemination is done also in case of azoospermia and in lesbian couples. Insemination can be done in natural cycle or with light ovarian stimulation (higher risk for twins).
Surgical treatment performs in case of fbroids, endometriosis, some uterine malformations, intrauterine polyps and adhesions. Surgical treatments can be done by laparoscopy, hysteroscopy and by open surgery.
Cancer treatment includes chemotherapy and radiation that can damage both female and male gonads. Consultation with fertility specialist should be scheduled before cancer therapy with the goal to tailor fertility preservation methode. There are following fertility preservation procedures: sperm, oocyte, ovarian tissue and embryo cryopreservation as well as ovarian transposition.
Women who was born without uterus or surgically removed uterus can achieve motherhood by uterus transplantation This procedure was developed by professor Mats Brännström and his team. IVF and embryo freezing performs before surgery. 6-12 months after transplantation surgery, embryo transfer can be performed. There are about 40 livebirths worldwide of which 20 in Sweden and 1 in Italy after uterus transplantation performed in Belgrade.
In vitro ovarian activation
Premature ovarian failure (POF) affects about 1 % of women before 40 years of age. The reasons for POF are often uknown, although some genes responsible for ovarian failure were found during the last years. POF may be caused by chemotherapy and radiation. Even in case of POF, some inactive eggs left in the ovaries, especially in the early phase of ovarian insufficiency.
During the last years, the procedure for ovarian activation was developed. The methode is based on research from University of Gothenburg and Karolinska Institute in Stockholm. The ovary removes by laparoscopic surgery and then ovarian tissue activates in the laboratory following by re-implantation of small ovarian pieces.
Ovarian stimulation and IVF performs after re-implantation. One part of the ovary cryopreserves for eventually next activation and re-implantation.
There are about 20 livebirths in the world after this procedure. The methode is regarded as experimental. The only established treatment for POF is egg donation.