Couples who need help getting pregnant can benefit from assisted reproductive technology (ART). ART is, in the broadest sense of the term, any Western medical treatment that uses artificial means to achieve pregnancy. ART procedures are used to treat male and female factor infertility including but not limited to ovulatory problems, tubal factor infertility, ejaculatory problems and unexplained infertility. Every year, ART is responsible for the successful birth of 200,000 babies in the United States, Europe, and North America. ART procedures are not for everyone. They can be financially, physically, and emotionally challenging and should only be considered after simpler forms of infertility treatment have failed. Have you been diagnosed with a serious fertility disorder? Are you feeling a lot of pressure as more and more time passes and your biological clock continues to tick without that baby you so desperately want in your arms? If you answered yes to either of these questions then this may be a good time to begin a discussion with your doctor about ART. Perhaps this is a way for you to become pregnant when natural techniques alone have, in your case, not been enough. Here is a brief rundown of some widely-used ART treatments:
Intrauterine Insemination (IUI)
Intrauterine insemination (IUI) is among the least invasive ART procedures. Also known as artificial insemination, this procedure can be done two ways. The first approach is called an unstimulated cycle or natural cycle, where no fertility drugs are used. The second approach is called a stimulated cycle and involves giving the woman a fertility drug to stimulate the production of multiple follicles. In both approaches, the man submits a sperm sample to a lab, where a technician separates the sperm cells from the semen. The IUI procedure starts around the time of the woman's ovulation. During an unstimulated cycle, a woman will be asked to use an ovulation predictor kit to pinpoint the time of ovulation accurately. For stimulated cycles, a doctor will use an ultrasound to detect ovulation. The IUI will then take place once ovulation is confirmed. Sperm cells are introduced directly into the uterine cavity via a tube inserted through the vagina and cervix. Sometimes, the sperm cells may be mixed with a large amount of fluid to help carry it to the fallopian tube. This additional technique is known as fallopian sperm infusion. Like other methods of ART, the success rate of IUI depends on the couple's age, and mostly that of the female partner. Generally, a woman under the age of 35 has a 10-15% chance of conceiving with an IUI; however, the success rate of stimulated cycles is higher at 30%.
In Vitro Fertilization (IVF)
In vitro fertilization (IVF) is one of the most popular and successful ART procedures. Every year, 48,000 IVF babies are born in the United States alone. IVF can help couples get pregnant by overcoming a diversity of fertility issues like severe endometriosis, blocked fallopian tubes, ovulatory problems, and even male factor infertility. During an IVF cycle, you will be closely monitored by your doctor during all phases. Treatment begins with a course of fertility drugs which are administered by injection prior to ovulation. The drugs contain hormones that stimulate the production of more than one egg. You will be scheduled for ultrasounds so that your doctor can determine when the follicles have matured to a stage when retrieval of your eggs can take place. At a very precise time, your doctor will instruct you to administer an injection of a specific hormone that will trigger ovulation. As soon as you ovulate, the retrieval procedure will take place. The eggs will then be combined with the partner's sperm with the hope that the sperm will fertilize at least some of the eggs. In a few days, the fertilized egg cells will start dividing and form embryos. The embryos will then be transferred inside your uterus by inserting a thin tube through the vagina and cervix. Normally, only two to three embryos are placed in the uterus; the rest, if any, may be cryo-preserved in case the eggs that were transferred fail to implant. In two weeks, you will take a blood test to determine if pregnancy has occurred. If the treatment is successful, the embryo will attach itself to the uterine wall and continue to develop normally.The success rate of IVF treatments varies according to the couple's age, general health issues and specific fertility challenges. Women younger than 35 have healthier eggs and generally have a 48-50% chance of conceiving with an IVF. Over 30% of IVF treatments result in a multiple pregnancy.
Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic sperm injection (ICSI) was first introduced in 1992 and is now the leading method of ART for male factor infertility. Every year, 24,000 babies are born in the United States through the assistance of ICSI. ICSI is the preferred treatment if the male has low sperm count, poor sperm motility, irreversible vasectomy, or a damaged vas deferens (the tube that brings the seminal fluid from the testicles to the penis). Unlike IVF, ICSI is not a stand-alone treatment; rather, it is a complimentary treatment that is only performed together with an IVF or ZIFT treatment. The man will have to provide a sperm sample by either masturbation, or if there is not enough healthy sperm in the ejaculate, the physician can obtain the sample surgically from the testicles or the passages that hold the sperm. The sperm sample may in some cases be collected in advance and frozen until the mature eggs are ready. Once the sperm and egg sample are obtained, the physician will inject a sperm cell into an egg cell using a microscopic needle to manipulate fertilization. (In an IVF without ICSI, the sperm are placed in close proximity to the egg in a petri dish without any medical intervention to stimulate fertilization.) When the fertilized eggs become an embryo, they are inserted into the woman's uterus through the same procedure used in a conventional IVF. In two weeks, the woman can take a pregnancy test to see if the procedure was a success. Some studies show that ICSI increases the pregnancy success rates of IVF procedures as opposed to IVF procedures without ICSI.
Gamete Intrafallopian Transfer (GIFT)
Gamete intrafallopian transfer (GIFT) is a less popular approach, making up less than 1% of ART treatments. GIFT is an option for women with cervical or ovulatory problems, or where male factor infertility is present. A woman must have at least one healthy fallopian tube for this technique to have a chance at being successful. The initial phase of the procedure is similar to IVF in that fertility drugs are used to stimulate egg production and a sperm sample is obtained from the male partner. The egg and sperm are then combined in a petri dish, but not long enough for fertilization to occur in that environment as it would in an IVF procedure. The combined egg and sperm are then inserted into the fallopian tube through a laproscopic technique. Some people are drawn to GIFT over IVF for ethical reasons because through this form of ART, fertilization is allowed to occur naturally inside the fallopian tube, rather than fertilization taking place outside the body in a petri dish as happens with IVF. The success rates vary but generally speaking, couples have a 21% chance of a successful pregnancy after a GIFT cycle. The risks of this procedure include multiple pregnancies and ectopic pregnancy (a pregnancy where the egg implants itself onto the fallopian tube).
Zygote Intrafallopian Transfer (ZIFT)
Zygote intrafallopian transfer (ZIFT) is used even less than GIFT. ZIFT is a very similar procedure to GIFT, the difference being that the sperm and egg are allowed to fertilize outside the body in a petri dish before they are inserted into a fallopian tube. For this reason, the success rate of ZIFT at approximately 26% is slightly higher than that of GIFT. Thirty-five percent of ZIFT pregnancies result in a multiple pregnancy.
Increasing your chance of success with ART
Although factors beyond your control can affect the outcome, there are things that would be beneficial for you to do to help improve your odds of becoming pregnant with ART. These simple steps should be part of everyone's basic pre-natal care and can boost your chances of success, especially if started months before the procedure.
A quality pre-natal vitamin contains nutrients that are essential to producing healthy eggs and a nutrient-rich uterine lining. But just because you take vitamins, doesn't mean that you should start neglecting your diet. A fertility diet filled with nutrient-dense organic foods can also really boost your fertility potential. Avoid refined carbohydrates, trans-fats, and caffeine. These foods consume a large number of nutrients before they get converted into bio-available energy.
Studies show that COQ10 and L-arginine can improve the pregnancy rates among IVF patients. COQ10 protects eggs from free radicals whereas the amino acid L-arginine improves ovarian response and endometrial receptivity. Ask your doctor's advice on the right dosage of these supplements.
Quit drinking and smoking
Researchers from Harvard Medical School discovered that women who drink at least two large glasses of wine a week have lowered chances of conceiving using IVF. Alcohol reduces the chances of an IVF pregnancy by 18%, where as men have a 14% reduced rate of successfully fathering a child using this procedure. Although the researchers could not determine exactly why alcohol consumption lowers the success rate of an IVF, these findings are strong enough to show that unhealthy lifestyle habits have a serious impact on fertility. If you are trying to conceive, your chances will increase if you quit drinking and smoking.
It may be an unconventional way to boost fertility, but research shows that acupuncture can increase the success rates of fertility treatment. A study by researchers from the University of Maryland and the VU University Amsterdam discovered that acupuncture increases the success rate of IVF by as much as 65%. Acupuncture is thought to stimulate the production of endogenous opioids to induce relaxation and make the body receptive to an embryo. The procedure is also known to increase the blood flow to the uterus. Consider starting acupuncture treatments as early as you can before your ART procedure. At the very least, get a treatment just before or right after the embryo gets transferred into your uterus.