Therapies And Treatments For Infertility
Some couples' plans for parenthood are challenged because it is not as easy as they expected to get pregnant. The term "infertility" refers to when something goes wrong in the process of ovulation (the release of the women's egg) and/or fertilization (male sperm meeting the egg). Approximately 10-15% of couples are not able to conceive after 1 year of trying. Fortunately, with new techniques and technologies, many of these couples can achieve a successful pregnancy.
If a woman has irregular periods with hormonal imbalances or deficiencies, the solution might be drug therapy. Other couples may have problems that require a little more than just drug therapy.
The term used to cover all types of treatment to help with female or male infertility is "assisted reproductive technology" (ART). Current types of ART include:
- Intrauterine insemination (IUI)
- In vitro fertilization (IVF)
- Gamete intrafallopian transfer (GIFT)
- Zygote intrafallopian transfer (ZIFT)
- Embryo cryopreservation
- Donor egg or embryo IVF
- Intracytoplasmic sperm injection (ICSI)
- Gestational care or surrogacy
In many of these procedures, women take medication to increase the number of eggs they will mature and release during a cycle. This is called an "ovulation induction protocol." Advances in these drugs have improved the success rates for many of these procedures.
- Intrauterine Insemination: A preparation step harvests the best sperm. These are then placed as high in the uterus as possible to increase the likelihood that the sperm will meet the egg and fertilize it.
- IVF: The most commonly known type of ART treatment for female infertility is in vitro fertilization (IVF). This is where one or more eggs are removed from the women's ovaries and fertilized with the man's sperm in a laboratory. Two to four fertilized eggs (called embryos) are then placed in the uterus through the cervix.
IVF was initially used for women who had problems with blockage in their fallopian tubes. This method essentially allowed for bypassing the tubes completely.
With technology and the success rate of IVF, the procedure is now used for couples experiencing a variety of problems. Recently, IVF laboratories have been able to successfully culture embryos to a higher level of cell development, the blastocyst stage. This recent advance is important because it has the potential to improve the efficiency of IVF and also control the complication of multiple pregnancies that may occur with IVF.
Previously with IVF, embryos were placed in the uterus 2-3 days after fertilization. With blastocyst transfer, however, they are placed in the uterus on the 5th or 6th day. This fosters stronger embryos with an increased chance of implanting in the uterus, and decreased likelihood of multiple births.
- Donor Egg Or Embryo IVF: Donor egg IVF allows women whose ovaries do not produce eggs to have children. A friend, relative, or volunteer may donate the eggs.
If it is a volunteer donor, the physician and other clinic staff try to locate donors who look most like the women seeking IVF treatment.
Once the donor eggs are ready for the infertile couple, they are fertilized with the sperm and the resulting embryos are placed in the woman's uterus.
- GIFT and ZIFT: GIFT and ZIFT were developed to assist fertilization but also use a woman's fallopian tubes as a natural incubator.
In GIFT (gamete intrafallopian transfer), the eggs are removed from the ovaries, mixed with the sperm, loaded into a catheter, and then injected into the fallopian tubes, where natural fertilization can take place.
In ZIFT (zygote intrafallopian transfer), the eggs are removed from the ovaries, fertilized in the laboratory, and then placed back in the fallopian tubes where they can travel to the uterus and implant on their own.
- Embryo Cryopreservation: This technique involves freezing the embryos for use at a later time.
- ICSI: This is an effective treatment for male-related infertility factors. Male factors include low sperm count, low motility or movement of sperm, or other conditions that make it more difficult for the sperm to fertilize the woman's egg naturally. This procedure takes place in the laboratory where one sperm is injected directly into the egg. Because ICSI is a relatively recent procedure (1992), there are limited data to show the risks involved with birth defects or abnormalities.
- Gestational Care/Surrogacy: In this technique, another women carries the fertilized embryo through the pregnancy and delivery but gives up the baby to the couple after birth.
Receiving therapy and treatment for infertility can be a trying time for a couple. Once you have reached a decision to seek treatment, it is very important to investigate various programs to make sure you choose a program that will be best for you as a couple.
Where To Go To Receive Treatment
Choosing the right place for infertility treatment is very important. According to the American Society for Reproductive Medicine, there are certain points that need to be considered when making that choice:
- Qualifications and experience of the people who work in the facility
- Types of patients being treated (this can have an effect on a program's pregnancy success rate; e.g., couples over forty are less likely to get pregnant than younger couples)
- Support services available - some programs may just have IVF or GIFT or they may combine more than one, but you want to be sure they have all services that you may need
- Documentation to support their success rates
- Details about the guidelines they follow, lab accreditations, and statistic reporting
Intracytoplasmic Sperm Injection video
Review Date: July/16/2001
Reviewed By: A.D.A.M. Medical Illustration Team
Review Date: June 29, 2001
Reviewed By: Peter Chen, M.D., Obstetrics and Gynecology, University of
Pennsylvania School of Medicine. Review provided by VeriMed Healthcare
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