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ART review
In its broadest sense, the term Assisted Reproductive Technologies
(ART) refers to any treatment intended to improve the chances of a
pregnancy for couples with reduced fertility. In day-to-day
practice, ART is reserved for those interventions in which
fertilisation is aided by bringing the egg and the sperm closer
together such as intrauterine insemination (IUI), or in which
fertilisation occurs outside the body in the laboratory such as
with in vitro fertilisation (IVF) sometimes combined with
intracytoplasmic sperm injection (ICSI). This section provides an
overview of ART procedures.
intrauterine insemination (IUI)
During sexual intercourse, the ejaculate (seminal fluid
containing sperm) is deposited in the vagina close to the neck of
the womb (uterus). The sperm cells swim through the cervix - aided
by the cervical mucous - enter the uterus and continue into the
fallopian tubes where fertilisation occurs. During intrauterine insemination (IUI), however, selected sperm
cells taken from the male partner are placed directly in the
uterine cavity (intrauterine). As a result, they are nearer to the
site of fertilisation. IUI is used for the treatment of a number of different types of
fertility problem. Couples may be considered for IUI if there is
reduced sperm quality or a low sperm count; if the cervical mucous
is hostile to the sperm or if anti-sperm antibodies are present.
IUI can also be used with couples with unexplained subfertility.
The procedure is very simple and must be carried out around the
time of ovulation in the doctor’s consulting room. To improve the
chances of pregnancy, IUI is often combined with drug therapy in
the woman. The chance of pregnancy is approximately 10% per IUI
cycle.  Back to top
in vitro fertilisation (IVF)
In vitro fertilisation is the most commonly used procedure and has
become increasingly popular since the first IVF child (Louise
Brown) was born in 1978. IVF is a multistage process, in which the
egg is taken from the woman’s ovary, fertilised in a laboratory
using the male partner’s sperm, allowed to develop into an early
embryo and then replaced into the woman’s uterus (womb). A maximum
of three embryos are replaced in the woman’s uterus after
fertilisation. The average success rate per IVF cycle is
approximately 20%.
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intracytoplasmic sperm injection (ICSI)
Intracytoplasmic sperm injection (ICSI) is used in conjunction with
IVF to improve the chance of fertilisation if severe sperm
abnormalities are present. It involves injecting a single sperm
cell into an egg in the laboratory with the help of a microscope
and special instruments. This method was first described in 1992.
It is not just used in couples with severe male infertility: it is
also used in those whose sperm quality is normal if a conventional
IVF procedure has produced no, or only a very few embryos. The
average success rate per ICSI cycle is approximately 25%.
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MESA/TESE
If the man produces sperm cells, but the sperm is ‘trapped’ within
the testicles as a result of occlusion or a hereditary condition,
the sperm can be collected surgically. An operation to collect
sperm from the epididymis is called MESA
(microsurgical sperm aspiration); while an operation to collect
sperm from the testicles is called TESE
(testicular sperm extraction).
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PESA
This treatment is a new option for couples where the male has
absolutely no sperm in his ejaculate as a result of a blockage in
the sperm ducts. In this case a needle is punctured into the
testicles and sperm cells may be obtained from the epididymis.
These sperm cells can be used in a conventional ICSI procedure to
bring about fertilisation.
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