Should methods of natural family planning fail then there are currently a number of methods of assisted conception that can be used. The choice of which technique to use (for any couple) is dependent on a range of factors and includes the:
With regard to the latter point, it is a sad reflection that in circumstances where public money is unavailable to fund treatment and the couple needs to fund their own, then the choice of treatment may be sometimes dictated by the cost rather than its clinical effectiveness. However, little has been published on this topic and so it remains anecdotal as to whether the avail-ability of funding is a major factor in influencing the outcome of fertility treatment in this group of patients.
As such, there are very different treatment prednisone online pharmacy options available for a man who has some recovery of spermatogenesis following a medical treatment compared with a man who might be azoospermic after treatment and only have the limited resource of his frozen samples in storage.
For example, for a man who, at the time of entering an assisted conception programme with his partner, is ejaculating moderate number of motile spermatozoa and from whose ejaculates at least five million motile sperm per millilitre can be prepared, a relatively simple procedure such as IUI using freshly ejaculated sperm would seem most appropriate. Whereas in a man whose ejaculates have been consistently azoospermic but who has frozen samples from which at least 10 or 20 motile sperm can be identified, then ICSI would certainly be required. However, in reality this is a some-what simple way of looking at the decision as in each case account needs to be taken of the biology of the man’s partner and there are many circumstances where the aggressiveness of the assisted conception treatment has to be increased because of pathological factors on the female side. For example, previous disease or damage to the Fallopian tubes will almost certainly require the couple to use IVF even if the quality of sperm available would be sufficient for IUI in another woman.
An interesting question is the decision that is made surrounding the use of fresh or frozen sperm in cases where the quality of the two (in terms of the concentration of motile sperm) is very similar post-treatment. Anecdotally, opinion is divided as to which is the better option, the anxiety being that following any medical treatments involving cytotoxic drugs there is a known increase in sperm chromosomal abnormalities that theoretically could lead to an increase in spontaneous abortions, stillbirths or birth defects in children.