Assisted reproductive technology (ART) is the technology used to help achieve pregnancy in patients with fertility problems. ART has made significant progress since the first in vitro fertilization (IVF) treatment.
INTRAUTERINE INSEMINATION (IUI)
Intrauterine insemination is the placement of a man’s sperm into a woman’s uterus using a long, narrow tube.
IUI is most effective for treating:
- Women who have scarring or defects of the cervix
- Men who have low sperm counts
- Men who have sperm with low mobility
- Men who cannot get erections
- Men who have retrograde ejaculation, a condition in which sperm are ejaculated into the bladder instead of out of the penis
IUI can be used in combination with medications that stimulate ovulation. In some cases this combination can increase the chance of pregnancy.
The success of IUI depends on the cause of the couple’s infertility. If inseminations are performed monthly with fresh or frozen sperm, success rates can be as high as 20% per cycle. This success rate is dependent on a number of factors including whether fertility medications are used, the age of the woman, and the infertility diagnosis.In Vitro Fertilization
During in vitro fertilization (IVF), eggs and sperm are taken from the couple and are incubated together in a dish in a laboratory to produce an embryo. The embryo is transferred into the woman’s uterus, where it may implant and result in a successful pregnancy.
THE IVF PROCESS
In this process, also known as ovulation induction, a woman takes medication to stimulate the ovaries to grow many mature eggs at one time.
She is closely monitored to check the development of the eggs using transvaginal ultrasound. Blood is taken to assess oestrogen production by the ovaries. When the eggs are mature—determined by the size of the ovarian follicles and the level of oestrogen—an hCG injection initiates the ovulation process. Egg retrieval follows 34 to 36 hours after the injection.
This is the process used to remove the eggs from the ovaries so they can be fertilized. A mild sedative and painkiller are often used during the procedure, and it normally takes about 10-15 minutes. The steps for egg retrieval are:
- An ultrasound probe is inserted into the vagina to visualise the ovaries and the follicles, which contain the eggs.
- A needle is inserted through the wall of the vagina to the ovaries.
- Suction is used to pull the eggs from the ovaries into the needle.
A man provides a semen sample. If the sperm are healthy, they are placed in a dish with the egg and left overnight in an incubator. Fertilization usually occurs on its own. However, sometimes sperm are not able to fertilise the egg on their own. When this is the case, a single sperm is injected into an egg using a needle. This process is called intracytoplasmic sperm injection (ICSI).
The number of pregnancies from IVF using natural fertilization is about the same as the number resulting from ICSI.
Couples should consider genetic testing if the sperm cannot fertilize the egg on their own. The testing can determine whether the sperm have chromosome problems that might cause development problems in the resulting embryos.
Embryos that develop from IVF are placed into the uterus from 1 to 6 days after retrieval.
The procedure is normally painless, but some women may experience cramping. A long, thin tube is inserted through the vagina and into the uterus where the embryo is gently expelled.