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In vitro procedures

Intrauterine insemination (IUI)

      Once known as artificial insemination, intrauterine insemination (IUI) is the process by which sperm is deposited in a woman's uterus through artificial means. For many couples, this is a less invasive and more affordable alternative to IVF.

Placing the Sperm

      The IUI process is when a very thin flexible catheter is inserted through the cervix and washed sperm is injected into the uterus.

      Most women consider IUI to be fairly painless, along the same lines as having a pap smear. There can be some cramping afterward, but often what is felt is ovulation-related rather than from the IUI. The catheter often isn't felt because the cervix is already slightly open for ovulation.

      You will be given instructions on how long beforehand and afterwards to abstain from intercourse, and any resting periods after the IUI.

When Should it be Done?

      Ideally an IUI should be performed within 6 hours either side of ovulation (for male factor infertility, some doctors believe after ovulation is better) with the sperm waiting for the egg. When timing is based on an hCG injection, the IUIs are usually done between 24 and 48 hours later. Typical timing would be to have a single IUI at about 36 hours post-hCG. If two IUIs are scheduled, they are usually spaced at least 12 hours apart between 24 and 48 hours after the hCG.

      If no use of drugs is done, then doctors will base timing of IUI on a natural LH surge. In that case, a single IUI at 36 hours is the norm, but doing them at 24 hours is also quite common.

Who is Suited to IUI?

      IUI can help where cervical mucus is a problem. It does make sense to try IUI if you can and haven’t had success with intercourse.

Success

      The success rates are reported to be just under 6% and as high as 26% per cycle. The low statistics are with one follicle, while multiple follicles resulted in as high 26% success.


IVF

      IVF is simply the uniting of egg and sperm in vitro (in the lab). Subsequently the embryos are transferred into the uterus through the cervix and pregnancy is allowed to begin. The process is done inconjunction with ovulation induction through drugs, monitoring of hormone levels and follicle scans with ultrasound.

Who is Suited to IVF?

    Below are some factors for using IVF:
                *Tubal problems can mean a woman’s fallopian tubes are blocked or damaged, which can make it difficult for the egg to be fertilized or for an embryo to travel to the uterus.
                *Male factor can include a low sperm count, problems with sperm function or motility which can inhibit sperm from fertilizing an egg on its own.
                *Severe Endometriosis affecting both fertilization of the egg and implantation of the embryo in the uterus.
                *Ovarian issues which prevent the release or production of eggs.
                *Abnormal uterus shape, fibroid tumors, or exposure to diethylstilbestrol (DES) as a fetus.
                *Unexplained infertility
       

How is IVF Done?

    The steps of IVF are as follows:
                *Ovulation Induction
                *Retrieval
                *Collecting and preparing the sperm
                *Insemination of eggs and embryos culture
                *Transferring embryos to the uterus
       

      If you have specific questions regarding IVF, the process used, or embryology, why not try asking one of our staff doctors?


ICSI

       In 1992, a revolutionary new reproductive technique was developed that would allow men who suffered from significant fertility problems to have biological children. This breakthrough was intracytoplasmic sperm injection (ICSI).

What’s So Great About It?

      Previous to ICSI, the only options to couples where the male partner had a low sperm count, a complete absence of sperm in his semen, a damaged or even absent vas deferens, an irreversible vasectomy or a host of other problems was to adopt, use a sperm donor or deal with the possibility of never having children. Understandably, many couples did not care for these limited options.

      Using micromanipulation technology, ICSI allows fertility specialists to fertilize an egg using just one sperm. While it is preferred to use sperm from a semen sample, specialists can retrieve sperm from the testicles if it is necessary. Once sperm has been collected, the specialist will draw a single sperm into a needle and inject it directly into an egg that has been collected from the female partner through the usual retrieval methods. This process bypasses the conventional IVF methods of fertilization, thereby ensuring that fertilization has taken place. The fertilized eggs are then left to culture for a few days before being transferred back to the woman’s uterus. ICSI is always used alongside IVF.

Who is Suited to ICSI?

      Couples that are infertile due to any of the following reasons may want to consider using ISCI with their IVF treatment.

                *Low sperm count
                *Poor sperm motility
                *Abnormally high amount of morphologically atypical sperm
                *Experienced fertilization failure for unknown reasons in a previous IVF cycle
                *Lack of any sperm in ejaculate due to CAVD, failed vasectomy reversal, failure to produce sperm, or an obstruction in the epididymus due to past inflammation
                *Retrograde ejaculation
                *Immunological factors
       

      Additionally, men who have been diagnosed with testicular cancer may choose to freeze a semen sample before undergoing treatment as this can later be used in ICSI.