Defined in its broadest sense, the term assisted reproductive technologies (ART) could be applied to any therapy directed toward improving the chances of conception. In the current vernacular ART is reserved to describe those interventions related to in vitro fertilization (IVF) and embryo transfer. A brief overview of current ART procedures is provided below.
In vitro fertilization (IVF) is the most effective procedure and has grown in demand since the first child was conceived by IVF in 1978. IVF is a multi-step process in which eggs (oocytes) are extracted from the woman’s ovary (where the eggs are produced), fertilized by sperm in a laboratory, cultured into early embryos and then transferred into the woman’s uterus. According to the Canadian Fertility and Andrology Society, the live birth rate from a combined total of 9,904 IVF/ICSI treatment cycles in 2008 was 29% per cycle started. In 2010, preliminary results reported the overall pregnancy rate from a combined total of 10,390 IVF/ICSI treatment cycles in 2009 was 37% per cycle started.
Intracytoplasmic sperm injection (ICSI) is done in combination with IVF to increase the chances of fertilization. In brief, this procedure involves injecting a single sperm into an egg using a microscope and specialized instruments. ICSI is the treatment of choice for severe male factor infertility and can be used for unexplained infertility where fertilization does not occur with standard IVF procedures. Fertilization rates for ICSI are reported to be between 60 – 70%.
Gamete intrafallopian transfer (GIFT) is a variation of IVF that is an option for women with at least one unblocked fallopian tube. In GIFT, eggs are retrieved from the woman’s ovary and placed with the male sperm (obtained prior to the procedure) into a small catheter. The catheter (a flexible tube) is used to immediately deliver the eggs and sperm into the woman’s fallopian tubes where nature takes over. Unlike IVF where fertilization occurs in the laboratory, in GIFT the fertilization takes place inside the woman’s body.
Zygote intrafallopian transfer (ZIFT) is essentially a blend of both GIFT and IVF. Fertilization of the eggs occurs in the laboratory and the newly fertilized eggs (zygotes) are placed into the fallopian tubes rather than into the uterus as they would in IVF. It involves two separate procedures: an egg retrieval on one day followed by a laparoscopy the next day to transfer the zygotes into the tube.
Intrauterine insemination (IUI) is used for women with thick cervical mucous or semen allergies, and for men with low sperm counts and motility. The procedure is fairly simple and can be done in a healthcare provider’s office near the time of ovulation.
IUI is performed when a woman is releasing eggs (ovulation). Sperm is collected from the man prior to the procedure and it is washed with a special solution in the laboratory. It is then injected into the uterus using a thin tube (catheter) attached to a plastic syringe. IUI is also used if sperm shows poor motility (swimming ability) or if there is an ejaculatory problem, but the effectiveness of IUI is naturally higher if sperm parameters are within the normal limits. Results depend on the diagnosis and the treatments done in conjunction with IUI.