There are many different types of fertility treatments, most of which fall under the umbrella term called ART, Assisted Reproductive Technologies. ART defined is when medical procedures are used to promote fertilization without intercourse. The objective of ART is to create an embryo by bypassing the factor or factors causing the fertility problem.
In Vitro Fertilization (IVF)
In Vitro Fertilization is the most common and most used form of ART. This process begins when fertility medications are taken by the woman to increase egg production. Once those eggs mature, they are then retrieved surgically by a doctor. The doctor will insert a probe into the vagina and with the use of ultrasound as guidance will pass a needle through the back wall of the vagina to reach the ovaries and retrieve the eggs. This is known as egg retrieval. This procedure does not require general anesthesia and is preformed as an outpatient procedure with conscious sedation.
The retrieved eggs are then combined with sperm in a laboratory Petri dish. Approximately 3-5 days later, the embryos are placed into the woman’s body. The patient can then return home after having spent about an hour of rest in bed.
GIFT (Gamete Intrafallopian Tube Transfer)
GIFT is a procedure where fertilization occurs in the woman’s fallopian tube. A woman’s eggs are retrieved with the assistance of a doctor. The eggs and sperm are then placed together in a catheter that is inserted into the fallopian tube. GIFT is a laparoscopic surgery which uses tiny instruments that are inserted into the body through small incisions in the abdomen. GIFT differs from IVF, where fertilization occurs in the laboratory, in GIFT the fertilization takes place inside the woman’s body. This procedure requires general anesthesia.
Zygote Intrafallopian Transfer (ZIFT)
ZIFT is a method to treat infertility similar to IVF where an egg that is fertilized outside the body is instead placed into a woman’s fallopian tube, not the uterus. The woman’s eggs are retrieved and then are fertilized with sperm in a lab. Two days later the transfer of the eggs will take place via a laparoscopic surgery.
Assisted hatching is performed in order to help an embryo hatch out of its protective layering and implant into the uterus. It is a technique that was developed from the observation that embryos that had a thin zona pellucida (shell) had a higher rate of implantation during in vitro fertilization. In assisted hatching, a minor defect is created in the shell of the embryo to allow for a greater chance of the embryo “hatching”, or shedding its shell, allowing for a greater chance of implantation in the endometrium.
ICSI Intracytoplasmic Sperm Injection)
ICSI is a common treatment choice that is used very often in unexplained and male infertility. It is used with in vitro fertilization to increase the chances of fertilization. With ICSI, the eggs are retrieved and then fertilized with sperm in a laboratory by direct injection of a single sperm into each egg. The embryos are placed into the uterus usually within three to five days.
Blastocyst Embryo Transfer
A blastocyst is an embryo that has developed for five days after fertilization and has divided into two different cell types. It is a highly developed embryo that is nearly ready to implant on the walls of the uterus.
A healthy blastocyst should hatch from its zona pellucida (shell) by the end of six days and within 24 hours after hatching, should begin to implant within the lining of the uterus. Studies conducted recently have shown that embryos that do not survive the blastocyst stage have a high incidence of abnormal chromosome numbers. Culturing embryos to the blastocyst stage may help to significantly decrease the number of abnormal embryos. The transfer of the embryo usually occurs five to six days after egg retrieval.
Egg donation occurs when a woman (donor) donates her eggs so that another woman (a recipient) may be able to conceive. The donor is usually required to take fertility drugs to help stimulate the production of eggs. The recipient may also receive drugs so that her cycle reflects the donor’s cycle and her body is prepared to receive the embryo. The egg is then fertilized in a laboratory and the embryos are implanted in the recipient’s uterus.
Preimplantation Genetic Diagnosis
Preimplantation genetic diagnosis (PGD) is a reproductive technology used with in-vitro fertilization. PGD is most commonly used to test embryos for a panel of the most common chromosome abnormalities and then use the healthy embryos for implantation. The use of PGD can result in a higher rate of implantation in the uterus. Some IVF centers have the capability of doing PGD in their own lab. Others contract with specialty labs and arrange for them to do PGD.
Embryo donation involves using another couple’s embryos in order to conceive. Many couples who go through IVF have embryos that were created, but not used. Instead of discarding the embryos, the couple donates them either to their fertility center or to a donation agency. A patient goes to her fertility doctor or a national agency and chooses from the donated embryos. The woman’s uterus is prepared to receive the embryos using fertility medications. The embryo is then transferred to her uterus.
IUI (Intrauterine Insemination)
IUI is a procedure in which a doctor places sperm directly into the uterus through the cervix using a catheter. It is a very simple and common procedure and is one of the first steps a patient takes before beginning ART. The woman’s egg production is stimulated through the use of oral medications such as Clomid or sometimes injectable medications prior to insemination. During the time of ovulation the insemination is performed.