Therapies and treatments for infertility

Intracytoplasmic sperm injection video
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Some couples have trouble getting pregnant. If you’ve been having intercourse on a regular basis for more than a year and haven’t conceived, you should see your health care provider for an evaluation. About 85 percent of couples get pregnant after trying for 1 year, and the remaining 15 percent are considered infertile. Many of these couples will go on to get pregnant without help, but some will need medications or other treatments in order to have a baby.

For a couple to conceive, they need a healthy egg, healthy sperm, and place for sperm and egg to meet. That meeting place requires healthy fallopian tubes and a normal uterus where the fertilized egg can set up a home for the next 9 months. Treatments for infertility depend on where in process the couple is having problems.

If a woman has irregular periods with hormonal imbalances or deficiencies, the solution might be drug therapy. Other couples may have problems that may be corrected by surgical procedures.

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: This process selects out healthy sperm and delivers them directly into the uterus, shortening the path the sperm need to travel, bypassing the cervix, and increasing the chance that sperm will meet an 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 woman's ovaries and fertilized with the man's sperm in a laboratory. Three to five days later, some of the fertilized eggs (called embryos) are placed in the uterus through the cervix. The trick is to pick the right number of embryos – if too few embryos are put back, none of them may implant in the uterus, and the woman won’t get pregnant. If too many are put back, she may have a triplet or quadruplet pregnancy. Multiple pregnancies – twins, triplets, or more – are at high risk of early delivery, with potential long-term consequences for the babies. IVF was initially used for women who had problems with blockage in their fallopian tubes. With the improved technology and success rate of IVF, the procedure is now used for couples experiencing a variety of problems. Recently, IVF laboratories have been able to culture embryos for longer periods of time (five days), allowing doctors to pick out healthier embryos and transfer fewer of them back to the mother’s uterus. This is important, because it reduces the risk of multiple pregnancies. It is important to note that the longer culture time does not improve the embryos or their chances of implanting. The extra time helps in choosing which embryo is the healthiest.
• Donor Egg Or Embryo IVF: Sometimes, a woman can’t get pregnant because her ovaries no longer produce healthy eggs. This problem becomes more common as a woman gets older. In these cases, a friend, relative, or volunteer may donate the eggs. The eggs are then fertilized with the man’s sperm and transferred into the recipient’s uterus so that she can carry the pregnancy. Women pursuing donor egg work with the fertility clinic to select an appropriate donor.
• GIFT and ZIFT: GIFT and ZIFT were developed to assist fertilization but use a woman's fallopian tubes as a natural incubator. They are generally used when a couple’s religious beliefs forbid in vitro fertilization. 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. If a couple goes through IVF and a large number of eggs fertilize successfully, the embryos that are not transferred back to the uterus can be frozen. The frozen embryos can be transferred to the woman’s uterus for another pregnancy.
• 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.
• Gestational Carrier: In this technique, another woman carries the fertilized embryo through the pregnancy and delivery. This technique is used for women who cannot carry a pregnancy themselves.

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
• Cost
• Convenience
• Documentation to support their success rates
• Details about the guidelines they follow, lab accreditations, and statistic reporting

Review Date: 12/1/2010
Reviewed By: Zev Williams MD, PhD, FACOG, Reproductive Medicine and Infertility, Weill-Cornell Medical Center, New York, NY. Review provided by VeriMed Healthcare Network.

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