The term assisted conception (assisted reproductive technology or ART) refers to a number of treatments that encourage better egg development, or assisting sperm to reach eggs, inside or outside of the body. Assisted conception includes invitro fertilization (IVF) in its various forms. Low level ART generally involves intra uterine insemination (IUI), with or without drugs to encourage egg development at the same time. At Genea we like to avoid confusion by distinguishing IUI undertaken in a woman’s natural cycle from that with hormone injections (stimulation IUI).
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Treatments like natural cycle IUI sound attractive to patients because of their simplicity, but the success rate is quite low. Particularly with unexplained infertility, the chance to conceive is elevated modestly with stimulation IUI but much more significantly with IVF. Very often, treatment decisions are made on the basis of the differential between intervention and return.
IVF involves similar hormone treatments to stimulation IUI but at a modestly higher dose, to attain a number of eggs. The eggs are collected via a vaginal ultrasound procedure, which Mark usually undertakes under local anesthetic and intravenous pain relief with minimal discomfort. A sperm sample is provided by the male partner and the eggs and sperm are placed together in the IVF laboratory. Following fertilization and early embryo development, a single embryo is returned to the woman’s uterus in a procedure as simple as a Pap smear. Other embryos can be frozen and kept for another attempt which would not require further injections nor a further egg collection.
At Genea, embryos are almost always grown to the day 5 (or blastocyst) stage and transferred one at a time. This leads to the highest chance of pregnancy with the lowest rate of complications.
You can read detailed descriptions of the IVF process at the Genea website.
In some causes of infertility, IVF is clearly indicated, for example blocked Fallopian tubes where surgery to repair the tubes has not been successful or is not indicated. IVF is also an excellent treatment for male factor infertility, often with a single sperm injected into each egg (a process called ICSI), to overcome issues such as a low sperm count or low sperm motility. However, studies increasingly show that IVF is also the best treatment for unexplained infertility. This is because IVF is the treatment most likely to overcome the multitude of subtle problems that may be present which cannot easily be tested for.
IVF can also be combined with genetic testing of embryos, using preimplantation genetic diagnosis or PGD. This technology is very useful for couples who carry a known genetic disease in their family, or for couples with repeated miscarriage. PGD also has an emerging role within general IVF.
Whether IVF is needed or not, when it should be employed and what form of treatment is best involves a highly individualized approach and discussion between Mark and the couple.