Assisted Reproductive Technology
What are the options?
Doctors recommend specific treatments for infertility based on test results, how long the couple has been trying to get pregnant the, age of both the man and woman, the overall health of the partners and preference of the partners.
Doctors often treat infertility in men in the following ways:
- Sexual problems: Doctors can help men deal with impotence or premature ejaculation. Behavioural therapy and/or medicines can be used in these cases.
- Too few sperm: Sometimes surgery can correct the cause of the problem. In other cases, doctors surgically remove sperm directly from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count.
- Sperm movement: Sometimes semen has no sperm because of a block in the man’s system. In some cases, surgery can correct the problem.
In women, some physical problems can also be corrected with surgery.
A number of fertility medicines are used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the possible dangers, benefits, and side effects.
What medicines are used to treat infertility in women?
Some common medicines used to treat infertility in women include:
- Clomiphene citrate (Clomid): This medicine causes ovulation by acting on the pituitary gland. It is often used in women who have Polycystic Ovarian Syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth.
- Human menopausal gonadotropin or hMG (Repronex, Pergonal): This medicine is often used for women who don’t ovulate due to problems with their pituitary gland. hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.
- Follicle-stimulating hormone or FSH (Gonal-F, Follistim): FSH works much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.
- Gonadotropin-releasing hormone (Gn-RH) analog: These medicines are often used for women who don’t ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray.
- Metformin (Glucophage): Doctors use this medicine for women who have insulin resistance and/or PCOS. This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth.
- Bromocriptine (Parlodel): This medicine is used for women with ovulation problems due to high levels of prolactin. Prolactin is a hormone that causes milk production.
Many fertility drugs increase a woman’s chance of having twins, triplets, or other multiples. Women who are pregnant with multiple foetuses have more problems during pregnancy. Multiple foetuses have a high risk of being born prematurely, and premature babies are at a higher risk of health and developmental problems.
What is Intrauterine Insemination (IUI)?
Intrauterine Insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, specially prepared sperm are inserted into the woman’s uterus. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.
IUI is often used to treat:
- Mild male factor infertility.
- Couples with unexplained infertility.
What is Assisted Reproductive Technology (ART)?
Assisted Reproductive Technology (ART) includes all fertility treatments in which both eggs and sperm are handled outside of the body. In general, ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman. The main type of ART is In Vitro Fertilisation (IVF).
How often is Assisted Reproductive Technology (ART) successful?
Success rates vary and depend on many factors, including the clinic performing the procedure, the infertility diagnosis, and the age of the woman undergoing the procedure. This last factor, the woman’s age, is especially important.
ART can be expensive and time-consuming, but it has allowed many couples to have children that otherwise would not have been conceived. The most common complication of ART is a multiple foetus pregnancy. This is a problem that can be prevented or minimised by limiting the number of embryos that are transferred back to the uterus. For example, transfer of a single embryo, rather than multiple embryos, greatly reduces the chances of a multiple foetus pregnancy and its risks such as premature birth.
What are the different types of Assisted Reproductive Technology (ART)?
Common methods of ART include:
- In Vitro Fertilisation (IVF), meaning fertilisation outside of the body. IVF is the most effective and the most common form of ART.
- Zygote IntraFallopian Transfer (ZIFT), or tubal embryo transfer. This is similar to IVF. Fertilisation occurs in the laboratory. Then the very young embryo is transferred to the Fallopian tube instead of the uterus.
- Gamete intrafallopian transfer (GIFT). This involves transferring eggs and sperm into the woman’s Fallopian tube. Fertilisation occurs in the woman’s body. Few practices offer GIFT as an option.
- Intracytoplasmic Sperm Injection (ICSI). This is often used for couples with male factor infertility. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg as opposed to “conventional” fertilisation where the egg and sperm are placed in a petri dish together and the sperm fertilises an egg on its own.
Serious complications from the medications and procedures required for In Vitro Fertilisation (IVF) are rare. However, as with all medical treatments, there are some risks.
Fertility medications called gonadotropins are typically prescribed during an IVF cycle to stimulate the ovaries to produce multiple follicles.
