Artificial insemination using the partner's sperm is useful in several situations:
Artificial insemination using anonymous frozen donor sperm is useful for women:
Somewhere in the world, a "test-tube" baby is born every day. The miracle of babies born through in vitro fertilization (IVF) no longer seems so miraculous. In fact, fertilization outside the human body is now available throughout the Western world. In North America, more than three hundred centers perform IVF, and the best report pregnancy rates of more than 30 percent per cycle after embryo transfer. That's even better than the 20 to 25 percent chance of natural pregnancy in any given month under ideal conditions.
Simply stated, IVF involves removing eggs from a woman, fertilizing them in the laboratory (in a culture dish, actually, not a test tube) and then transferring the fertilized eggs, or zygotes, into the uterus a few days later. More specifically, after superovulation with hormones to produce multiple eggs, the IVF team places the retrieved eggs in sterile culture media along with processed sperm and keeps them at normal body temperature inside an incubator, where fertilization and early cell division take place. Then the team returns the fertilized and dividing eggs to the uterus. From that point, if the zygotes implant successfully and become embryos, the pregnancy progresses as it would naturally.
There are more than three hundred IVF clinics in the United States and Canada, and finding the right one for you is just as important as your search for the right fertility specialist. Some, but not all, are members of the ASRM's Society of Assisted Reproductive Technologies (SART), which has established criteria to assess the quality of IVF clinics and also monitors clinic results.
Inquire about the program's patient selection process, including any age limitations and the types of infertility patients it accepts. Most programs won't accept a woman over the age of forty. You should know the number of cycles the clinic has performed and how soon you can be seen. Waiting for your IVF cycle usually takes a few months.
Ask straightforwardly about your chances of achieving a pregnancy at that clinic. How does this compare with your chances at other IVF centers? How does it compare with that of other couples with similar diagnoses at that particular clinic?
Reputable IVF centers report only clinical pregnancy rates and do not include "chemical" pregnancies in their statistics. Chemical pregnancy refers to a rise in hCG levels about ten to fourteen days after hCG administration, but many chemical pregnancies never make it to the more advanced stage at which the pregnancy can be seen with an ultrasound exam of the uterus.
The clinical pregnancy rate is a more important statistic. A clinical pregnancy continues at least until it can be documented with an ultrasound exam showing the presence of a fetus. But even pregnancies that reach this stage can miscarry, and—as after natural conception—up to one-fourth of all clinical pregnancies established through IVF don't progress to a live birth. The most important statistic, of course, is the clinic's live birth rate. The live birth rate should be calculated by taking into account all of the couples who have had treatment there over a specified length of time. Ask what your chances are of taking home a baby, based on the clinic's past experience.
There are various ways to calculate the outcome of IVF. A program will report its pregnancy rate, which is the number of couples who conceived clinical pregnancies divided by the total number of couples treated, regardless of how many treatment cycles they had. A program may also report its pregnancy ratio per treatment cycle or per embryo transfer. Find out how many cycles were done before the clinic had its first pregnancy and what the success rate has been since then.
It may also help you evaluate a program to find out the canceled cycle rate. A canceled cycle means the woman began ovarian stimulation but never got to the stage of attempting egg retrieval. A high rate of dropped cycles (30 percent or more) may reflect a poor ovulation induction technique, or it may just mean that the clinic has stringent criteria before proceeding to egg retrieval.
Cost is obviously important. Does your health insurance policy cover any of the costs incurred during the IVF cycle? Most clinics now offer transvaginal ultrasound-guided egg retrieval instead of laparoscopy, which decreases the cost of the egg retrieval.
Another way to assess a clinic's suitability for you is to examine the variety of services and support systems it offers. For example, most IVF clinics provide embryo freezing. The clinic may also provide adjuncts to IVF as well, such as embryo or egg donor programs.
Embryo freezing—actually freezing and storing fertilized eggs or zygotes—allows preservation for transfer in future spontaneous ovulation cycles. This is an advantage if many eggs are retrieved and fertilized, since most centers transfer back only a limited number of zygotes per IVF cycle due to the increased risk of multiple pregnancy. If the center offers freezing, ask whether any basic research, using animal models, has been performed to assess the viability of the freezing and thawing technique. This quality-control measure is required of all SART member clinics.
There should be a clear-cut policy regarding any remaining frozen embryos that are left after a woman becomes pregnant. What happens to them? How long will they be kept in storage? Would you consent for them to be donated to other couples after you have your child? These issues should all be clearly addressed and approved by the couple in a written consent form provided by the clinic.
IVF is an exceedingly difficult technique to perform with good results. Launching and maintaining an IVF program is an expensive, time-consuming process. Strict quality-control standards need to be established and met. A team of committed professionals, each with a specialized expertise, is essential. Besides a reproductive surgeon and reproductive endocrinologist, the team will probably include an embryologist, andrologist, IVF lab technician(s), nurse-coordinator, and a counselor. Familiarize yourself with the qualifications and previous experience of the staff of the program. Its O.K. to ask about their credentials and experience. You should receive a written document from the clinic regarding the training and experience of the staff, and their success rates.