Assisted Fertilization Techniques

CURRENT TECHNIQUES
Timed Intercourse (IC) or Cycle Monitoring This is a technique using ultrasound scans, blood and urine tests to accurately pin point if and when ovulation is occurring. It will require 2 to 4 visits to the Centre on average, over a two week period. All the investigations are bulk-billed. Ovulation Induction (OI) This is a technique using ultrasound scans, blood and urine tests to accurately pin point if and when ovulation is occurring. It will require 2 to 4 visits to the Centre on average, over a two week period. All the investigations are bulk-billed. This is a treatment that uses medications, either tablets or injections, to stimulate the ovary to produce a mature egg. It is suitable if the only fertility problem is a lack of spontaneous ovulation. Tablets such as clomiphene or bromocriptine are taken where appropriate. However, often by the time a couple come to a fertility unit, these medications have already been tried unsuccessfully. Hormonal injections are given which mimic the hormones your brain produces to stimulate an egg to grow. As it is important that only one egg grows to maturity, careful monitoring using ultra sound scans, blood and urine tests is done. The amount of time involved will depend on how quickly the ovaries respond and whether the woman has polycystic ovaries. Polycystic ovaries are more likely to over or under respond and therefore it might take some weeks before ovulation successfully occurs. We expect a pregnancy rate of 15 to 40%, depending on the woman’s age. Artificial Insemination using Partner’s Semen (IUI) This is a treatment that combines a small amount of ovarian stimulation, to maximise the maturity of the egg and the lining of the uterus, with intrauterine insemination of the best of the sperm from a man’s ejaculate. It is suitable for couples with unexplained infertility or minor semen problems provided the woman’s fallopian tubes are normal. The aim is to maximise the number of normal, motile sperm around the egg at the time it is in the fallopian tube. Analysis of the studies of IUI indicates that it is 2 to 3 times more effective if the ovarian stimulation is given via injection rather than with clomiphene tablets. A pregnancy rate around 27% is expected at Fertility First but if the above guide lines are not followed, the rate will fall to 5 to 6%.

Donor Insemination (IUDI) This is a treatment in which donated sperm is inseminated into a woman’s uterus. It is suitable for couples where the partner has no sperm in the reproductive tract or so few that a pregnancy would only be possible using IVF technologies. It is also suitable if the man carries a genetic disease he does not wish to pass on to his children. The woman needs to have normal fallopian tubes. The first reported birth from this technique was in 1884. A pregnancy rate of 15 to 25% is expected, depending on the woman’s age. Oocyte Donation (DOP) This is a treatment for women who are no longer producing their own eggs, or who have a significant egg problem such that the embryos are unlikely to result in a pregnancy. It involves a donor, who can be known to the couple, going through an IVF treatment cycle. The donor’s eggs are fertilised with the partner’s sperm and the embryos transferred into the uterus of his partner. The first reported birth from this technique was in 1983. A pregnancy rate of 15 to 30% is expected, depending on the age of the egg donor and her recipient. In Vitro Fertilisation (IVF) Eggs are collected from the ovaries then fertilised with sperm in the laboratory (‘in vitro’ is Latin for ‘in glass’). Two or three of the resultant embryos are returned to the woman’s uterus ‘fresh’ two to three days later and the remainder, if of appropriate quality, frozen (cryo-preserved) for transfer at a later date. IVF was originally developed to assist couples whose fertility was impaired by fallopian tube disease. However, the applications have widened to include most types of infertility if simpler forms of treatment have not been successful. The first reported birth from this technique was in 1978. A pregnancy rate of 10 to 30% is expected, depending on the woman’s age and the number and quality of the embryos transfer red. Intra Cytoplasmic Sperm Injection (ICSI) This is a technique to assist fertilisation of an egg A single sperm is injected into each egg using a microscopic technique. As the fertilisation occurs outside the woman’s body it is another form of IVF. This technique is used when it is unlikely that sperm can penetrate the coating of the egg (the zona pellucida) on their own. The commonest situation is when there is a significant problem with the sperm (the absolute number or

the number of sperm moving are very low, or there are large numbers of abnormally shaped sperm). ICSI is also used when a man has a large number of antibodies to sperm in his ejaculate (usually following vasectomy reversal or testicular surgery) or the woman has a large number in her blood, which impair the sperm’s ability to function normally. The other principal indication is pre implantation genetic diagnosis, when it is important that only one sperm has had access to the egg. The first reported birth from this technique was in 1992. A pregnancy rate of 10 to 30% is expected, depending on the woman’s age and the number and quality of the embryos transferred. Embryo Freezing & Frozen Embryo Transfer (FET) This is a technique of assisting the eggs and sperm to make contact in the fallopian tubes, in the hopes of improving the chance of fertilisation in vivo (‘in vivo’ is Latin for ‘in life’). Eggs are collected from the ovaries and then immediately transferred (using a laparoscope) into a fallopian tube with a droplet containing pre-prepared sperm. This technique is only suitable for couples where the fallopian tubes have been shown to be healthy, and the sperm have been shown to produce adequate fertilisation rates on a previous IVF cycle. If more than two eggs are collected to transfer at GIFT, the extra eggs can be fertilised with IVF and the resultant embryos frozen for later use. The first reported birth from this technique was in 1984. A pregnancy rate of 10 to 27% is expected, depending on the woman’s age and the number of eggs transferred. We can get the same pregnancy rates at Fertility First with intrauterine insemination, which is easier, cheaper and less prone to significant complications, such as ovarian hyper stimulation. Therefore GIFT is rarely performed at Fertility First. Testicular Sperm Extraction (TESE) & Percutaneous Epididymal Sperm Aspiration (PESA) This is a technique for couples who produce more embryos during an IVF cycle than are required for their initial transfer. The remaining embryos, if sufficiently healthy to survive the freeze-thaw process, can be frozen at -196°C and safely stored for 5 to 10 years. When the couple are ready for fuller treatment they can be thawed out and transferred into the woman’s uterus without her having to go through all the steps (injections and egg collection) involved in a full IVF cycle. The first reported birth from this technique was in 1983. A pregnancy rate of 14 to 25% is expected depending on the woman’s age and the number and quality of the embryos transferred.

Gamete Intra Fallopian Transfer (GIFT) These are surgical techniques to collect sperm from the testis or epididymis of a man who has a blockage in the ducts between his testes and penis, and therefore no sperm in his ejaculate. Collection is usually done by needle aspiration (PESA), or a small biopsy of the testes (TESE), if the aspiration is not successful in obtaining sperm. IVF and ICSI techniques, mentioned above, are used to achieve fertilisation in the laboratory because of the small number of sperm obtained with this method. The first reported birth from this technique was in 1985, but pregnancies were very rare until ICSI became available. The pregnancy rate is the same as that expected for IVF and ICSI. Pre-Implantation Genetic Diagnosis (PGD) This is a technique used when one or both partner’s carry a serious genetic disease. It combines the techniques of IVF and ICSI with the removal of 1 or 2 cells from the embryo, when it is at least three days old. The cells are examined to see if the embryo is at risk of having the genetic condition. Only those embryos that are not affected are transferred. It is an alternative for couples who wish to avoid the possibility of a termination later in pregnancy. We can assist you to have this treatment in association with another fertility service. The first reported birth from this technique was in 1985. The pregnancy rate is less than expected for IVF and ICSI, probably due to the extra procedures carried out on the embryo.