Health Conditions

Beginning in the 1980s, scientific advances have led to improvements in treating infertility. Assisted reproduction techniques (ART) may use eggs and sperm from the couple trying to conceive or from donors. Between 1996 and 2002, the number of live births for women using ART more than doubled from about 14,500 to over 33,000. The number of live births is less than the actual number of ART-conceived babies, because a multiple birth (twins, triplets, or more babies born at one time) is counted as only one live birth. Most often, doctors performing ART procedures return fertilized eggs to the couple?s female partner. Because more than one fertilized egg is usually returned to the woman, the chance of having a multiple birth increases between 20% and 40% for women who undergo ART.

The Division of Reproductive Health at the Centers for Disease Control and Prevention (CDC) keeps track of U.S. fertility-treatment success rates at each infertility clinic. However, comparing rates between clinics may not be appropriate because patient populations and treatment offerings vary widely. The woman?s age also plays a big role in whether or not ART will work. In addition, success rates differ according to the source and storage of the eggs. In general, the highest success rates result from using donated fresh eggs and the lowest rates from using the woman?s own frozen eggs. Usually, though, ART procedures that use frozen eggs are less expensive, so the couple may be able to afford more attempts if the first procedure is not successful. According to the most recent available CDC report, over 90,000 ART procedures were attempted in 2002. Overall results were:

ART Procedure Success Rates, United States-2005
	Woman?s Age
	Under 35	35 to 37	38 to 40	41 to 42
Pregnancy	43.1%	35.7%	26.8%	17.6%
Live Births	37.3%	29.5%	19.7%	10.%
Results of ART with fresh, nondonor eggs

For more information, see the full report at: http://apps.nccd.cdc.gov/ART2005/nation05.asp

Sometimes, the female partner can get pregnant, but she cannot carry a baby to a live birth. In fewer than 1% of those who have an ART, the couple may decide to use the services of a surrogate mother (a healthy woman who agrees to have the fertilized egg or eggs implanted in her uterus). Surrogate mothers are usually paid and they often sign contracts agreeing to give the couples all parental rights for children that result from successful live births.

Most common current ART techniques include:

Intracytoplasmic Sperm Injection (ICSI)
Best used when sperm numbers, quality, or movement are inadequate, intracytoplasmic sperm injection (ICSI) addresses male factor infertility. In ICSI, healthy, active sperm are isolated from a semen sample and mature eggs are taken from a woman?s ovaries. In a laboratory, one sperm is injected into each egg. After a few days, some of the eggs that have been fertilized are transferred to the woman's uterus. If the procedure is successful, one or more eggs will implant in the uterus and a pregnancy will result. Any extra fertilized eggs may be frozen for possible future use. When infertility has both male and female causes, ICSI can be paired with another type of ART, such as in vitro fertilization, to improve the chances of successful conception. In about 50% of couples undergoing fertility treatments, ICSI is used in addition to an ART procedure for the woman.

In Vitro Fertilization (IVF)
First used successfully in the United States in the early 1980s, in vitro fertilization (IVF) is now fairly common. According to information from the Centers for Disease Control and Prevention, over 99% of women who decided to use ART in 2005 chose IVF as their first treatment option. IVF is estimated to have resulted in the births of over 115,000 American children (who are sometimes called ?test tube babies?) to date. In IVF, several eggs are taken from a woman's ovaries and fertilized in a laboratory dish using sperm from her partner or a sperm donor. If the female partner cannot produce healthy eggs, donor eggs may be used. Two to four (or more) of the fertilized eggs (embryos) are placed into the woman?s uterus, where they may implant and grow naturally. Eggs that are fertilized by IVF but not inserted into the uterus may be saved by freezing them. Because each implanted embryo has a 20% to 25% chance of resulting in a birth; IVF frequently produces twins, triplets, or more babies at one time.

Gamete Intrafallopian Transfer (GIFT)
Developed in 1984 to more closely mimic natural conception, gamete intrafallopian transfer (GIFT) is very similar to IVF. The main difference is that fertilization occurs in the woman's body instead of in a laboratory dish. Several eggs are extracted from the ovaries, examined under a microscope for maturity, and then the healthiest, most mature eggs are placed directly into one of the woman?s fallopian tubes along with purified and concentrated sperm. Because GIFT requires laparoscopy (surgery using small incisions) and general anesthesia, it is both more involved and more expensive than IVF. In addition, fertilization cannot be confirmed as easily as with other ART procedures. Due to these disadvantages, GIFT is not as common as other ART procedures. However, GIFT may be more successful for women over 40 years of age, who tend to have lower success rates with IVF.

Zygote Intrafallopian Transfer (ZIFT)
During a zygote intrafallopian transfer (ZIFT) procedure, which has aspects of both IVF and GIFT, some of a woman's eggs are taken from her ovaries or from an egg donor. The eggs are fertilized in a laboratory dish where they are allowed to develop into zygotes ? an early development stage in which the fertilized egg has divided into two or four cells. Viable zygotes are then transferred to the woman's fallopian tube ? usually within one day of fertilization, which is confirmed before the zygotes are returned to the woman?s reproductive tract. Like GIFT, ZIFT also requires laparoscopy.

Tubal Embryo Transfer (TET)
Tubal embryo transfer (TET) is nearly identical to ZIFT. Eggs and sperm are united outside the body, but any resulting fertilized eggs are allowed to divide in a laboratory dish for a longer period of time (two or more days) before being placed in one of the woman?s fallopian tubes.

Peritoneal Oocyte and Sperm Transfer (PROST)
A somewhat newer procedure known as peritoneal oocyte and sperm transfer (PROST) is also very similar to ZIFT. However, in PROST, eggs that are fertilized by sperm in a laboratory dish are placed into the fallopian tube before cell division occurs.

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Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It is not intended to diagnose a health condition, but it can be used as a guide to help you decide if you should seek professional treatment or to help you learn more about your condition once it has been diagnosed.