HEALTH MATTERS: Assisted reproductive technologies available
By Seth G. Derman
This article previously appeared in the Princeton Packet
Infertility the inability to get pregnant or stay pregnant is a common problem in the United States, affecting about 10 percent of women of childbearing age, according to the Centers for Disease Control and Prevention.
How does IVF work?
When most people talk about ART, they are referring to in vitro fertilization or IVF. IVF has been used for decades to help women get pregnant. In fact, the first IVF baby is now over 30 years old and has a child of her own.
With IVF, eggs are surgically removed from the body, fertilized with sperm and allowed to grow in the laboratory. In vitro literally means “in glass,” as the fertilization and early development happens in a laboratory dish.
Fertilization can occur naturally with the sperm selecting the egg or in cases where there are problems with the sperm, can be assisted with doctors inserting the sperm directly into the egg. After 3-6 days the embryos are inserted directly into the uterus.
While IVF was first developed to help women with missing or damaged fallopian tubes, it is now routinely used to treat infertility caused by many different problems such as sperm problems, endometriosis, unexplained infertility and any other type of infertility that does not respond to more conventional treatments.
Other methods of ART include gamete intra-fallopian tube transfer (GIFT), zygote intra-fallopian tube transfer (ZIFT) and tubal embryo transfer (TET). With these, the embryo is transferred to the fallopian tube through laparoscopic surgery instead of into the uterus, except with GIFT in which the eggs and sperm are inserted into the tube and fertilization occurs inside the body. With ZIFT and TET, fertilization occurs outside the body. These procedures are rarely performed today as their advantages in terms of pregnancy rates have been overcome by modern laboratory technology and improved methods of embryo transfer.
Who is a candidate for IVF?
The majority of patients who are candidates for ART suffer from tubal problems, sperm problems, unexplained infertility or certain inherited genetic diseases, according to the Society for Assisted Reproductive Technology (SART). Candidates for ART generally have:
- No evidence of premature menopause
- At least one accessible ovary, and
- A normal uterus
Menopause and ovarian function are irrelevant for candidates using donor eggs. SART recommends that all ART candidates should be in good health and have no medical conditions that would pose a serious health risk to themselves or the children they would carry.
How successful is IVF?
Success rates vary and depend on many factors. Some factors that can affect the success rate of ART include the following:
- Age of the partners
- Reason for infertility
- Type of ART
- If the egg is fresh or frozen
- If the embryo is fresh or frozen
In addition, the clinic itself can have an impact on success rates, according to the CDC. Princeton IVF's affiliated Laboratory takes advantage of the latest in “clean room technology,” to help improve pregnancy rates.
A specialized ventilation and HVAC system allows for improved air quality, flow and temperature control. Air quality is further enhanced by the use of eco-friendly, low VOC (volatile organic compounds) paints and building materials. This type of technology can have an enormous impact on embryo quality, survival and clinical outcomes of IVF treatment, research has shown.
What are risks of IVF?
The biggest risk factor associated with ART is multiple fetuses, but that can typically be prevented or minimized in many different ways. Other risk factors include surgical risks from the egg retrieval, side effects of the fertility drugs for mom and risks associated with pregnancy.
And while ART can be expensive and time-consuming, it has enabled many couples to have children that would have otherwise not been conceived.
What is pre-implantation genetic testing?
Pre-implantation genetic testing (PGD) and pre-implantation genetic screening (PGS) can be used following IVF to diagnose genetic diseases prior to implanting the embryo in the uterus. Doctors can test a single cell from the embryo to determine chromosomal abnormalities that, among other things, can lead to miscarriage and birth defects.
Talk with your doctor
If you are one of the millions of couples struggling with infertility, talk with your doctor about ART. For many, it is a promising option that can help couples realize the joy of parenthood.
Seth G. Derman, MD, FACOG, is board certified in gynecology and reproductive endocrinology. He is a fellow of the American College of Obstetricians and Gynecologists and a member of the medical staff at University Medical Center of Princeton at Plainsboro.