The goal of ovarian stimulation is to obtain ovulation in anovulatory patients (PCOS patients). Sperm analysis should be normal. Stimulation can be performed by letrozole, clomiphene citrate and gonadotropins. Couple tries to achieve pregnancy by sexual intercourse.
Artificial insemination is fertility treatment when sperm (partner’s or donor’s) is introduced in female uterus and fallopian tubes, often in couples with unexplained infertility and light male factor as well as azospermia (donor’s). Insemination can be done in natural cycle or with light ovarian stimulation (higher risk for twins).
Fibroids, endometriosis, some uterine malformations, intrauterine polyps and adhesions may be treated surgically, often by laparoscopy or hysteroscopy. In some case open surgery must be performed.
Cancer treatment including chemotherapy and radiation can damage both female and male gonads. Consultation with fertility specialist should be performed before cancer therapy with the goal to tailor fertility preservation method. There are following fertility preservation methods: sperm, egg, ovarian tissue and embryo freezing as well as ovarian transposition.
Women who was born without uterus or surgically removed uterus can achieve motherhood by uterus transplantation, the procedure developed by professor Mats Brännström and his team. IVF and embryo cryopreservation performs before surgery. 6-12 months after transplantation embryo transfer can be done. There are 13 livebirths in the world, of which 8 in Sweden and 1 in Italy after uterus transplantation performed in Belgrade. Uterus transplantation is still regarded as experimental procedure.
In vitro ovarian activation
Premature ovarian insufficiency (POI) affects about 1 % of women before 40 years of age. The reasons for POF are often unknown, although some genes responsible for ovarian failure were identified during the last years. POI can be caused by chemotherapy and radiation.
Regardless POI, some inactive eggs left in the ovaries, especially in the early phase of ovarian insufficiency. During the last years, the method for ovarian activation was developed. The method 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 ant re-implantation.
There are about 20 livebirths in the world after this procedure, of which one baby was born in Zagreb in Croatia. The method is regarded as experimental.
The only established treatment for POI is egg donation.