IVF, or in vitro fertilization, follows a similar path for most couples. First, the ovaries are stimulated with fertility drugs, after which the eggs are retrieved and put together with sperm in the lab. Then, any resulting fertilized eggs are transferred to the woman's uterus. (For a detailed breakdown of IVF, read this article on IVF treatment step by step.)
That said, a variety of additional assisted reproductive technology treatments are available in addition to basic IVF. They may be used depending on a couples specific fertility problems, goals, age, and past success or failure rates.
ICSI, pronounces ick-see, is an acronym for intracytoplasmic sperm injection. In regular IVF treatment, an egg is placed in a petri dish, along with lots of sperm, in hopes that one of the sperm will fertilize the egg on its own. With ICSI, an individual sperm is injected directly into an egg using a specialized needle. ICSI may be used in severe cases of male infertility
, like when the sperm shape is impaired (aka abnormal sperm morphology) or in cases of very low sperm count. ICSI must be used if testicular sperm extraction
(TESE) is used.
PGD stands for pre-implantation genetic diagnosis. During PGD, one or two cells are taken from an embryo
, and tested for genetic diseases, before transferring the embryos to the woman’s uterus. PGD may be used in cases of recurrent miscarriage
or to avoid passing on a deadly genetic disease, specifically for couples with a high-risk. It’s important to note that PGD doesn’t guarantee the child will not have the inherited disease being tested, but it does significantly lower the risk. A controversial use of PGD is to select embryos with particular traits
, like eye color. This isn’t widely used, however, and the ability to accurately select “children-by-order” isn’t proven.
Assisted Hatching (AH)Assisted hatching (AH) involves making a tiny hole in the outer layer of the embryo, known as the zona pellucid. (Normally, an embryo hatches out from the zona pellucid during the blastocyst stage of development.) The hole may be made with acid or with a laser. This is done before the embryo is transferred to the woman’s uterus, in hopes that it will help the embryo implant into the uterine wall after transfer. Assisted hatching may be recommended for older women, or if previous IVF treatment cycles have failed. With the exception of these two groups, assisted hatching does not seem to improve the pregnancy rates.
IVM, or in vitro maturation, is a relatively new assisted reproductive technology, where the immature eggs, or oocytes, are placed in a special solution of hormones, to enable the eggs to fully mature in the lab. With IVM, the woman either takes no fertility drugs, or very low doses, and then, immature eggs are retrieved. IVM is considered safer for the mother, because the risk of developing OHSS
is lower. IVM may be suggested for women with PCOS
(because they are at a higher risk for OHSS), younger women who do not have trouble with ovulation, or cancer patients (who want to freeze eggs or embryos for later use). It may also be used to mature eggs retrieved during regular IVF, which were not yet ready for fertilization.
Autologous Endometrial CocultureAutologous endometrial coculture, or AEC, is an assisted reproductive technology that involves placing a fertilized egg on top of a layer of endometrial cells. The endometrial cells (or uterine lining cells) are taken during an endometrial biopsy. The cells are then treated and frozen, until they are need during the IVF treatment. AEC may be used for couples who have repeated IVF failures, poor implantation, or poor embryo quality.
Cryopreservation, when used as an assisted reproductive technology, is when embryos, eggs, ovarian tissue, or sperm are frozen for later use. Sperm freezing has a better rate of success than embryo freezing, and embryo freezing is more successful than egg freezing
. Ovarian tissue freezing
is still experimental. If there are extra embryos created during an IVF treatment cycle, you may want to freeze them for a later cycle. Sperm may be frozen prior to IVF treatment as back up (in case the man has trouble producing ejaculate the day of the egg retrieval), or prior to cancer treatment. Egg freezing may be used prior to cancer treatment, or as a means of preserving fertility despite age
(though this is controversial).
FET (Frozen Embryo Transfer)If a couple has frozen embryos from a previous IVF treatment cycle, they can have them thawed and transferred in a future cycle. A frozen embryo transfer is significantly less expensive than a full IVF treatment cycle, though success rates vary. Some studies have found FET is less effective than fresh embryo transfer, while other studies have found it more effective. For an FET, the woman takes hormones to help prepare the uterine lining for implantation, and at the right time, the frozen embryos are thawed and transferred to the woman’s uterus. Sometimes the frozen embryos do not survive the freezing and thawing process.
Blastocyst TransferA fertilized egg is known as an embryo, and it begins as just a collection of cells, which divide and multiply. By the fifth day, a fluid cavity forms, and the tissues that will become the placenta and the fetus begin to separate. This is known as the blastocyst stage, and in some cases, a doctor may decide to wait until the cells reach the blastocyst stage before transferring them to the uterus. One advantage is that an embryo that makes it to this stage is probably healthier, and fewer blastocysts can be transferred, lowering the risk of multiples. A potential disadvantage is that embryos that may have made it if transferred earlier might die before reaching the blastocyst stage, leaving the couple with nothing to transfer.
Micro-IVF, or mini-IVF, is a brand new version of IVF treatment, meant to be more affordable. It’s significantly cheaper than typical IVF, but it is not for couples who need full IVF treatment. Compared to regular IVF, micro-IVF uses lower doses of medications, and less monitoring of the developing embryos. For couples considering IUI treatment
, micro-IVF may be a good choice. However, few studies have been done to prove the effectiveness of micro-IVF.
Using an Egg, Sperm or Embryo Donor
Gamete donation is an option for IVF treatment. A sperm donor may be used in cases of severe male infertility
, or if a single woman wants to have a child. An egg donor may be used in cases of poor ovarian reserves
, previous cancer treatment that has eliminated fertility, or age related infertility
, to increase the odds of conception. (IVF pregnancy rates drop significantly at age 40.) Embryo donation is also an option. The donor may be someone the couple knows personally, or the donor may be found through a fertility clinic
or an agency.