Assisted Reproduction Options for Infertility

National Infertility Awareness Week 2013

Our National Infertility Awareness Week blog continues! Every day this week, we’ll feature one of our Circle of Support Sponsors as they share helpful information and advice about infertility, your options and coping. Today’s post is brought to us by Gold Sponsor Reproductive Science Center (RSC) of New England.

By Samuel C. Pang, MD, Medical Director

In recognition of National Infertility Awareness Week the following provides basic information about intrauterine insemination (IUI) and in vitro fertilization (IVF).

Intrauterine Insemination (IUI)

IUI is often a first-step of treatment when couples are having trouble getting pregnant through naturally occurring, unprotected intercourse. IUI involves the placement of sperm, either from the intended father or a sperm donor, directly into the uterus immediately prior to and during ovulation. IUI may be performed with or without the use of fertility drugs taken by the woman. When medications are used, the therapy is referred to as controlled ovarian hyperstimulation (COH). IUI with COH may result in an increased likelihood of multiple pregnancy (twins, triplets, etc.).

Those who benefit from IUI include:
  • Couples with no identifiable cause of infertility (“unexplained infertility”)
  • Women with ovulatory disorders who respond well to fertility medication
  • Women with minimal or mild endometriosis
  • Women using donor sperm

In Vitro Fertilization (IVF)

IVF is a process in which oocytes (human eggs), retrieved from a woman’s ovaries, are fertilized in an embryology laboratory with sperm provided by her husband, partner or a donor. When fertilization is successful, the resulting embryos are transferred into the woman’s uterus. There are four major steps in an IVF cycle:

1. Follicular stimulation and monitoring

Reproductive Endocrinologists (fertility specialist doctors) prescribe hormonal medications to increase the likelihood of collecting multiple eggs. Medication is also used to control the timing of a patient’s menstrual cycle. The patient’s progress is monitored through blood testing and vaginal ultrasound to evaluate the number of ovarian follicles in development. A follicle is a sac of fluid in the ovary that may contain oocytes. Just prior to egg retrieval, a patient takes an additional injectable medication to complete egg maturation. Egg retrieval only takes place if an adequate number of follicles are ready. If not, the cycle is cancelled and the patient’s treatment plan is evaluated by her fertility doctor and, perhaps, revised.

2. Oocyte Retrieval

Egg retrieval takes place under intravenous sedation at the patient’s fertility treatment facility. While sedated, the fertility doctor inserts a probe through the vagina under ultrasound guidance into the ovaries to withdraw follicular fluid from each follicle. (Not all follicles necessarily contain eggs).

3. Fertilization and Incubation

Once eggs have been retrieved, sperm (from the intended father or donor) and eggs are brought together for fertilization in the controlled environment of an embryology laboratory. The embryologist may choose from a number of insemination techniques including the microdrop method or a microinsemination technique called intracytoplasmic sperm injection known as ICSI (“ik-see”). In ICSI, a single sperm is injected directly into an egg under a microscope. Fertilized eggs are then incubated in the laboratory for two to five days prior to embryo transfer.

4. Embryo Transfer Procedure

If the embryos have developed normally, a fertility doctor transfers a predetermined number of embryos through the cervix into the uterus via a small catheter (hollow tube). No anesthesia is required for this procedure. To enhance the likelihood of conception, hormonal therapy follows embryo transfer. As in the natural reproduction process, a pregnancy may or may not result. If any excess embryos exist after the initial transfer, the patient may request evaluation for possible cryopreservation (freezing) and use for a subsequent treatment cycle.

Frozen Embryo Transfer (FET)

While pregnancy rates with frozen embryos are not quite as high as with fresh embryos, the success rates are still quite respectable and the preparation for a frozen embryo transfer is much simpler and less expensive compared with a fresh cycle attempt.

IVF with Donor Eggs

IVF with donor eggs involves retrieving oocytes from a young, healthy egg donor, inseminating them with the sperm of the intended father (or sperm donor), and transferring resulting embryo(s) into the uterus of the intended mother. IVF using donor eggs is a treatment option when there is an absence of ovaries, or ovaries that are unable to produce viable eggs. This treatment option can also be used to help couples with potential genetic abnormalities that might be carried by the woman.

Frozen Donor Eggs

Vitrification, an effective method for freezing and thawing human eggs, has been in development for nearly a decade. In October 2012, the American Society for Reproductive Medicine removed the “experimental” designation for this process. Today, IVF using frozen donor eggs acquired through egg banking services, is another option for those couples that need to use donor eggs.

IVF with Gestational Surrogacy

Gestational surrogacy with IVF is an option for women who are unable to carry a pregnancy to term. There are many reasons why this may be necessary including, among other reasons, the absence, scarring or deformity of a uterus, or when the intended mother has a significant medical condition. In many cases, IVF with gestational surrogacy can be done using the woman’s own eggs if she has normally functioning ovaries. Her eggs are inseminated with sperm provided by the intended father or a sperm donor. The resulting embryo(s) is/are then transferred to the uterus of a gestational surrogate, who carries the pregnancy and delivers the baby or babies of the intended parents. Using both donor eggs and a gestational surrogate is also an option.

About the Author

Dr. Samuel Pang, Board Certified in Reproductive Endocrinology and Infertility, has been the Medical Director at the Reproductive Science Center (RSC) of New England since 2007 and is also the Medical Director of the Third Party Reproduction Program at RSC New England, which provides IVF for patients needing to use donor eggs and/or a gestational surrogate. A leading advocate for education about and access to infertility treatment, Dr. Pang, in coordination with Resolve New England, was a chief author of the 2011 mandate requiring insurance coverage for infertility treatment in Massachusetts.

Celebrating its 25th Anniversary, RSC New England is one of the areas oldest and largest fertility treatment centers providing comprehensive diagnosis, evaluation and treatment for infertility. Among many commendations, RSC New England is the first and only fertility center in New England to be recognized by the American Society for Reproductive Medicine for its commitment to following guidelines regarding embryo transfer numbers in an effort to protect the health of IVF patients and their babies.

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