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Issue 12013

The Quest for Fertility

The Quest for Fertility

Michelle Flippin

For every couple in America that simply “gets pregnant,” there are five more who dream, pray, wish, medicate and — quite literally — do whatever it takes to have a baby. Thanks to advances in reproductive medicine, couples hoping to conceive now have even more options that multiply their chances.

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Intrauterine insemination

In IUI, sperm that have been “washed” and concentrated are placed directly in the woman’s uterus on the day her ovary releases one or more eggs to be fertilized. Ideally, the sperm will swim into the fallopian tubes and fertilize a waiting egg, resulting in a normal pregnancy. IUI is most often coupled with some form of ovulation induction, in which ovulation is stimulated through the use of medication. This ovulation induction must be carefully monitored, as a lack of control over the number of fertilized eggs that reach the uterus can cause a multiple-fetus pregnancy.

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In vitro fertilization

With IVF, specialists surgically remove eggs from the ovary and combine them with sperm outside of the body. This is the source of the term “in vitro,” meaning “in glass.” Fertilized eggs are then placed directly into the woman’s uterus. Conception with IVF happens more quickly than with other methods, and it has a higher success rate per cycle. Still, due to variations in insurance coverage for fertility procedures, couples frequently choose other options because of IVF’s high cost (approximately $12,000 for a cycle of IVF compared to $3,000 for a cycle of IUI).

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Intracytoplasmic sperm injection

ICSI follows IVF as the second revolution in fertility treatments. It is usually used to treat causes of male infertility. After eggs are retrieved from the woman’s ovaries, a single sperm is injected directly into each egg. The eggs that show signs of fertilization are then transferred into the uterus.

Risks

While fertility treatments increase the odds of conception, there are risks. Complications of fertility treatments can include bleeding and infection, as well as ovarian hyperstimulation syndrome, which can cause significant pain and discomfort.

In cases where fertility treatments result in multiple pregnancies, these mothers face much higher risks of gestational diabetes, anemia and preeclampsia. Multiple pregnancies also raise the chances of premature birth and low birth weight — with premature birth in turn increasing the risk of further health and developmental problems.