Dr. Gunasheela Gynaecologist & Obstetrician, Chairperson Of The Indian Branch Of Royal College Of Obstetricians And Gynaecologists Of U.K.

If you’ve been trying to conceive and have not met with any luck so far, do not despair. Medical advancement over the last several decades has made it possible for babies to be born by means other than the conventional method of conceiving.

In my last article, I had outlined the possible options for treatment of infertility on a broad scale. Here, let’s get a better understanding of one of the most complex methods of infertility treatment, through what is known as Assisted Reproductive Technology (ART).

What is ART?

The basic concept in ART involves taking the egg out of the woman’s body in order to assist the process of fertilization by combining it with the sperm in a laboratory and then returning it to the woman’s body.

However, there is an age constraint. Most hospitals accept patients below the age of 40, while some may be willing to take in patients upto the age of 45 years.

The different types of ART procedures include:

• IVF (Invitro fertilization)
• ICSI (Intracytoplasmic Sperm Injection).
• GIFT (Gamete intrafallopian transfer)
• ZIFT (Zygote intrafallopian transfer)

Invitro fertilization (IVF)

Invitro fertilization (IVF) is one of the simplest and most common techniques among the ART procedures and has resulted in hundreds of successful pregnancies over the last 20 years. Invitro fertilization literally means fertilization in glass, i.e., fertilization outside the body. It is used to treat both male and female infertility.

The IVF procedure involves using drugs to stimulate egg production, removing a mature or ripened egg or eggs from the female ovary and fertilizing it with semen, incubating the dividing cells in a laboratory dish and then replacing the developing embryo in the uterus at the appropriate time through the cervix. IVF is highly complicated and requires meticulous and experienced hands to carry out the procedure.

Though it has proven successful in hundreds of cases, IVF is not suitable for all infertile couples. The cause of infertility in some cases may involve other complications and therefore cannot be handled through IVF.

Intracytoplasmic Sperm Injection (ICSI)

Some men have poor quality semen, which may not contain even the small number of sperm required for IVF. There are some men who may not have any sperm at all in their ejaculate. Healthy sperm may be retrieved by inserting a fine needle into the sperm producing tissue in the testis or they may be obtained at a little higher level from a portion known as the epididymis. Once the sperm is obtained they can be stored for future use.

ICSI is a highly technical procedure for which the embryologist should have received special training. The ICSI procedure is considered the highest technology in Assisted Reproductive Technology.

Gamete Intrafallopian Transfer (GIFT)

As in the case of IVF, GIFT uses the same hormonal treatment to stimulate ovulation. The oocytes (eggs) are harvested from the woman’s ovaries and a few mature eggs are mixed with the partner’s sperm. Ultrasound laparoscopy is used to guide the transfer of unfertilized eggs and sperm (gametes) into the woman’s fallopian tubes through small incisions in her abdomen. The fertilized egg then moves down into the uterus and implants just as it would in a regular conception cycle.

For women with open fallopian tubes, absence of severe pelvic adhesions, etc GIFT is an option. But it comes with its disadvantages. There is a risk of tubal pregnancy and actual fertilization cannot be documented.

Zygote Intrafallopian Transfer (ZIFT)

In a ZIFT cycle, which is a variation of IVF, the woman’s mature eggs are collected via ultrasound-guided aspiration, fertilized in the laboratory and then guided back into the fallopian tubes using a laparoscope. The fertilized egg that is transferred back into the woman is allowed to divide only to the 2-cell stage, instead of the 4 or 8-cell stage as with conventional IVF. This fertilized egg at the 2-cell stage is called a "zygote". Unlike GIFT, the advantage in ZIFT is that fertilization can be documented. But the disadvantage lies in the fact that the zygote must be transferred using a laparascope.

In summary

Although the technique of Assisted Reproductive Technology (ART) has paved the way for success in many families, the success rates vary from one hospital to another. Before a couple decides on which treatment course to follow, a good number of tests have to be carried out to determine which method is most suitable for them. The couple should also consider the financial and emotional viability of going in for infertility treatment through ART. It is therefore advisable to seek out the best doctor who will guide you through the entire process.

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Other Articles By Gunasheela

Age and Infertility-How old is too old?
Infertility : Myth v/s Reality
Making  Sense Of Menopause
Postmenopausal Therapy
Stressed Out Over Infertility
Tubal Infertility
Unexplained Infertility
Your Guide To Infertility Treatment