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Question: When should a woman consider using ART to enhance her chances of becoming pregnant?
Dr. Garcia: ART is indicated in patients who have no fallopian tubes because of previous infections, exposure to DES, or because they have been removed due to previous tubal pregnancy; patients who have had a tubal ligation and whose fallopian tubes are beyond repair; and patients whose husbands have a low sperm count or have had a vasectomy.
Question: What are the various procedures available?
Dr. Garcia: Patients interested in ART can look for centers that offer the following procedures:
1. Assisted Hatching: Helps embryos attach to the lining of the uterus for implantation.
2. Intrauterine Insemination (IUI): Semen from the husband is "washed" to improve its concentration and function, and placed into the uterine cavity.
3. In Vitro Fertilization (IVF): Medications stimulate the ovaries to produce more eggs, which are then harvested and placed with the husband's sperm in a culture dish for fertilization and subsequent transfer into the uterus.
4. Gamete Intrafallopian Transfer (GIFT): Involves placing eggs and sperm into the open end of a healthy fallopian tube, allowing fertilization to occur naturally.
5. Zygote Intrafallopian Transfer (ZIFT): Identical to GIFT except that the eggs are fertilized in a culture dish before being placed in the fallopian tubes two days later.
6. Intracytoplasmic Sperm Injection (ICSI): A variation of IVF in which the egg is injected with a single sperm and embryos are placed in the uterus several days later.
7. Cryopreservation: Embryos are frozen for future IVF attempts.
8. Donor Egg: women unable to produce an egg or an embryo but who still wish to carry a baby to term may use eggs donated by another woman between the ages of 21 and 30 years of age.
9. Donor Sperm: Used when the man is sterile, donor sperm is screened for several hereditary and infectious diseases, and to match desired physical characteristics as closely as possible.
10. Transmyometrial Embryo Transfer: Involves placing the embryos between the endometrial mucosa and the myometrium (uterine muscle).
Question: What should I look for when selecting an IVF specialist?
Dr. Garcia: Look for an IVF program that is affiliated with the Society for Assisted Reproductive Technology (SART), that has a group of physicians and embryologists with good experience in the field, who are knowledgeable about all the forms of ovulation induction, oocyte retrieval, embryo transfer, and the ART procedures listed above. You should also look for a program where the ICSI procedure is performed. The pregnancy rate depends upon the age of the patient, the ovarian stimulation, and the number of embryos to be transferred, and is judged on a case-by-case basis.
Question: What are the risks of undergoing IVF?
Dr. Garcia: Risks include multiple pregnancy, tubal pregnancy, infection, bleeding during the procedures, development of Ovarian Hyperstimulation Syndrome (enlarged ovaries, fluid retention, shortness of breath, and other complications that require immediate and expert attention).
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