Possible side effects of ovarian stimulation drugs include:
- Mild bruising and soreness at the injection site. Using different sites for the injections can help.
- Allergic reaction, gastrointestinal distress, headache or mood changes.
- Ovarian Hyper Stimulation Syndrome (OHSS). This is a condition in which the ovaries produce many follicles and fluid may leak from the blood vessels into the abdominal cavity and lungs. Usually, symptoms of OHSS are mild and resolve without treatment. However, in severe cases, OHSS can result in very enlarged ovaries, dehydration, fatigue and the collection of large amounts of fluid in the abdomen and lungs. Very rarely (in fewer than 1% of women undergoing egg retrieval through IVF), OHSS can lead to blood clots and kidney failure.
Despite previous reports suggesting a link between ovarian cancer and the use of fertility medications, more recent studies show no such link.
During egg retrieval, your doctor uses vaginal ultrasound to guide the insertion of a long, thin needle through your vagina into the ovary and then into each follicle to retrieve eggs. Patients are usually sedated.
Possible risks for this procedure include:
- Mild to moderate discomfort (during or after the procedure).
- Injury to organs near the ovaries, such as the bladder, bowel, or blood vessels. Rarely, injury to adjacent structures such as the bowel or blood vessels can be a severe complication and may require blood transfusions and surgery for repair.
- Pelvic infection (mild to severe). Such infections are very rare. However, if they do occur, they may be severe and typically are treated with intravenous antibiotics. Rarely, surgery may be required to remove one or both of the ovaries and tubes and/or uterus. Individuals with prior pelvic infections are at greater risk.
A speculum is placed in the vagina and a catheter containing the embryos is used to gently place them into the uterus under ultrasound guidance. Patients may experience mild cramping when the catheter is inserted through the cervix into the uterine cavity. Very rarely, an infection may develop, which can be treated with antibiotics.
If you are considering or are undergoing IVF, your doctor has probably talked to you about the risk of multiple pregnancy (twins or more). The more embryos that are transferred into the uterus, the greater the risk. Multiple pregnancies carry significant risks, including:
- Preterm (early) labour (with possible risks to the infant)
- Preterm (early) delivery
- Maternal haemorrhage
- Caesarean delivery
- Pregnancy-induced high blood pressure
- Gestational diabetes
Your doctor should transfer the minimum number of embryos necessary to provide a high likelihood of pregnancy with the lowest risk of multiple pregnancy. If you do become pregnant with three or more foetuses, you should consider having a consultation with a maternal-foetal medicine specialist. This type of doctor is specially trained in high-risk pregnancies and can provide information and guidance about complications that can occur during a multiple pregnancy. You may also wish to consider reducing the number of embryos you are carrying.
Babies conceived by IVF may be at slightly increased risk of birth defects. The risk of birth defects in children conceived naturally is 2 to 3% whereas the risk of birth defects in children conceived by IVF is estimated to be 2.6 to 3.9%. Also there may be an increased risk of sex chromosome abnormalities, hypospadias (no urinary opening at the tip of the penis) and imprinting disorders when intracytoplasmic sperm injection (ICSI) is performed along with IVF.
Miscarriage and Ectopic Pregnancy
The rate of pregnancy loss or miscarriage following IVF is similar to the rate following natural conception, with the risk increasing with the mother’s age. The rate of miscarriage may be as low as 15% for women in their 20s to more than 50% for women in their 40s.
There is a 2% to 4% risk of an ectopic (tubal) pregnancy. If an ectopic pregnancy occurs, you will need medication to end the pregnancy or surgery to remove it. If you are pregnant and experience a sharp, stabbing pain; vaginal spotting or bleeding; dizziness or fainting; low back pain or low blood pressure (from blood loss), call your doctor immediately. These are all signs of a possible ectopic pregnancy.
Donor Eggs and Sperm
ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who cannot produce eggs. Also, donor eggs or donor sperm are sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.
Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man’s sperm and her own egg. The child will be genetically related to the surrogate and the male partner.
Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn’t become pregnant because of a serious health problem. In this case, a woman uses her own egg. It is fertilised by her partner’s sperm and the embryo is placed inside the carrier’s uterus.