Introduction
Treatment of infertility may be required when ovulation does not occur. This can be treated by the physician or gynecologist with hormones.
However, if fallopian tube blockage or cervical mucous plug problems exist, artificial insemination would have to be considered. There are a number of assisted reproductive technologies (= ART) used in any fertility clinic around the country. I have summarized the most important techniques and their abbreviations in the table below.
On the other hand, I left out the highly controversial human cloning technique (see Ref. 3, p.344 to 351). It would be inappropriate for me to explain these highly technical procedures in more detail. Most of these techniques have now at least a 20 to 33% pregnancy rate (Ref. 3, p.350). When planning pregnancy in a couple with an infertility problem, enough time and patience has to be spent to achieve an overall success rate of 40% to 60% with intervention by a gynecologist. This assumes an active pursuit of the couple with input from a specialist over a period of up to 3 years.
Some common abbreviations and their meaning in the in vitro fertilization arena (ART)
| Abbr.: | Translation into English: | What it means: |
| IVF | “in vitro” fertilization | causing a woman to get pregnant with the help of lab techniques (using in vitro dish) |
| ICSI | intracytoplasmic sperm injection | injection of sperm DNA into the center of an egg cell |
| GIFT | gamete intrafallopian tube transfer | transferring fertilized egg in the gamete stage of division into the upper part of the fallopian tube |
| ZIFT | zygote intrafallopian transfer | transferring fertilized egg in the zygote stage of division into the upper part of the fallopian tube |
| CET | cryoembryo transfer | transfer of a previously frozen embryo that was kept in liquid nitrogen for storage |
| ART | assisted-reproduction technologies | this is any technique described here where artificial means are used to assist a woman to get pregnant |
Historically, the standard technique (artificial insemination) was to use sperm from the husband or sperm donor to get a woman pregnant when everything appeared to be normal with a gynecological exam. With the traditional intrauterine insemination (= IUI) the gynecologist inserts washed sperm into the uterus. However, the intrauterine insemination success is not that good (only 10% to 15%) and other techniques were developed, which are now labelled collectively as “assisted reproduction technologies” (ART for short).
The goal is to mimic what nature does as closely as possible by transferring the initial cell divisions (thanks to www.fda.gov for this image) of the fertilized egg into the fallopian tube. It is there where the best chances are for survival of the early cell divisions of the zygote (stage of cell division). This can be done from below with a hysteroscopy (thanks to www.valleyhealth.com for this image) and guided by ultrasonography
or from above with by laparoscopy (ZIFT, thanks to www.ivf-infertility.com for this link). This is a rapidly developing area of medicine, but the efforts in the past 20 years have resulted already in an improvement from 15% success rate to 50% or 60% success rates now. These women in the past had no hope for a successful pregnancy and now they do.
Ethical concerns re. artificial insemination and assisted reproduction technologies (ART)
Artificial insemination is the introduction of sperm into the uterus or the upper tube. ART or artificial reproduction technologies is the summation of technical procedures that lead to pregnancy. Many religious denominations have ethical concerns about some of these methods. When a husband’s and wife’s sperm and egg is involved in the procedure most religious groups have no ethical concern. When a donor egg or donor sperm is involved, most religions point out that this is the equivalent of adultery. I already pointed out that with donor semen there is a potential health risk of transmitting diseases such as AIDS or genetic diseases. There can also be serious legal problems with claims of the donor regarding paternity rights to the offspring and legal rights of a woman receiving donor sperm regarding alimony payments, if there has not been a proper legal disclaimer. Similar problems occur with donor eggs. These discussions are ongoing and I merely wanted to point out that this is a highly contentious topic. At the end the responsibility stays with the couple that has problems with infertility. But society at large needs to come to terms with these issues as well and there are committees around the world including politicians, religious leaders, university professors, lawyers and lay people that hopefully will be helpful in providing guidance.
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