Assisted Reproductive Technologies

The HOPE FRMC offers counselling and infertility workshops designed to give you the information you need about the treatment process and help you…

Timed Intercourse

This is the most basic of treatment for infertility. If testing determines normal tubal patency, follicular development, endometrial development, and semen analysis, you can attempt pregnancy through timed intercourse. This procedure may include using a urine surge test kit to determine the time of ovulation upon which you and your partner will have intercourse. This is done to ensure that the sperm is in the fallopian tube at the time the egg is released and begins to travel down the tube.

Preimplantation Genetic Diagnosis (PGD)

When a couple has a family history of a known genetic abnormality, PGD technology may be useful. PGD, which is not yet widely available, allows for the manipulation of the blastocyst and the removal of a cell to perform genetic diagnosis prior to the transfer of the embryo.

Ovulation Induction (OI)

Ovulation stimulation is the use of medications - 'fertility drugs' - to stimulate the growth and the release of eggs from the ovaries. Ovulation induction usually precedes IUI, IVF and ICSI. During ovulation induction, the women's response to therapy is monitored with blood estrogen levels and ultrasound examinations.

 

Intra-uterine Insemination (IUI)

When a woman is ovulating, sperm from her male partner or a sperm donor is prepared and inserted into the uterus. The hope is that this will give the sperm a greater chance of finding its way through the fallopian tubes to fertilize the waiting egg.

IUI depends on the sperm's ability to fertilize an egg within the uterus, so it's important that sperm function well with regard to number, movement and shape. To facilitate this, sperm are often washed (sperm washing) and concentrated in a sterile medium, which is then injected directly into the uterus. IUI is also often supported by ovulation that is induced by fertility medications (ovulation induction). The chance of achieving pregnancy with IUI is from 10% to 20% per cycle depending upon the problem.

 

In Vitro Fertilization (IVF)

In vitro fertilization (IVF) is a technique that refers to the fertilization of a woman's egg with her partner's sperm, in a laboratory dish. The process was originally developed for women with blocked fallopian tubes but is now also recommended when the male partner has poor quality sperm, or for women with polycystic ovary syndrome (PCOS) when other treatment strategies have failed.

  • The first step in an IVF cycle is to take fertility medications. These are used to stimulate ovulation (egg production), to increase the chances of fertilization, and to help speed up the process.
  • Daily blood tests and ultrasound scanning are used to monitor ovulation.
  • Eggs produced in the ovary are removed (egg retrieval) using a trans-vaginal probe under light anaesthetic.
  • At the same time the woman's eggs are being removed a sperm sample is obtained from the male partner.
  • The eggs are then exposed to the sperm in a laboratory dish.
  • Over the next 24-hours fertilized egg(s) are identified, graded and several are allowed to develop.
  • 1-3 fertilized eggs are inserted into a woman's uterus, with the hope that one will continue to develop naturally.
  • IVF has a high success rate and may, overall, be the best and fastest way of becoming pregnant.

IVF is a treatment and a valuable diagnostic tool. We can see how sperm interact with the egg in vitro so it gives us valuable insight as to why conception has not occurred.

When we obtain embryos we can observe their morphology, the thickness of the 'shell' around the embryo, the potential for the embryo developing to the blastocyst stage, and clues to the 'quality' of the subsequent embryo. Good quality embryos may develop to the blastocyst stage but fail to implant, which points to an implantation problem and an alternative course of treatment.

 

Intracytoplasmic Sperm Injection (ICSI)

For many years the only option for couples when the male partner had an extremely low sperm count, was donor insemination but as a process that takes IVF a step further, ICSI makes it possible to address this issue.

A single healthy sperm is injected into the centre of a woman's egg using a fine needle directed under a high-powered microscope. We hope this sperm will fertilize the egg so we can re-insert it as an embryo into your uterus. Fertilization rates after this procedure are between 50 and 70%.

The difference between IVF and ICSI is that IVF relies on fertilization to occur on its own - a sperm (one of several) must be able to penetrate an egg when they're placed together in a dish, whereas, with ICSI one healthy sperm is specifically selected to fertilize one healthy egg.

The success of the procedure is contingent upon the quality of the individual egg and the quality of the individual sperm. ICSI is considered when:

  • The man has a low sperm count or poor sperm motility
  • Sperm has to be extracted from the testicles or epididymis in cases of obstruction
  • Antisperm antibodies
  • Varicocele repair or a vasectomy reversal have failed
  • Fertilization rates through IVF are low or absent

The process involves many of the same steps as IVF:

  • The woman usually undergoes ovulation induction
  • The best eggs are selected
  • Sperm are washed
  • One sperm is isolated and is placed into the centre of one egg
  • After two or three days embryos (usually more than one egg is fertilized) are transferred into the woman's uterus

Even though sperm is actually injected directly into the egg, the process does not guarantee that fertilization will take place. In some instances, the sperm can be seen lying inside the egg after 48-hours without any evidence of fertilization.

There are some perceptions that ICSI should, perhaps, be performed for every case of IVF, to ensure that the sperm penetrates the egg to increase fertilization rates.

At the HOPE FRMC, we believe that ICSI should be performed only when necessary. We also believe that it is extremely important to establish whether or not the male partner's sperm are capable of fertilization through conventional IVF. This is necessary for diagnostic reasons and has implications for future treatment options.

There are numerous advantages and disadvantages with ICSI, which will be discussed prior to your egg retrieval.

 

Ovarian Hyperstimulation Syndrome (OHSS)

Ovarian Hyperstimulation Syndrome is when a woman's ovaries become excessively enlarged as a result of hormone therapy that stimulates the development of follicles and prompts ovulation.