Common Infertility Procedures
Assisted reproductive technology (ART) uses special methods to help infertile couples conceive. Both the woman’s egg and the man’s sperm are involved. Many factors influence the rate of success. ART has been refined over the years and today offers the best hope for couples wishing to conceive, but have not been successful without help. The process is very expense and time consuming and unfortunately most insurance companies do not include infertility coverage at all. Although some insurance companies do offer very limited coverage. Some states have laws that require insurance companies to offer some coverage, but are different from state to state. So check with your health insurance provider for more information on coverage.
Invitro fertilization (IVF)
Invitro fertilization (IVF) is a tool of assisted reproductive technology (ART) that is often used when a woman’s fallopian tubes are blocked or when a man has a low sperm count. It is a process by which the eggs are fertilized outside the womb. When other methods of assisted reproductive technology have failed, doctors turn to IVF. The process involves hormonally controlling the ovulatory process, removing healthy eggs from the woman’s ovaries and introducing healthy sperm to fertilize in a fluid medium outside the body. The fertilized eggs are then transferred into the woman’s uterus.
Typically on the third day of menstruation, a regime of fertility medications designed to stimulate the development of multiple follicles of the ovaries are injected. This requires close monitoring. Usually ten days of injections are needed.
When adequate follicle maturation is deemed complete, human chorionic gonadotropin (hCG) is injected. This agent’s purpose is to cause ovulation about 42 hours after injection. A retrieval procedure takes place just prior to that in order to retrieve the eggs from the ovary. Ten to 30 eggs are typically removed. The eggs are retrieved from the patient using a transvaginal technique involving an ultra-sound guided needle piercing the vaginal wall to aspirate the follicles. The retrieval process takes about 20 minutes under general anesthesia or conscious sedation.
In the laboratory, the eggs are prepared for fertilization. Semen is prepared by removing inactive cells and seminal fluid. The sperm and the egg are incubated together in a culture media for around 18 hours. In the case of a low sperm count or motility, a single sperm may be injected directly into the egg. The fertilized egg is passed to a special growth medium and left for about 48 hours until it has reached the 6-8 cell stage. Typically embryos that have achieved 6-8 cell stage are transferred 3 days after retrieval. This is not always the case, but it is typical.
The embryos are graded based on a number of criteria indicating viability. The number to be transferred depends on the number available, the age of the woman, and other diagnostic results. Different countries have their own legal limits to how many embryos can be transferred. The embryos judged to be the ‘best’ are transfer to the woman’s uterus through a thin plastic catheter, which goes through her vagina and cervix.
IVF is a process that can be used on women who have already gone through menopause. The success rate is 35%. Due to the expense of this procedure, IVF is generally attempted after less pricey procedures have failed. This process bares the nickname test tube baby.
Gamete Intrafallopian Transfer (GIFT)
Gamete intrafallopian transfer (GIFT) is a tool of assisted reproductive technology. This process allows fertilization to take place in the female’s body. Many prefer this method on moral grounds. Eggs are removed from a woman’s ovaries and placed into one of her fallopian tubes along with a man’s sperm. The procedure is done using laparoscopy. A cycle of GIFT takes 4 to 6 weeks to complete. The female must first take a fertility drug to stimulate egg production within her ovaries. The doctor will monitor the growth of the ovarian follicles, and once they are mature, the woman will be injected with human chronic gonadotropin (hCG). About 36 hours later, the eggs will be harvested, male sperm added, and placed into the woman’s fallopian tubes using a laparoscope.
A woman must have at least one normal fallopian tube in order to be considered a good prospect for GIFT. This method is used on the occasions where there is a sperm dysfunction or where the cause of infertility is unknown. Success depends on the age of the couple and the woman’s quality of eggs. Approximately 25-35% of GIFT cycles result in pregnancy, one third of those being multiple births.
When there is a blockage in the fallopian tubes, zygote intrafallopian transfer (ZIFT) is used. Eggs are removed from the woman’s ovaries and in vitro (outside the uterus) fertilized. The zygote (newly fertilized egg) is placed into the fallopian tube by laparoscopy. This is a procedure born of the gamete intrafallopian transfer (GIFT) procedure. ZIFT has a success rate of 64.8%.
