Assisted reproductive technology is a term used to describe the treatment available to help those who have difficulty in conceiving a child naturally. These treatment options usually involve handling and manipulation of eggs and/or sperm in the lab to carry out simple procedures like artificial insemination/ intra uterine insemination (AI/IUI), or more advanced procedures including in vitro fertilization (IVF), intra cytoplasmic sperm injection (ICSI) and various other treatments.
1. Ovulation Induction and Follicle Tracking: Hormonal tablets or injections are given to the woman to help herovulate. The response to the medication (growth of follicles in the ovaries) is monitored by hormonal tests and byserial scans.
2. Intrauterine Insemination (IUI): This is a treatment where a prepared sample of the stronger sperm isinserted into the uterus using a fine plastic catheter close to the time of ovulation. Sometimes the woman is givenmedication to help her ovulate.
IUI is useful if:
- You are having difficulties with intercourse
- Unexplained infertility of relatively short duration
- Minor problems with the semen samples
- Mild endometriosis (a condition in which cells that normally line the womb are found elsewhere in thebody)
- You are using donor sperm
3. In Vitro Fertilization (IVF): In this technique the woman’s eggs areremoved from her ovaries and fertilized with the man’s prepared spermsample in the lab. The woman is given medication to stimulate the ovary toproduce a number of eggs. These are removed by transvaginal ultrasoundguidance under anesthesia requiring a few hours of hospitalization. The eggsand sperm are then allowed to fertilise overnight in a culture dish in the laband develop in the incubators for 2-6 days. The best embryos are then putback into the uterus to achieve pregnancy. Additional good quality embryos, ifavailable, are frozen for future use.
IVF is useful when:
- The female partner has blocked or damaged fallopian tubes and theegg and sperm may not be able to meet or the fertilised egg may notbe able to make its way into the womb
- The female partner has problems with ovulation (the release of anegg) each month
- The female partner has endometriosis
- Unexplained infertility where no cause has been found for not beingable to conceive, especially when couples have been trying to getpregnant forpregnant for more than two years
- Failed IUI
4. Intra Cytoplasmic Sperm Injection: (ICSI): This involves injecting a single sperm into each egg, in the lab totry and achieve fertilization. The earlier part of the treatment including ovarian stimulation and egg retrieval arethe same as in IVF.
ICSI is useful when:
- The sperm sample contains decreased numbers of sperm, reduced movement or there are a highernumber of abnormal sperm
- The male partner has no sperm in his ejaculate but sperm can be obtained from the testicles, usingsurgery
- The male partner produces high levels of antibodies against his own sperm which affects the ability ofthe sperm to bind to the egg
- Couples have already had IVF treatment but had unexplained failed fertilisation of all of the eggs or lowfertilisation rate
- The male partner has retrograde ejaculation, where the sperm passes backwards into the bladder andcan be found in the urine
5. Blastocyst Transfer: A blastocyct is an advanced stage of an embryo that has developed 5 or 6 days afterfertilization in the lab. In IVF and ICSI, embryos may be transferred into the uterus between two and six daysafter fertilization. A blastocyst transfer is done in selected cases to allow better selection of embryos.
6. Embryo Freezing and Frozen Embryo Transfer (FET): Embryo freezing is carried out when excess goodquality embryos are available. The frozen embryos can be thawed and used for embryo transfer in subsequentcycles without the need for ovarian stimulation and its associated complications.
7. Micro Surgical Sperm Aspiration (PESA-Percutaneous epididymal sperm aspiration,TESE-testicular spermextraction, MESE-microsurgical epididymal sperm extraction): These are surgical procedures carried out by theandrologist on the male, if the male is azoospermic, in order to aspirate or extract sperm to carry out ICSI toachieve a pregnancy. Azoospermia is a condition where no sperms are present in the fluid a man ejaculates. Aman might have azoospermia because of a blockage in the connecting passages from the testicles-called obstructive azoospermia or very few or no sperm are being produced in the testicles-called non-obstructive azoospermia.
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