Assisted Reproductive Technologies Fact Sheet
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Assisted Reproductive Technologies at UK HealthCare
The Division of Reproductive Endocrinology provides care in the treatment of reproductive problems such as menstrual abnormalities, infertility, premenstrual syndrome and a range of other reproductive and endocrine problems.
Assisted reproductive technologies, ART, refers to all techniques that involve taking eggs outside of the body to attempt pregnancy. In vitro fertilization, IVF, refers to fertilization of a woman's egg in the laboratory by a sperm then transferring the embryo(s) to the uterus. IVF was the first, and remains the most common ART procedure. Gamete intrafallopian transfer, GIFT, requires an outpatient laparoscopy procedure to place eggs along with sperm in the fallopian tube to allow for fertilization in the body.
Over the years, complex protocols involving hormone shots have developed. These injections cause multiple eggs to develop. The hormone injection therapy continues for eight to 10 days. During this time, response to the medication is monitored by ultrasound scans and blood tests to check the estrogen level and make any necessary adjustments to the dose of medication. Ideally five to 15 eggs will grow.
The eggs are retrieved by a minor surgical procedure that lasts about 30 minutes. Using an ultrasound probe placed in the vagina, a needle is passed into the ovary where the eggs are aspirated.
After collection, the eggs are evaluated for maturity in the laboratory. Prepared sperm is placed with mature eggs in an incubator for fertilization. Depending on the quality of egg and sperm, 40 to 75 percent of eggs will fertilize. Over the next few days, fertilized eggs will continue to divide into a developing embryo. Within two to six days, the embryos are placed in the uterus by a small catheter. The number of embryos to be transferred is determined on a number of factors including the woman's age.
If the remaining, nontransferred embryos are of high quality, they can be frozen, or cryopreserved, for future use. Frozen embryos allow for a much less involved, less expensive future ART cycle. However, not all embryos will typically survive the thaw. Pregnancy rates for frozen ART cycles tend to be considerably lower than those with fresh cycles.
Donor sperm can be used in the absence of a male partner, or when sperm does not respond to intracytoplasmic sperm injection, ICSI, in which a single sperm is injected into a mature egg. While using a known sperm donation can be done, a sperm bank is most commonly used. With sperm banking, the donor undergoes extensive medical and genetic testing and the sperm is quarantined for six months to allow for testing for transmittable disease.
The most common reason for using an egg donor is decreased fertility in the woman due to her advancing age. The fertility of ovaries may be decreased even at a fairly young age. Due to the complexity of retrieving eggs, egg donation is more involved and more expensive than sperm donation. The egg donor must undergo hormone stimulation of her ovaries and egg retrieval while the woman to receive the embryo undergoes treatment to prepare her uterus. This may be done with either a known or unknown donor from an egg donor program.
Egg freezing is a new and exciting technology. While it is still considered investigational, initial results are promising. Freezing eggs has allowed the development of a frozen egg bank for quarantining the eggs as is required for sperm. Egg freezing may allow other opportunities in the future such as
preservation and prolongation of a woman's fertility.
Risk with ART
The highest risk associated with ART is the risk of multiple babies. When multiple embryos are
transferred, there is always a risk that all of them will implant. However, the risk of triplets or additional babies is decreasing. Unrelated to the higher incidence of multiple pregnancy, ART babies also
appear to have an increased incidence of being slightly small.
In addition, a slightly increased risk of miscarriage and tubal pregnancy exists with ART.
Kentucky Women's Specialists
American Society of Reproductive Medicine
Resolve: The National Infertility Association