Assisted Reproductive Technology (ART)

Accessing Assisted Reproductive Technology Options

According to the American Society for Reproductive Medicine, a couple is considered infertile if unable to achieve pregnancy after 12 consecutive months of unprotected intercourse. Couples who experience infertility have numerous options. Assisted reproductive technology (ART) includes several procedures for the treatment of infertility. Among these are in vitro fertilization-embryo transfer (IVF-ET), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), intracytoplasmic sperm injection (ICSI), assisted hatching, and surgical sperm aspiration. These techniques apply to oocyte donation and gestational carriers. ART has helped many couples conceive successfully and is used when other treatments and procedures fail, such as intrauterine insemination. Fertility therapy with ART is used when the woman has endometriosis, tubal scarring, and other causes of infertility. Surgical sperm aspiration and ICSI can help when the man is infertile from anti-sperm antibodies, congenital absence of the vas deferens, or a severely low sperm count.

In Vitro Fertilization-Embryo Transfer (IVF-ET)

In vitro fertilization with embryo transfer (IVT-ET) is a procedure designed to improve egg fertilization. Several eggs are surgically removed from the ovary and fertilized in the laboratory environment. Once one egg is fertilized successfully, it is considered an embryo and is transferred into the uterus for implantation.

IVF is used for:

  • Women who have absent or severely damaged fallopian tubes.
  • Women who have endometriosis and cannot achieve pregnancy.
  • Women with a history of DES exposure during pregnancy.
  • Women with ovulatory dysfunction who do not respond to ovulation induction.
  • Couples with unexplained infertility.
  • Men who have severely low sperm count.
  • Men born with congenital absence of the vas deferens.
  • Men who have failed vasectomy reversal.
  • Men who have a history of anti-sperm antibodies.

Gamete Intrafallopian Transfer (GIFT)

Gamete intrafallopian transfer (GIFT) is a surgical technique used to maximize fertilization of an egg within the fallopian tubes. The egg is retrieved vaginally using ultrasound guidance and placed into the fallopian tube by laparotomy or laparoscopy. Before GIFT is performed, women are assessed for fallopian tube function by a hysterosalpingogram.

GIFT is used for:

  • Women with at least one normal fallopian tube who have infertility issues.
  • Couples who have a moral or religious concern with IVF-ET.
  • Couples where the man has more than two million sperm in the ejaculate.

Intracytoplasmic Sperm Injection (ICSI)

Intracytoplasmic sperm injection (ICSI) is a laboratory procedure that involves micromanipulation of the sperm and egg. It involves the injection of a single sperm into the cytoplasm of a mature egg via a micropipette. Three to five days after the procedure, the resulting embryos are transferred to the woman's uterus or frozen for future use. ICSI is used when fertilization fails due to IVF or male infertility. ICSI is done when a man has infertility due to low sperm count, low sperm motility, or poor quality of sperm. In the case of no sperm in the ejaculate due to a blockage, sperm aspiration or testicular biopsy is done in order to retrieve the sperm for ICSI.

ICSI is used for:

  • Couples who undergo IVF due to male infertility.
  • Couples with a previous history of infertility after IVF.

Zygote Intrafallopian Transfer (ZIFT)

Zygote intrafallopian transfer (ZIFT) is an assisted reproductive procedure designed to transfer the fertilized embryo into the fallopian tube rather than the uterus. The eggs are retrieved using ultrasound guidance through the vagina and inseminated with the partner's sperm in the laboratory. The fertilized egg or zygote is placed into the fallopian tube by laparascopic means under general anesthesia. The embryo then travels through the fallopian tube to the uterus.

This procedure is recommended for:

  • Women who have at least one normal fallopian tube.
  • Couples who have had unsuccessful IVF attempts.

Embryo and Sperm Cryopreservation

Embryo and sperm cryopreservation are techniques used to preserve embryos and sperm for future use. Couples who choose these procedures include those who will undergo treatments that could potentially destroy future fertility, such as cancer therapy.

Surgical Sperm Aspiration

Surgical sperm retrieval is a treatment used for men who have a blockage of the tube for sperm passage or complete absence of sperm in ejaculate. Two methods for this are percutaneous epidydimal sperm aspiration (PESA) and testicular sperm aspiration (TESA). With PESA, the sperm is collected from the epididymis inside the scrotum using a fine needle and syringe. The TESA technique is where the sperm is aspirated directly from the testicle.

Assisted Hatching

Assisted hatching is a technique used when IVF fails. After an egg is fertilized in the laboratory, cells can divide and an embryo forms. In order to successfully implant into the uterine lining, the embryo must hatch out of a layer called the zona pellicuda. Assisted hatching is a new procedure that allows micromanipulation of the zona pellucida so that the egg can be release to implant in the uterus.

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