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Infertility Cubby

Assisted Reproductive Technology

The first "test tube" baby was born in 1981. Since then, tens of thousands of babies have been conceived with the help of Assisted Reproductive Technology (ART). This high-tech field has seen great advances in a relatively short time period, making pregnancy possible for many women and couples who would otherwise have little chance of conceiving. Several procedural options are available at this time.

Procedure
Explanation
Artificial Insemination

First, a sperm sample is collected into a sterile cup. Then the sperm are washed, rinsed and concentrated in the laboratory. The sperm are transferred into the woman's vagina with a syringe. This procedure must be timed with the woman's peak fertility time; ovulation. The sperm can be collected from the husband, partner, a friend or obtained at a sperm bank through an anonymous donor.

IUI - Intrauterine Insemination
This form of artificial insemination places the prepared sperm sample into the woman's uterus. A small catheter (tube) is used to pass the sperm through the cervical opening. Uterine placement increases the odds of success since that the sperm don't have to battle their way through the vagina, which is an acidic and often hostile environment to the sperm.
OI - Ovulation Induction
Fertility drugs, specifically hormones, are used to induce ovulation. OI is used to produce mature eggs that can be fertilized via intercourse, or by artificial insemination. OI may produce more than one egg, which can lead to multiple births. Mature eggs may also be harvested (collected) to be used in ART procedures such as IVF, GIFT and ZIFT.
Donor Eggs
When a woman cannot produce any eggs, or has other medical reasons not to use her own eggs, OI can be used to produce and collect eggs from a donor. Donor eggs can be fertilized with the husband's/partner's sperm, or by donor sperm. The fertilized egg is then inserted into the woman's fallopian tube or uterus. In this case, the woman nourishes the fetus for nine months and gives birth to the baby. The baby contains the genetic material of the woman who donated the egg, and the man who's sperm was used to fertilize the egg.
IVF - In Vitro Fertilization
A sperm sample is obtained from the father. Eggs are harvested from the mother. Fertilization occurs in the laboratory when the sperm are mixed with the eggs. The fertilized eggs (zygotes) begin cell division. After 2-3 days, the zygotes are ready to be implanted into the mother's uterus. Some clinics are waiting a full 5-6 days to allow more cell division before implantation. To improve the chances that an embryo will develop into a baby, approximately 3 fertilized eggs are introduced into the uterus at one time. Often this leads to multiple births.
GIFT - Gamete Intrafallopian Transfer
A sperm sample is obtained from the father. Eggs are harvested from the mother. Then, both the sperm and the eggs are injected into the mother's fallopian tube in hopes that fertilization will occur naturally.
ZIFT - Zygote Intrafallopian Transfer
The procedure is similar to IVF in that the sperm and eggs are united in the laboratory. But then, the fertilized eggs are injected into the fallopian tube, not the uterus.
Embryo Cryopreservation
Many ART procedures result in harvesting and fertilizing multiple eggs. Usually only 3 fertilized eggs are transferred back into the mother. If there are more fertilized eggs produced than needed, they can be frozen to be used in a later cycle.
FET - Frozen Embryo Transfer
Previously frozen embryos can be transferred into the woman's uterus or fallopian tube.
TESA - Testicular Epididymal Sperm Aspiration

TESA is used to collect sperm from men who have very low sperm counts, or have blockages in the sperm delivery tract, such as a vasectomy. A small syringe is inserted 1/2 inch into the testicle and a tissue sample is obtained. (Local anesthesia is used and the procedure takes place in the physicians office. The man is usually back to normal activities in a day). Sperm are separated from the tissue sample and individual sperm are injected into eggs that have been harvested from the woman. This procedure is known as Intracytoplasmic Sperm Injection (ICSI). The fertilized eggs are cultured for 2-3 days and inserted into the woman's uterus or fallopian tube.

Surrogate Mother

When a woman cannot go through a pregnancy for medical or other reasons, she may use a surrogate mother. A surrogate mother would be impregnated, carry the baby to term, give birth to the child and return the child to the other woman. The surrogate mother may use her own egg, the other woman's egg or a donor egg. The sperm may come from the partner of the woman who cannot carry the pregnancy, or from a sperm donor.

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ART does involve some risk. Depending on the method of ART employed, the risks can be minor or significant. The health status of the mother at the time of procedure may also impact risk. Discussion of specific risks and the couple's acceptance of risk are important before any procedure is undertaken. What are the risks of ART?

Risks Of ART
Pain and Bruising at Injection Sites Fertility drugs that require injections may cause minor pain or bruising.
Bleeding or Infection When eggs are harvested a syringe must pass through the vaginal wall to get to the ovaries. There is a slight risk of bleeding, infection or damage to nearby tissues.
Surgical Complications Laparoscopy is often used for GIFT, and ZIFT, and this surgical procedure requires the use of general anesthesia. Surgeries and anesthesia carry their own set of risks.
Ovarian Hyperstimulation Syndrome
(OHSS)
Fertility drugs can cause too many eggs to mature at once. This leads to enlarged ovaries and accumulation of fluid in the pelvic region or abdominal cavity. There may be decreased blood flow to other key organs and tissues and an increased risk of blood clots forming.
Cancellation When too many, or too few eggs develop during ovulation induction using fertility drugs, the medical team may decide to cancel the cycle and wait until a later month to try again. This can be disappointing for the couple trying to conceive and also incurs costs of therapy without reward.
Tubal Pregnancy These ectopic pregnancies occur in about 2-5% of couples using ART.
Multiple Births ART increases the risk of becoming pregnant with more than one fetus. The various ART procedures carry differing risks. For example with IVF, GIFT, or ZIFT, the more fertilized eggs that are transferred into a woman, the higher the chance of having multiple births. The chance of multiples may be as high as 30%.

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Ethical Considerations
For many individuals, couples, families and groups significant ethical considerations accompany a decision to employ Assisted Reproductive Technology. This section is included to address some of the social and ethical controversies of ART. Recognizing these considerations present personal dilemmas for many, no conclusions are drawn or side taken in these debates.

ART Controversies
  • There are those that argue that humans don't have the right to tamper with, or manipulate conception. Many couples using ART find that they don't have the support of certain family members, friends or their church. This can be an emotionally isolating situation.

  • In the event of divorce or death of the parents, who owns the fertilized eggs that have been frozen? Who has access to the sperm that has been saved in a sperm bank?

  • If ART produces a multiple pregnancy, the couple may have to consider selective abortion of some of the embryos, so that the remaining embryo(s) have a better chance for survival. Aborting embryos is a difficult decision for the parents and carries all of the judgments and controversy of any type of abortion.

  • ART occasionally results in delivery of 3 or more babies. These babies often have significant medical problems, often as a result of premature delivery. The medical expenses can be astronomical. Who pays the bill? These issues are topics of hot debate.

  • ART itself is a costly undertaking. Insurance usually doesn't cover much, if any, of the expense. Is it fair that only those couples who can afford ART have access to what may be their only chance of procreating? What about the people who can't afford ART but desperately want to have a child?

  • What happens if a surrogate mother changes her mind? What if she wants to keep the baby? These questions are approached before the surrogate agreement is made. Legal documents and consent forms are signed. But if anyone involved in these unconventional situations changes their mind, the legal battle is another mountain of stress and anxiety.

 
Excerpted From Nutrition For You, Nutrition For Two

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