Fertility Treatments Health Article

Precautions

Couples involved in fertility treatments face many legal, ethical, psychological, emotional and financial questions. It is imperative to explore these issues before beginning a course of treatment in order to maintain a realistic attitude. It is difficult, if not impossible, to identify problems that may arise during treatment, but it is important to make an attempt to set limits, physically, financially, and emotionally, on what can be handled during the course of treatment. It is likewise crucial to consider potential legal, practical and ethical problems associated with each choice of treatment and to contact resources available to individuals with infertility problems for an objective viewpoint. Just because the treatment is available does not mean it has to be utilized. All individuals have their own ethical standards and limitations and need to investigate all courses of treatment before undergoing them.

Informed consent is a medical term that means a patient gives permission for a test or invasive procedure to be performed, after being informed by the physician in clear language exactly what the test or procedure involves. If at any point in the course of treatment a patient does not understand something, he or she should be encouraged to ask questions; and if the answer is not satisfactory, the patient should know that a second opinion may be solicited.

Prior to undergoing assisted reproductive technology (ART), women should be advised to avoid all pain medications other than Tylenol and discuss prescription medications with the specialist. They should not smoke cigarettes or drink alcohol, avoid caffeine-containing beverages, and inform the physician if they have active genital herpes. They should also maintain a healthy well-rounded diet and take a multiple vitamin containing folic acid every day.

Men should report any fevers within three months before ART treatment, as fevers may adversely affect sperm quality. They should avoid hot tubs or saunas for three months, as the heat can affect sperm function. Men should also avoid alcohol, drug use, and cigarette smoking for three months prior to treatment and during the

ART cycle as well. Any prescription drugs should be reported to the specialist along with active genital herpes. It is preferable to avoid intercourse for three days but not more than seven days before collection of semen for an ART cycle.

Description

Assisted reproductive technology (ART) is defined by the U.S. Centers for Disease Control and Prevention (CDC) as "all treatments or procedures that involve the handling of human eggs and sperm for the purpose of helping a woman become pregnant." Types of ART include in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), embryo cryopreservation, egg or embryo donation, and gestational carriers. ART does not include intrauterine insemination (IUI) with either partner or donor sperm.

In vitro fertilization (IVF)

This name comes from the fact that fertilization occurs outside the body in a laboratory, instead of in the woman's fallopian tube. In vitro is a Latin term that means 'in the glass' and refers to procedures performed outside of a living body in a laboratory or other artificial environment. Thus, IVF involves joining an egg and a sperm in a laboratory dish; if fertilization occurs, the resulting pre-embryo is transferred into the woman's uterus for possible implantation. IVF was developed as a technique to assist women who had blocked, damaged or absent fallopian tubes to become pregnant. The first successful IVF procedure was performed in the United Kingdom and resulted in the birth of Louise Brown in 1978. Today IVF is utilized to treat infertility caused by endometriosis; certain types of male factor infertility; tubal factors; and unexplained infertility.

The procedure utilized for IVF may vary somewhat from clinic to clinic, but generally it involves the following:

• Stimulating the woman's ovaries to produce multiple eggs during a specific time of her menstrual cycle.
• Detecting the presence of multiple eggs through the use of vaginal ultrasound.
• Retrieving eggs from her ovaries (while under intravenous sedation) by means of guiding a needle through the wall of the vagina and into the follicles and aspirating them.
• Determining the maturity of the eggs and adding sperm to them once mature.
• Transferring the embryo into the uterus by a catheter (long, slender tube with a syringe on one end) is relatively simple and requires no anesthesia.

Stimulating a woman's ovaries to produce multiple eggs may vary by program or patient, but the majority require several days of medications to be given by injection. Two main medications are used in the stimulation phase of an IVF cycle. The first is Lupron, which suppresses the ovaries by shutting down the body's normal production of luteinizing hormone (LH) and follicle stimulating hormone (FSH). Both of these hormones are essential to produce ovulation. Lupron is given by injection subcutaneously (just under the surface of the skin). It shuts down the ovaries completely so that when the induction drugs are given the follicles will mature evenly. The second type of medication is either pure FSH or FSH in combination with LH. It is given by injection to stimulate the ovaries to produce eggs in a controlled but hyperstimulated manner and at a dosage that will produce the highest number of good-quality eggs. With IVF, egg retrieval may take thirty minutes to one hour.

The transfer process takes only about ten to twenty minutes and results in the transfer of one or more embryos because the presence of multiple embryos makes it more likely that at least one embryo will attach to the uterine lining. The transfer of multiple embryos also increases the chance of multiple pregnancy. A couple may choose to maintain additional embryos before the transfer procedure so that they can be frozen, thawed and transferred at a later date. In the United States in 1996, 300 clinics reported doing over 64,000 ART cycles, and 92% of these were IVF.