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Assisted Reproductive Technologies (ART)

Many times couples cannot become pregnant without specialized medical care. As the name implies, ART procedures are those that employ advanced technologies to help couples become pregnant. This page includes brief descriptions of various ART procedures with links to more detailed discussions.

ART procedures include in vitro fertilization, intracytoplasmic sperm injection, donor egg IVF, preimplantation genetic diagnosis, assisted hatching, and blastocyst transfer, where physicians, embryologists, and other technicians utilize their training, skills, and equipment to cause eggs to fertilize, develop, and implant in the uterus.

In vitro fertilization is an ART procedure that was first successfully performed in 19789 in England by doctors Steptoe and Edwards and later in the United States by Howard Jones, MD and Georgianna Jones, MD at the Jones Institute for Reproductive Medicine in Norfolk, VA.

In in vitro fertilization the female receives medication causing her ovaries to produce numerous eggs that will be retrieved from the ovarian follicles by the reproductive specialist. The partner's sperm are obtained by masturbation and combined with the eggs, "in vitro, or outside of the body". After fertilization, the resultant embryos are placed in an incubator until they are ready for transfer back to the uterus. IVF pregnancy rates have improved dramatically over the last several years and vary by infertility clinic.

Intracytoplasmic sperm injection (ICSI) was introduced in early 1990's and made it possible for "infertile" men to produce genetically related children. Before ICSI the only option for couples with male infertility was to use a sperm donor.

ICSI involves injecting a single sperm into the egg retrieved during an IVF cycle. Sperm can usually be obtained from the ejaculate even if the sperm count is very low. In cases where there are no viable sperm in the ejaculate, sperm can often be retrieved from the male reproductive tract. Testicular sperm aspiration (TESA) involves retrieving sperm directly from the testicles and microepididymal sperm aspiration involves taking sperm from the tubes known as the epididymus.

Donor egg involves an IVF cycle where another woman's eggs are combined with the partner's sperm. The resultant embryos are placed in an incubator until ready for transfer back to the recipient mother's uterus. The baby will have the genetic makeup of the egg donor and male partner. The recipient mother experiences the joy of pregnancy and delivery.

Donor egg is recommended for women who have reduced ovarian reserve or ovarian failure. It is also used in some cases of infertility from unexplained causes and in older women.

Zygote intrafallopian transfer (ZIFT) is a procedure similar to IVF. In ZIFT, the embryo is surgically placed in the end of the fallopian tube, where fertilization normally takes place. Success rates for ZIFT are not superior to IVF and the procedure is more expensive.

Gamete intrafallopian transfer (GIFT) is another procedure that is similar to IVF. In GIFT, the eggs are combined with the sperm in the distal end (near the uterus) of the fallopian tube which is where fertilization occurs. ZIFT is different in that it involves placing an embryo in the end of the tube instead of the gametes (sperm and egg). GIFT is more expensive than IVF because it involves laparoscopic surgery and many studies show lower success rates compared to IVF. The incidence of tubal pregnancies is also higher with GIFT and ZIFT. Some couples choose GIFT for religious reasons because fertilization occurs in the body, not in a Petri dish as in IVF.

Preimplantation genetic diagnosis (PGD) allows the IVF team to screen the embryos for certain birth defects before they are replaced into the mother's uterus. It is now possible to screen for many diseases including sickle cell anemia, Tay-Sahs, hemophilia and others. A small amount of genetic material is removed from the embryo and examined using techniques known as fluorescent in situ hybridization or PCR. This procedure does not damage the embryo. Only "disease free" embryos are transferred back to the mother thus eliminating embryos carrying the genetic disease.

Assisted hatching is an ART procedure that helps embryo's "hatch" and successfully implant in the uterus. In assisted hatching, a small hole is made in the membrane surrounding the embryo, known as the zona pellucida. Piercing the membrane makes it easier for the embryo to break free and ultimately attach to the uterine wall. Assisted hatching is used in cases of unexplained infertility, in older couples, and other situations where the embryologist and physician deem it appropriate.

A blastocyst is a type of embryo that has been incubated for at least five days and has differentiated into two different cell types. Embryos that survive to the blastocyst stage are usually more "hearty" and produce higher pregnancy rates. Since blastocysts are more likely to survive, fewer can be transferred thus reducing the occurrence of high order (3 or more) multiple births.

The next several years should bring the addition of several new ART procedures that will help infertile couples.

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