Infertility treatment options

Infertility treatment options

Myth : Fertility treatment means we’ll have twins or triplets

Truth : The chance of a multiple birth depends on how many embryos are transferred. Most             women give birth to one baby, about 1 in 5 to twins, and 1 in 100 to triplets1

If your attempts at falling pregnant haven’t worked, or you need more advanced help to conceive, there are still options available to you. Ovulation induction (OI) and assisted reproductive technologies (ART) treatments have helped millions of women to have a baby.2 Here, you can get a brief introduction to a range of fertility treatments.

Ovulation induction (OI)3

OI is used to induce maturation and ovulation of follicles to release at least one egg. The egg can be fertilised in the body naturally via intercourse, or through assisted conception with intrauterine insemination (IUI).

In OI, a woman will usually be given clomiphene citrate to stimulate follicle growth. If this is unsuccessful, then the gonadotropins follicle stimulating hormone (FSH) and luteinising hormone (LH) may be prescribed to promote egg maturation and release.3

Assisted reproductive technologies (ART) treatments 

Ovarian stimulation3

  • Ovarian stimulation is a fertility treatment for women in which the ovaries are stimulated to produce multiple eggs, in the hope that one or more of these will mature to become suitable for fertilisation.
  • Ovarian stimulation is often used alongside in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) cycles.

Intrauterine insemination (IUI)4

  • High quality sperm are placed in the cavity of the uterus, by means of a fine catheter passed through the cervix, to be placed closer to the egg.
  • This treatment ensures accurate timing of sperm in the uterine cavity and bypasses any hostile effects of cervical mucus on the sperm, increasing the chance of fertilisation.

 

dapted from Rowell and Braude 2003.4

In vitro fertilisation (IVF)5

  • Following female hormonal stimulation, sperm and eggs are collected, combined and fertilised in the fertility clinic’s lab, outside of the woman’s body.
  • Any viable embryos are then nurtured and developed in an incubator for a few days*, before being transferred to the uterus.

 

Adapted from Braude and Rowell 2003.5

Intracytoplasmic sperm injection (ICSI)5

    • Some patients who undergo IVF will also have ICSI treatment, which involves a single sperm being injected directly into an egg. This process is different from IVF, which just involves the sperm and the egg being combined, rather than directly injecting the sperm into the egg.
    • ICSI may be suggested if a man has a very low sperm count, low sperm motility, poor quality sperm or blocked sperm ducts. The best sperm can then be picked for injection.
    • Any viable embryos are then nurtured and developed in an incubator for a few days*, before being transferred to the uterus.

Adapted from Braude and Rowell 2003.5

Gamete intrafallopian transfer (GIFT)4

  • GIFT is a process in which sperm and an egg are combined in the fertility clinic’s lab.
  • The pre-mixed egg and sperm are then transferred to a woman’s fallopian tubes.
  • This allows fertilisation to happen inside a woman’s body.

    Zygote intrafallopian transfer (ZIFT)6

    • ZIFT is a process in which sperm and eggs are combined in the fertility clinic’s lab.
    • After fertilisation, a very early embryo (known as a zygote) is transferred to a woman’s fallopian tube.

      * Incubation times prior to embryo transfer are patient and clinic dependent.

      References

      1. Ferraretti et al. Assisted reproductive technology in Europe, 2009: results generated from European registers by ESHRE. Human Reproduction. 2013;28(9):2318-2331.
      2. European Society of Human Reproduction and Embryology (ESHRE). ART fact sheet. Press information. Available at:                                                                                                                         https://www.eshre.eu/Press-Room/Resources/ARTfactsheet.  Accessed:March 2020.
      3. American Society for Reproductive Medicine (ASRM). Medications for inducing ovulation. A guide for patients. 2016. Available at:                                                                                                 http://www.reproductivefacts.org/globalassets/rf/news-   and-publications/bookletsfact-sheets/english-fact-sheets-and-info                                                                                                           booklets/booklet_medications_for_inducing_ovulation.pdf. Accessed:March 2020.
      4. Rowell P and Braude P. Assisted conception. I—General principles. BMJ 2003;327(7418):799–801.
      5. Braude P and Rowell P. Assisted conception. II—In vitro fertilisation and intracytoplasmic sperm injection BMJ 2003;327(7419):852–855.
      6. Levran D, et al. Zygote intrafallopian transfer may improve pregnancy rate in patients with repeated failure of implantation Fertil Steril 1998;69(1):26–30.

      SEA/NONF/0520/0016c. May 2020.