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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.
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Procedure
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Explanation
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Artificial
Insemination
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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.
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IUI
- Intrauterine Insemination
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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. |
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OI
- Ovulation Induction
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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. |
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Donor
Eggs
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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. |
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IVF
- In Vitro Fertilization
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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. |
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GIFT
- Gamete Intrafallopian Transfer
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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. |
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ZIFT
- Zygote Intrafallopian Transfer
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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. |
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Embryo
Cryopreservation
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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. |
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FET
- Frozen Embryo Transfer
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Previously
frozen embryos can be transferred into the woman's uterus
or fallopian tube. |
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TESA
- Testicular Epididymal Sperm Aspiration
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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.
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Surrogate
Mother
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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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Back to the Top
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?
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Risks Of ART
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| 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%. |
Back to the Top
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.
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ART
Controversies
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- 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.
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