ART

ART (assisted reproductive technology) involves many facets of IVF (invitro fertilization) that have developed since 1978. Louise Brown was the first In Vitro Fertilization (IVF) baby, and was born in England in 1978. Numerous assisted reproductive technologies (ART) have developed since 1981 when the first IVF baby was born in the United States. Infertile couples now face what is often a confusing collection of acronyms when deciding how to proceed with what may be their best possibility for their own genetic child. Understanding these technologies is important if couples are to make informed decisions regarding the applicability of different assisted reproductive technology procedures.

Before patients receive treatment through these assisted reproductive technologies, they typically undergo a basic infertility evaluation. The evaluation involves a series of tests, and starts with a comprehensive history and physical of both partners.

In Vitro Fertilization is a process whereby eggs are removed from the ovaries with a small needle passed through the top of the vagina and combined with prepared semen in the laboratory. After fertilization, one or more embryos are returned via a small catheter passed through the cervix into the uterus where the embryo implants and develops. With Gamete Intra Fallopian Transfer (GIFT) the eggs are combined with washed semen inside the fallopian tubes before fertilization. The relative indications and success rates for IVF and GIFT remain somewhat unclear.

Much of the decision regarding which procedure to pursue will depend on the individual laboratory's experience since the success rates of IVF and GIFT in any program are relative to each other. Where a clinic is having apparently higher success rates with GIFT, it may be that they are simply having relatively lower success rates with IVF, and vice versa. The average age, diagnostic categories, and degree of infertility of the population being treated will also influence relative success rates of IVF and GIFT. It is still not clear for which patients GIFT is more appropriate than IVF. Most clinicians agree that for significant tubal disease IVF is more appropriate. However, in the presence of known male fertility- such as previous fertilization documented in a pregnancy or during IVF- then most clinicians feel GIFT is appropriate if other conditions for GIFT are met. Where there is no proof of prior male fertility and/or any evidence of male factor infertility, IVF will provide information on the fertilizing capability of the sperm, but GIFT will not. It is important, in most cases, to evaluate the male's fertility prior to exposing the patient to GIFT. The proportion of GIFT procedures have dropped dramatically in the past few years, and now comprise only approximately 1% of all assisted reproduction technology procedures.

For men with very poor sperm a procedure called Intra Cytoplasmic Sperm Injection (ICSI) at the time of IVF can normalize fertilization rates. During the ICSI procedure a single sperm is injected into each egg, using a microscope for visualization, as a part of the regular IVF cycle treatment. ICSI cannot be performed without IVF- it is performed in the laboratory as part of the IVF treatment cycle. Sometimes a urologist performs a Testicular Epididymal Sperm Aspiration (TESA) to collect sperm specimens through a small testicular biopsy. Sperm can often be retrieved directly from the testicles or epididymus even in men who have no sperm at the time of ejaculation. A single sperm is then injected manually into a harvested egg via micropipettes and micromanipulation. This procedure has given new hope to men who have been previously diagnosed with male factor infertility. If ICSI treatment is unsuccessful, or if patients prefer, Donor Insemination (DI) can be attempted by cervical or intrauterine insemination with cryopreserved donor sperm specimens.