Understanding Advanced Fertility Treatment Options

Getting pregnant seems like it should happen naturally and effortlessly, and yet for many couples that’s not the case. If you’ve exhausted other less-invasive methods, such as fertility hormone treatments, your doctor may recommend trying one or more advanced fertility treatments including Artificial Insemination and Assisted Reproductive Technologies.

Artificial insemination describes procedures that enhance egg production and then place sperm directly in the woman’s reproductive tract to promote fertilization. Advanced Reproductive Technologies include fertility procedures in which eggs are removed from your ovaries, processed in a laboratory, and placed in your uterus, sometimes already fertilized.

There are many different options to improve your chances of pregnancy. Here are some of the most commonly offered procedures.

Ovulation Induction and Ovarian Stimulation

Ovulation induction (also called ovarian stimulation) can improve your chance for pregnancy by increasing the number of eggs ready for fertilization during each menstrual cycle. It also is used before artificial insemination or in vitro fertilization to precisely time the placement of sperm. This procedure uses medications such as Clomid® (clomiphene citrate), follicle stimulating hormones (FSH) or human menopausal gonadotropins (hMG) to encourage the development and maturity of multiple eggs. These drugs have been used extensively and are considered safe when used under a doctor’s supervision

Assisted Hatching

For an embryo to implant in the uterus, it first must “hatch” from its surrounding membrane. A reproductive specialist can assist this process using a chemical solution or laser. Performed just before in vitro fertilization, this procedure can improve the odds of a successful implantation, especially in older women, frozen embryos, embryos with thickened cell walls, or in couples where prior IVF attempts have not proved successful.

Blastocyst Transfer

In some cases, embryos can grow in the laboratory until the blastocyst stage, which typically occurs five to six days after egg retrieval. This is done to allow for genetic testing of the eggs, to identify the eggs most likely to implant and to allow us to implant fewer embryos to lower the likelihood of multiple births.

In Vitro Fertilization

With this technique, eggs are collected from your ovaries or those of a donor, fertilized in a laboratory with partner or donor sperm, and placed into your uterus. You will likely take a fertility drug beforehand to increase egg production. Eggs then are harvested using an ultrasound-guided needle passed through the vagina or abdomen, under light anesthesia. Once the eggs have been fertilized, they are transferred to the uterus using a very fine catheter passed through the cervix.

Intracytoplasmic Sperm Injection

In cases of severe male infertility, this technique directly injects single sperm into the egg in a laboratory setting to achieve fertilization. Injected eggs are then used as part of conventional in vitro fertilization.

Intrauterine Insemination (IUI)

The most common form of artificial insemination, intrauterine insemination involves placing sperm high into the uterus using a small catheter. This increases the chance of pregnancy, especially when combined with ovulation induction.

Pre-Implantation Genetic Screening and Diagnosis

For patients with certain inherited diseases or risk factors, pre-implantation genetic testing is available. After egg retrieval and three to five days of embryo development, specially trained laboratory technicians remove one or two cells and test the DNA material for a variety of inherited and chromosomal factors. Unaffected embryos are then selected for transfer to the uterus.

Surgical Sperm Retrieval

In cases where the release of sperm is impeded by a blockage, a reproductive specialist can surgically collect the sperm. Testicular sperm extraction involves removing the sperm from the testes. Microsurgical epididymal sperm aspiration takes the sperm from the tubules next to the testicles. The sperm then is used as part of the in vitro fertilization process.