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Step 7: ASSISTED REPRODUCTION TECHNIQUES

If the couple are producing enough healthy eggs and sperm and the fallopian tubes are normal then the problem is likely to be one of fertilization.

There is a range of modern techniques to assist the natural process of fertilization. These can sometimes be outside of the body (this is called in vitro fertilization – IVF) and some involve introducing sperm into the woman’s body, along with increasing the number of eggs released at the time of ovulation, for fertilization to take place (this is called super ovulation combined with intrauterine insemination – IUI).
If the previous treatment steps have not been successful, your doctor may suggest using donor eggs or sperm as part of these techniques.
Some of the other assisted reproduction techniques that you may hear include intracytoplasmic sperm injection (ICSI) and gamete intrafallopian transfer (GIFT).

How long should this stage last?

The duration will depend on what treatment is used, so discuss with your doctor the length of time each treatment will take.

Questions about Assisted Reproduction Techniques

How long has this clinic offered this procedure?
Which procedure has the greatest chance of success for us?
Can you provide an information sheet describing the treatment?
What are the side effects of this treatment?
What are our chances of having a baby if we have this treatment at this clinic?
How long will we have to be on this treatment before stopping or trying another treatment?
What are the risks of multiple pregnancies?
What should we do next if this treatment does not work?
What support or counselling is available?
What are the costs involved with this treatment and are they reimbursed?

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^{The information provided in this article was adapted from THE ACT PATHWAY BOOKLET developed by The Assisted Conception Taskforce (ACT). ACT is an international group of healthcare professionals and patient representatives from 17 countries with a specialist interest/expertise in conception difficulties. ACT aims to provide education, advice and support to couples experiencing conception difficulties by raising awareness of the issue. ACT has been supported by an unrestricted educational grant from Merck Serono S.A. Find information on ACT initiatives at www.assistedconception.net}

Obstetrician/Gynaecologist

A doctor who delivers babies and specialises in the treatment of female reproductive organs.

Oestrogen

A hormone that stimulates secondary female sexual characteristics and controls the course of the menstrual cycle. Oestrogen is also produced in low quantities in males.

Oligospermia

A condition when a sperm sample contains less than 20 million spermatozoa per ejaculate. Many medical conditions reduce sperm concentration. The effects may be temporary or permanent. See also Azoospermia.

Outpatient

A Person undergoing a clinical procedure that does not require admission to hospital.

Ovarian failure

The failure of the ovary to respond to hormonal stimulation from the pituitary gland because of damage to or malformation of the ovary, or a chronic disease such as autoimmune disease or ageing process.

Ovarian follicle

The structure in which eggs are nurtured to maturation. Although in general only one egg is released at a time, somewhere between 10 and 20 follicles begin the process of maturation monthly. The excess ovarian follicles are reabsorbed before ovulation occurs.

Ovulation

The release of the matured egg or ovum from the ovarian follicle.

Ovum

A matured egg.

Ovulation Induction (OI)

Medical treatment carried out to initiate ovulation.

Ovarian Hyper Stimulation Syndrome

A condition characterised by enlargement of the ovaries, fluid-retention and weight gain. May occur when the ovaries are over-stimulated during assisted reproduction.

Ovaries, Ovary

Almond-sized organ(s) located on either side of the uterus, which produce and release mature egg cells and the hormones oestrogen and progesterone.

Idiopathic infertility

Unexplained infertility.

Infertility or primary infertility

The inability of a couple to achieve conception after a year of unprotected intercourse – six months if the woman is over 35 – or the inability to carry a pregnancy to live birth. Also see Subfertility.

Intracytoplasmic Sperm Injection (ICSI)

A single sperm is injected directly into an egg cell with microscopic guidance. If fusion takes place, the embryo is transferred into the uterus for implantation. This clinical procedure is often used in conjunction with In Vitro Fertilisation if the male partner has a very low sperm count, low sperm motility or poor-quality sperm.

Intrauterine device

(IUD): A contraceptive device consisting of a small piece of bent plastic, which prevents pregnancy by changing the environment of the uterus.

Intrauterine Insemination (IUI)

A procedure whereby sperm are deposited directly into the uterus via the cervix using a catheter.

Irregular ovulation

Menstrual cycles that vary more than a few days in length from month to month are considered irregular. Most menstrual cycles occur about every four weeks, with the normal range lasting between 24 and 35 days.

In Vivo

A process that occurs inside the body.

In Vitro Fertilization (IVF)

Eggs produced with the assistance of fertility drugs are retrieved from the woman’s body and fertilized by sperm in a laboratory environment. The resulting embryos are transferred via catheter to the uterus.

