Assisted Reproduction

The Challenge

The challenge is to use advanced reproductive technology to assist couples who have trouble conceiving through normal means.

• Scope of the Problem: 10%–15% of couples who are infertile require or benefit from assisted reproductive technologies.

• Objectives of Management: To achieve a successful pregnancy (carried to term) with minimal intervention. The treatment of an infertile couple is based on identifying the impediment to fertility and overcoming or bypassing it to achieve pregnancy. A number of techniques are available to accomplish this end. Most are less exotic than their acronyms suggest ( Table 189.1 ). Among infertile couples seeking treatment, 85%–90% can be treated with conventional medical and surgical procedures and do not require assisted reproductive technologies such as in vitro fertilization (IVF).

  Table 189.1

  Abbreviations for Techniques

  Abbreviation	Technique
  AID	Artificial insemination, donor (using donor sperm, occasionally referred to as therapeutic donor insemination [TDI])
  AIH	Artificial insemination, homologous (using the partner’s sperm)
  BT	Basal body temperature
  GIFT	Gamete intrafallopian transfer (gametes placed in the fallopian tube for fertilization)
  HSG	Hysterosalpingogram or uterine cavity radiograph
  ICSI	Intracytoplasmic sperm injection
  IUI	Intrauterine insemination (placement of either donor or partner sperm directly into the uterine cavity)
  IVF/ET	In vitro fertilization with embryo transfer
  PCT	Postcoital test or Huhner–Sims test
  SPA	Sperm penetration assay (also known as a hamster egg test or zona-free egg penetration test)
  ZIFT	Zygote intrafallopian transfer (fertilization takes place in vitro and the zygote is transferred to the fallopian tube to be transported into the uterine cavity)