Assisted Reproductive Technologies (ART) refer to those advanced techniques (IVF,GIFT, ZIFT, etc.) which are used to bring eggs and sperm together in order to help infertile couples achieve pregnancy. Here is a brief summary of each type of procedure:

In Vitro Fertilization (IVF)IVF cartoon
Sometimes described as the "test tube baby procedure," IVF gets its name from the fact that fertilization occurs outside of the body, in a laboratory dish. This procedure has been performed successfully thousands of times throughout the world for nearly 2 decades. The indications for IVF include damaged fallopian tubes, endometriosis, abnormal sperm, unexplained infertility and failure to respond to other treatments. These are the steps involved:

(1) Pre-procedure evaluation includes day 3 hormone testing, evaluation of the uterus with HSG or hysteroscopy, semen analysis, measurement of the uterine cavity and counseling

(2) Suppressing the ovaries with birth control pills and a medication called GnRH agonists such as Lupron® in order to prevent the eggs from releasing prematurely.  Some women will use a GnRH antagonist such as Cetrotide or Antagon which starts later in the cycle.

(3) Stimulating the ovaries with fertility drugs such as Gonal-F®, Follistim® or Repronex® in order to obtain as many eggs as possible for the procedure. This process is monitored with early morning transvaginal ultrasound exams and blood tests about every other day, and then daily as the eggs mature.

(4) Stimulating the eggs to release with hCG (Profasi®,Pregnyl®)

(5) 34-36 hours after the hCG injection (just before the eggs are released), the Egg Retrieval is performed using a needle guided by a transvaginal ultrasound. This can be done with intravenous sedation, local anesthesia or general anesthesia.

(6) The eggs are handed off to the Embryologist who places the eggs in a dish with the husband's sperm. Fertilization occurs in a laboratory dish and can usually be appreciated under the microscope by the following morning.

(7) After 3 days in the laboratory, the embryos have usually divided to the 6 or 8 cell stage and are ready for transfer. Embryo transfer is accomplished by passing a small plastic transfer catheter into the uterus. The embryos may be grown an extra 2-3 days and transferred at the blastocyst stage.  Anesthesia is usually not required.

(8) Progesterone supplements which were begun the day after retrieval continue until the pregnancy test is negative or throughout the first trimester of pregnancy. Pregnancy test results are available just over 1 1/2 weeks after transfer.

Intracytoplasmic Sperm Injection (ICSI)ICSI

The is a variation of IVF in which each egg is directly injected with a single sperm via a microscopic needle. For men with very low sperm counts, this has revolutionized the treatment of male infertility


Donor Eggdonor egg IVF
This is a variation of IVF in which an egg donor undergoes steps 1-5 and has the eggs removed. The donor's eggs are then inseminated with the recipient husband's sperm. And the embryos are then transferred into the uterus of the recipient (the woman being treated). The recipient receives hormones to coordinate her menstrual cycle with that of the donor. This is used in women who are not candidates for regular IVF due to age, high FSH levels, premature menopause or poor response or have failed multiple IVF attempts.

Gestational Carrierdonor egg IVF
This is a variation of IVF in which the patient undergoes steps 1-5 and has her eggs removed. Her eggs are then inseminated with the husband's sperm. And the embryos are then transferred into the uterus of the gestational carrier (the woman who will carry the pregnancy). The gestational carrier receives hormones to coordinate her menstrual cycle with that of the donor. This is used in women who are unable or unwilling to carry a pregnancy, but desire their own genetic children.

Testicular Sperm Extraction (TESE)
Microsurgical Epididymal Sperm Aspiration (MESA)
Round Spermatid Nucleus Injection (ROSNI)

These procedures are used when the male partner has sperm in the epididymis or testes, but none in the ejaculate. A biopsy is obtained from the testes or a needle inserted into the epididymis. Sperm are then isolated. These sperm are then used as part of an IVF/ICSI procedure.


The Following Procedures are done very infrequently today...

 

Gamete Intrafallopian Transfer Procedure (GIFT)

The is the one ART procedure in which only the gametes (eggs and sperm) leave the body, and conception takes place spontaneously in the fallopian tube. GIFT can only be done when the sperm quality is adequate and the fallopian tubes are intact. These are the steps involved:


(1-4) Steps 1-4 are identical to steps 1-4 of IVF.

(5) 32-34 hours after the hCG injection (just before the eggs are released), the Egg Retrieval is performed using a needle guided by a transvaginal ultrasound or through laparoscopy. This is usually done under general anesthesia.

(6) The eggs are handed off to the Embryologist who places the eggs and the husband's sperm in a special catheter. Laparoscopy is performed and this catheter is threaded in the fallopian tube and the gametes transferred.

(7) Progesterone supplements which were begun the day after retrieval continue until the pregnancy test is negative or throughout the first trimester of pregnancy. Pregnancy test results are available just over 1 1/2 weeks after transfer.

 

 

Zygote Intrafallopian Transfer Procedure (ZIFT)

The is a fusion of IVF and GIFT in which a fertilized eggs are transferred into the fallopian tubes. The indications are the same as IVF but the fallopian tubes must be intact. These are the steps involved:


(1-5) Steps 1-5 are identical to steps 1-5 of IVF.

(6) The eggs are handed off to the Embryologist who places the eggs in a dish with the husband's sperm. Fertilization occurs in a laboratory dish and can usually be appreciated under the microscope by the following morning.

(7) That day, the embryos (more correctly, zygotes) are prepared . Zygote transfer is accomplished by laparoscopy, usually under general anesthesia.. A catheter containing the zygotes is threaded in the fallopian tube and the gametes transferred.

(8) Progesterone supplements which were begun the day after retrieval continue until the pregnancy test is negative or throughout the first trimester of pregnancy. Pregnancy test results are available just over 1 1/2 weeks after transfer.

 

 

Tubal Embryo Transfer (TET)

The is a variation of ZIFT in which the embryos are transferred by laparoscopy 2 days instead of 1 day after retrieval




 

All rights reserved.  Seth G. Derman, M.D., 1996-2008