Assisted Reproductive Technology (ART)

ART procedures for the treatment of infertility include artificial insemination, in vitro fertilization (IVF), gamete intra-fallopian tube transfer (GIFT) and zygote intra-fallopian tube transfer (ZIFT). Insemination with husband or donor sperm is the most common. Of the others, IVF is the procedure most frequently performed.

IVF involves stimulation of the ovaries with hormones or other medications followed by retrieval of the eggs. The purpose of the ovarian stimulation is to grow several ovarian follicles to increase the likelihood that several mature eggs will be obtained. The eggs are usually retrieved by transvaginal ultrasound-guided needle aspiration of the follicles. This does not require general anesthesia. It is usually performed with intravenous sedation. The eggs and sperm are incubated together in the IVF laboratory and observed for fertilization. In cases with severe male factor (very low sperm count or motility) or when fertilization has failed in the past, intracytoplasmic sperm injection (ICSI) is performed. ICSI involves direct injection of a single sperm into each egg.

Fertilized eggs are transferred to the uterus 2 - 3 days after the aspiration. The transfer is performed by inserting a small plastic tube through the cervix. This procedure does not require anesthesia. Generally, no more than 5 fertilized eggs are transferred (usually 3 or 4). If more than 5 eggs are retrieved, the patient may elect to have all of the eggs fertilized and freeze (cryopreserve) those that were not transferred. These may be reserved for future implantations.

In the 1980's, IVF required laparoscopy for retrieval of the eggs. Gamete intra-fallopian transfer (GIFT) was frequently performed instead of or in addition to IVF. In GIFT, the eggs are retrieved by laparoscopy and immediately placed with properly prepared sperm in the fallopian tube(s). Since GIFT requires a laparoscopy under general anesthesia, this procedure is now rarely performed, unless a laparoscopy is otherwise indicated. For the same reason ZIFT is rarely performed now. The success rates of IVF, GIFT and ZIFT are very similar at the present time; IVF is the least invasive and expensive.

Ovarian Stimulation for ART

TIRME is involved in the first step of the ART procedures, namely the ovarian stimulation. Prior to the initiation of the stimulation, a TIRME physician will review all the medical records to reveal factors that could interfere with optimal ovarian stimulation or conditions that should be corrected prior to ovarian stimulation. The physician will also advise the couple which ART procedure is indicated in their case.

Prior to the IVF procedure, both members of the couple should have undergone testing for HIV and hepatitis and the husband should have had a semen analysis. The wife should not have received ovarian stimulation treatments for at least one month prior to the procedure. She should be seen at an office visit during the menstrual cycle prior to the procedure. She will be expected to keep a basal body temperature chart during this cycle. An ultrasound is performed during this visit to detect any possible abnormalities that may be present (e.g. ovarian cysts). The treatment schedule and medications to be used are decided upon during this visit.

Ovarian stimulation is generally started on the second day of the menstrual period. Daily injections of the appropriate inducing medication(s) (such as Fertinex, Metrodin, Humegon, Pergonal or Lupron) will be given. The response to the agent will be monitored by ultrasound and by measurement of estradiol levels in the blood every 1 - 3 days. The number and size of the follicles and the level of estradiol determine the dose of medication to be used. When the follicles are large enough and the estradiol level sufficient, an injection of human chorionic gonadotropin (hCG) is administered to finally mature the eggs. This usually occurs on the 10th to 12th day of the menstrual cycle. Thirty-five hours after the hCG injection, the patient proceeds to the IVF lab where the eggs are retrieved, mixed with the sperm, observed for fertilization and division and then transferred to the uterus as described above.

Your TIRME physician may prescribe progesterone treatment for you to take after the procedure to increase the likelihood of successful implantation. In this case, you should continue this treatment as prescribed until the follow-up visit two weeks after the procedure, even if you experience vaginal bleeding. You are expected to return for a visit 14 - 16 days after the procedure for determination of the pregnancy hormone levels and possible ultrasound examination, whether or not you have started bleeding. Bleeding following IVF does not necessarily mean that pregnancy has not occurred.

Previous page
Home Page