Although many factors must be considered before deciding on a course of treatment, options generally progress from the most basic to more sophisticated surgical procedures. Options include:
- Intrauterine Insemination (IUI): Often referred to as artificial insemination, IUI is a simple procedure in which sperm is placed directly into the wife's uterus, using a catheter inserted through the cervix. Medication may be prescribed prior to the IUI to stimulate the woman's ovaries.
- In Vitro Fertilization (IVF): The most common form of assisted reproductive technology is IVF, which is the process of uniting the egg and the sperm in the laboratory. The prospective mother receives medication prescribed by her physician that stimulates her ovaries to produce several mature eggs. Frequent blood hormone tests and periodic ultrasound examinations of the ovaries determine when the eggs are mature. Eggs are then retrieved from the ovaries, placed with fresh sperm samples and allowed to fertilize naturally. Once fertilization occurs, embryos are selected and transferred into the uterus using a catheter inserted through the cervix. The intense activity leading up to embryo transfer is followed by a waiting period. Two weeks after egg retrieval, a blood pregnancy test is performed to determine whether implantation into the uterus has occurred.
- Intracytoplasmic Sperm Injection (ICSI): In cases of male factor infertility, ICSI can be used. In this process, fertilization is achieved by injecting a single sperm directly into a mature egg. Similar to in vitro fertilization, embryos are then transferred to the uterus. When sperm cannot be obtained naturally from the husband (e.g., due to spinal cord injury or a break or obstruction in the vas deferens), sperm can be harvested directly from the testicle or epididymis. These sperm can then be used for ICSI.
- Cryopreservation: Unused, healthy embryos can be frozen and stored almost indefinitely through a process called cryopreservarion. These embryos can be transferred later at a fraction of the cost of a new IVF cycle.
- Blastocyst Transfer: In order to improve embryo selection and decrease high order multiple birth rates embryos may be transferred on the fifth day of development known as the blastocyst stage.
- Preimplantation Genetic Testing (PGD): For prospective parents who have experienced repeated miscarriages (e.g., due to translocations) or whose offspring might be at risk for inherited diseases such as cystic fibrosis or sickle cell anemia, genetic testing in vitro can drastically improve the chances of transferring embryos that are healthy and do not carry defective genes.
- Donor Oocytes: Egg donation has become an integral part in the management of infertility for women who are unable to conceive due to egg factors. Women who have premature menopause, absence of ovaries, carriers of a genetic disorder or poor response to hormonal stimulation are candidates for this type of technology. High pregnancy rates may be achieved using this type of technology.
Single Embryo Transfer
Physicians on the medical staff are committed to giving infertile couples the opportunity of becoming pregnant without risking the significant consequences of twin and triplet pregnancies commonly associated with assisted reproductive technologies. Risks for the infants associated with multiple pregnancies include learning disorders, lower IQ scores, eye problems, lung problems, neonatal deaths and premature births.
A Safer Option
The ARTS Program gives patients the option of limiting twin pregnancies, without necessarily compromising their chance of becoming pregnant, through single embryo transfer. While many infertility programs transfer two or more later-stage embryos, called blastocysts, ARTS offers couples the option of transferring a single blastocyst to the woman's uterus.
Physicians believe that transferring two embryos at different times gives couples who meet certain criteria the same chance statistically to become pregnant as what they would have had if they had chosen to transfer two blastocysts in the original cycle.
Single embryo transfers are offered to patients 37 or younger and to patients using donor eggs from donors 37 or younger. Additionally, patients need to have one quality blastocyst for transfer as well as at least one other quality blastocyst for cryopreservation on the day of transfer.
While ARTS can't guarantee a pregnancy to every couple, the program will assist you as you try to conceive a child. Once a healthy ongoing pregnancy is confirmed by ultrasound, you will be referred back to your obstetrician for care. Your ARTS team will work with your doctor for a smooth transition during your first trimester. If you don't have an obstetrician, call 1-877-THR-WELL (1-877-847-9355) or use our Find a Physician feature.