Some couples may need to investigate the options provided by some form of assisted conception. Assisted conception means using reproductive technology to increase your chances of getting pregnant during the month that you undergo assisted conception treatments.
Before being referred to an IVF clinic, you and your partner will most likely have had initial tests to determine the possible causes of your fertility problems. These might include:
Progesterone level test to determine whether ovulation is occurring
Sperm count to test the number and quality of sperm
Ultrasound of the uterus, fallopian tubes and ovaries to check the condition of the uterus and ovaries
Laparoscopy to identify and/or treat Endometriosis
The tests will most likely show whether or not you are completely infertile or whether you have relative infertility. More conclusive testing can be carried out at an IVF clinic.
The financial and emotional cost of assisted conception can be high. Couples need to be aware of all the issues involved and it is essential that these issues are discussed thoroughly. Couples considering assisted conception can receive counseling from hospitals and fertility clinics.
Types of assisted conception include:
- In-vitro fertilisation
- Assisted insemination using your partners sperm or the sperm of a donor
- Egg donation
- Embryo donation
IVF (in-vitro fertilisation)
This is the most commonly known and used form of assisted conception. The term in-vitro fertilisation means fertilisation in glass (or in the laboratory). The term IVF refers to any form of assisted conception where fertilisation takes place outside the body.
The first IVF child was born in 1978, since then IVF treatment has come a long way. IVF can now be used to treat numerous reproductive problems, including low sperm count, irregular ovulation and unexplained infertility.
Research and ever-improving techniques mean that embryos can be kept in the lab for longer and have a greater chance of surviving and implanting to form a pregnancy after they are transferred back to the body.
IVF involves the use of hormone injections over 2 weeks or so to stimulate multiple ovulation in the ovaries. In natural conception, just one egg is released each month. With IVF stimulation techniques it is possible to obtain up to 20 or more eggs.
Your progress is monitored every 3 days by blood tests and ultrasounds. During ultrasounds, your ovaries are viewed to determine the number of developing eggs and their size. When the eggs are mature and ready for collection, a trigger injection is given to trigger ovulation (usually 34-36 before the egg pick-up is scheduled).
The eggs are retrieved via the vagina using a guided ultrasound and needle, or via a laparoscopy (an incision in the navel). Ultrasound collection is performed using a local anasethetic, and a fine needle is passed through the vaginal wall into each ovary. Each follicle is ruptured to release its fluid, and the scientist sorts through the fluid to locate the eggs.
The eggs are then fertilised in the lab by adding your partners sperm (or the sperm of a donor) to the culture dish containing your eggs. The next day, the scientist checks for signs offertilisation and any resulting embryos are incubated in a special culture medium until they are transferred back into the uterus 2-5 days later. If there are remaining embryos, they can be frozen for later use.
A variation on IVF is ICSI. This stands for Intra-Cytoplasmic Sperm Injection, and involves the careful injection of a single sperm into the soft body of an egg. ICSI is used in extreme cases of male infertility, where there are not enough sperm in the ejaculate, or when it is thought that sperm will not be able to fertilse an egg on its own using conventional IVF techniques (spontaneous fertilisation in a dish).
GIFT (Gamete Intra-Fallopian Transfer)
GIFT is not a form of IVF. It is a form of assisted conception where eggs and sperm are collected and introduced together into the fallopian tube for fertilisation to occur naturally. GIFT has been widely used in the past, but is becoming less common as IVF techniques and success rates improve. GIFT is mostly requestd by couples who have religious or moral objections to external fertilisation.
Before IVF, Assisted Insemination (usually using the sperm of a donor) was used as a treatment for low sperm counts. Today, Assisted Insemination is still used to an extent, using either the sperm of your partner or a donor. The sperm are washed and specially prepared for fertilisation, before being placed in the uterus at the time of ovulation. Fertilisation and embryo development take place as they would naturally, and because of this, assisted insemination is not a form of IVF.
For more detailed information about assisted conception, take a look at the Sydney IVF web site.
Or join our Assisted Conception forum group.