Common Methods of Assisted Reproduction

Methods of Assisted Reproduction
Methods of Assisted Reproduction

What is Assisted Reproductive Technology?

Assisted Reproductive Technology (ART) includes IVF but there are also some other methods used that are customized to the specific diagnosis of the patient or couple. Most ART procedures typically deal with the use of fertility medications. Success rates for ART procedures are at an average of 30%.

In vitro fertilization (IVF) is when fertilization takes place outside of the body. In vitro fertilization, also known as IVF, yields the highest success rates of all forms of assisted reproduction. Male factor infertility (sperm quality and quantity) or female issues may require some couples to pursue IVF. With IVF, a woman is given various fertility medications in order for her to produce a large number of eggs. When the eggs reach maturity, they are retrieved from the woman during a procedure called egg retrieval. At this time, the husband or partner will typically give a semen sample. The eggs and the sperm are put in a dish for fertilization. After fertilization occurs, anywhere from 3 to 5 days, the best embryos are placed back into the woman’s uterus, this is called and embryo transfer.

If there are severe male factor issues, it may be recommended that the couple pursue IVF with ICSI.

  • Intracytoplasmic sperm injection (ICSI) – In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus.
  • Gamete intrafallopian transfer (GIFT) – GIFT involves putting the eggs and sperm into the woman’s fallopian tube so that fertilization occurs within the body. (This procedure is not common.)
  • Zygote intrafallopian transfer (ZIFT) – ZIFT begins similar to IVF as the embryos will be created the same way and fertilized outside of the body. In the ZIFT procedure the embryo is placed back into the women’s fallopian tube rather than the uterus.

Donors: For various reasons, couples may need to use a donor when seeking assisted reproduction. Eggs, sperm and embryos are all available for reproductive purposes. For women who are older or unable to produce eggs, she may seek the use of a donor egg. If the couple also faces issues that are both male and female factor, they may decide to use donor embryos. Donor sperm is commonly used for male factor issues.

Gestational Carrier (Surrogacy): If a woman doesn’t have a uterus or has been medically advised against carrying a pregnancy, she may decide to use a gestational carrier. This means that she will undergo treatment similar to IVF and will produce multiple eggs. The eggs will then be fertilized by her husband/partner and transferred back into the surrogate. (A surrogate is a women who carries a baby and at birth, the baby will be raised by other parents.) Many legal and ethical issues surround surrogacy. Dependent on the fertility clinic and state laws, certain practices may or may not be allowed.

Very Poor Sperm Morphology – Will IVF and ICSI Work?

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A lot of our readers wonder if it’s possible to still get pregnant if you have a very poor sperm morphology. The answer is, absolutely! With advancements in Assisted Reproductive Technologies, IVF with ICSI is a great option for those of us who have very poor sperm morphology. I speak from a personal experience as I was diagnosed with very poor sperm morphology. I was sad, shocked and confused at first but after learning more about possible treatments, my eyes were opened and I began to relax knowing there are options.

Right now, my wife Wendi, is in her second trimester (over 15 weeks pregnant). My Kruger Strict Morphology Analysis came back at under 2%. Our first fresh IVF cycle was not successful but we had some frozen embryos from the first round that we used for our first frozen embryo transfer a few months after our fresh IVF cycle. Our first FET was successful! IVF with ICSI made this happen for Wendi and I. All it takes is one little sperm injected into the egg and pregnancy is possible.

Besides having a very poor sperm morphology, I also have a low sperm count and low viscosity. I thought it was the end of the world. Don’t let it get you down. It’s not worth spending your energy on. You will have many other things to focus on such as IVF treatment and keeping stress levels as low as possible so there is no need to waste time getting down on yourself. Some of us were blessed with great sperm and some of us were not. If you are like me and were not blessed with high quality sperm, just know that there are options out there.

So, having poor sperm quality is not the end of the world. It took me time to realize this but I did finally come around after some stress and depression from my semen analysis results. Take what I’ve learned through our infertility experience and don’t let this eat at you. If you find out that you have poor sperm morphology, move on to the next step of the fertility process which is researching IVF clinics and various fertility treatments.

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IVF with ICSI

IVF with ICSI Procedure
IVF with ICSI Procedure

What is ICSI?

ICSI stands for intra cytoplasmic sperm injection. In simple terms, this is when the embryologist injects a single sperm into the middle of the egg. ICSI can increase the chance of getting the eggs to fertilize after they have been retrieved from the female patient. ICSI utilizes special medical devices and equipment including micro-manipulation tools and inverted microscopes that allows the embryologist to pick and capture individual sperm into a ICSI needle which is then injected into the shell of the egg where the sperm is injected into the inner part of the egg which is called cytoplasm. On average, when ICSI is utilized, about 70-85% of the eggs injected with sperm will fertilize. Before ICSI can be done, the female partner must take stimulation medications and go through the egg retrieval process in hopes that numerous eggs will be retrieved for the ICSI procedure.

Am I a good candidate for ICSI?

There is really no right or wrong answer. ICSI can increase the chance of fertilization in many cases but whether you are a good candidate or not is a discussion you should take up with your doctor. Often, ICSI is recommended for couples with severe male factor infertility which includes low sperm count, very poor sperm morphology and that do not want to use donor sperm. Some couples choose to do everything in their power to increase the chances of a successful IVF cycle so they choose to add on ICSI to the IVF procedure. ICSI can also help those who have a low yield of eggs that are retrieved in order to get them fertilized.

Success Rates When Using ICSI

Success rates for ICSI vary depending on each individual situation. Many IVF programs see anywhere from 70-85% of the eggs injected using ICSI become fertilized. Fertilization rate is different from the actual pregnancy rate. Just because an egg is fertilized does not mean it will develop into a viable pregnancy.

Often, pregnancy rates when doing IVF with ICSI show to be higher than IVF without ICSI. Once again, each individual situation varies based on infertility issues for both the male and female, age, skill of the infertility specialist and quality of the eggs. Often, ICSI is recommended for cases of male factor infertility due to the sperm not being able to penetrate and fertilize the egg(s). ICSI is also done when there is an egg factor case such as low ovarian reserves. This can mean there is a low number of eggs, low quality eggs or both low quantity and quality.

What is the cost of ICSI?

The cost of ICSI can vary based on different IVF treatment facilities and location. ICSI pricing can range anywhere from $1,000 to $4,000 just for the ICSI portion alone. Once again, this varies from IVF clinic to IVF clinic so ask specific questions when you are at your IVF consultations.