Immune system disorders

On rare occasions, an impaired immune system may regard the egg or sperm as a ‘foreign body,’ and attack it as an ‘intruder.’

Implantation

The process whereby the embryo embeds itself into the lining of the uterus. The cells from the embryo eventually connect with the mother’s blood vessels to form the placenta. See also ectopic pregnancy.

Gamete

A reproductive cell: sperm (male) or egg (female).

Genital herpes

A sexually transmitted disease caused by the herpes simplex viruses type 1 or type 2, resulting in genital ulcers.

Genital warts

Benign growths on the genitalia, externally or internally, which are caused by the Human Papilloma Virus (HPV).

Gonadotrophin-releasing hormone

A hormone secreted from the brain, which in turn stimulates the pituitary gland to produce hormones involved in the fertility cycle, mainly Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH).

Gonadotrophins

Hormones secreted by the pituitary gland that control reproductive function, such as Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH).

GnRH analogues

Drugs that temporarily block the natural release of Luteinizing Hormone (LH) or Follicle Stimulating Hormone (FSH) to allow the hormonal cycle to be controlled clinically. By suppressing these hormones, doctors can precisely control ovarian stimulation and prevent spontaneous ovulation before egg retrieval takes place.

Fallopian tube

A funnel-shaped passage through which sperm are guided towards the egg, and fertilized eggs are conveyed to the uterine cavity.

Fertilization

The moment of conception when the genetic material contained in the sperm and egg combine to create an embryo. Fertilization usually occurs inside the fallopian tube. It may also occur in vitro during a clinical process. See also In Vitro Fertilization.

Fertility treatment

Any procedure used to enhance fertility or to help couples achieve pregnancy.

Fertility psychologist

A health specialist with professional qualifications in psychology and counselling relating to fertility issues.

Fibroid tumour

A benign (that is, not malignant or life-threatening) tumour made up of fibrous tissue that may form in the uterine wall. Fibroid tumours may be present without any symptoms, or may cause abnormal menstrual patterns or infertility.

Follicle

A fluid-filled sac in the ovary, which contains the egg released during ovulation. Each month a new egg matures and travels to the fallopian tube.

Follicle Stimulating Hormone

A hormone released by the pituitary gland in both sexes. In women, FSH stimulates the growth of the ovarian follicle necessary for egg production. In men, FSH stimulates and supports sperm production. Elevated FSH levels are associated with gonadotrophin failure in both men and women.

Freezing

(See Cryopreservation)

Cervical mucus

A natural lubricant produced by the female body that aids the transportation of sperm and helps protect against infection.

Cervix

The cervix or neck of the uterus is the lower, narrow portion of the uterus where it joins with the top end of the vagina.

Chlamydia

A sexually-transmitted infection, which may be asymptomatic or cause genital inflammation and discharge, pelvic pain and fever. Untreated, chlamydia can lead to Pelvic Inflammatory Disease (PID) and fertility problems.

Chromosomes

Structures found in the nucleus of cells that contain genes and carry heredity information, such as eye colour, blood type and vulnerability to disease. Humans have 23 pairs of chromosomes. One set of 23 chromosomes is inherited from the biological mother via her egg and the other from the biological father, via his sperm. Each sperm cell contains either male or female sex chromosomes. As such, it determines the gender of the foetus. Genetic abnormalities occur when an individual is born missing a chromosome or has more copies of a chromosomal pair.

Clomiphene citrate

A prescription drug used to bring on ovulation. It comes as a tablet and is often used as an initial treatment for women with ovulation problems. Clomiphene citrate induces ovulation in 80% of women who have trouble ovulating on their own.

Conception

The moment of fertilization when the sperm meets and penetrates the egg.

Congenital abnormalities

Physical abnormalities present at birth.

Corpus luteum

A hormone-secreting mass within the ovary that forms from the remains of a follicle each time an egg is released. The hormones it produces prepare the uterus for embryo implantation. If pregnancy does not occur, the mass is shed during menstruation.

Cryopreservation

A technique used to store human tissue at very low temperatures. Embryos that are not used in an ART cycle may be preserved in this way for future use. Also known as “Freezing”.

Cryptorchidism

A condition usually detected at birth or childhood whereby the testicles fail to descend. When a male foetus develops in the uterus, his testicles normally form inside his abdomen and descend into the scrotum shortly before birth. Undescended testicles usually descend themselves by the sixth month of life, but are unlikely to descend after this period of their own accord.