Treatment Of Infertility

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[edit] Treatment Of Infertility

As indicated above ovulation problems can be treated by the physician or gynecologist with hormones. However, when fallopian tube blockage or cervical mucous plug problems exist, artificial insemination will have to be considered. There are a number of reproductive technologies (= ART) used in fertility clinics around the country. I have summarized the most important techniques and their abbreviations.

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)
Abbre-viation:	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	transfering fertilized egg in the gamete stage of division into the upper part of the fallopian tube
ZIFT	zygote intrafallopian transfer	transfering 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 donor sperm 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 uterine cavity. However, the intrauterine insemination success is not that good (only 10% to 15%) and other techniques were developed, which are now lablelled 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 of the fertilized egg into the fallopian tube. It is there where the best chances are for survival of the early stages of cell division. This can be done from below with hysteroscopy and guided by ultrasonography or from above by laparoscopy (ZIFT). 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 disease 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 and university professors that hopefully will be helpful in providing guidance.

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