Advanced Fertility Treatments

Review some of the most common advanced treatments and what to consider before deciding what is a good fit for you.

There are many types of treatments for families who have issues with fertility. Your reproductive endocrinologist, who is a board certified fertility specialist, can help you decide what treatment plan may be a good fit for you*. Here are some advanced treatment options you may want to consider:

In Vitro Fertilization (IVF)

In vitro fertilization is a procedure that involves having the sperm and egg joined outside the body.  The embryo (the fertilized egg) is then placed within the uterus.  IVF is different from intrauterine insemination (IUI). With IUI, the sperm is placed inside the uterus at the time of ovulation to help increase the chance of the sperm joining with the egg.

The success rate of IVF depends on a number of factors, including a woman’s age and the cause or causes of infertility.  In 2014, the live delivery rate for a woman younger than age 35 using IVF was over 50 percent. However, the more advanced the maternal age of a woman, the lower her chance of success using IVF.

What to expect  during IVF

During this type of process, a woman takes medication (usually gonadotropins). These drugs are used to help stimulate follicles in the ovaries, in an effort to release one or multiple eggs. While the woman is taking medication, she will need to visit the doctor’s office to get blood work and ultrasounds done regularly to monitor the growth of the follicles. Before the woman ovulates, an egg retrieval is performed.

• Egg retrieval
  Using a vaginal ultrasound, the doctor will insert a thin needle into the ovary, then into the follicles to retrieve the eggs. This procedure generally takes 20 to 30 minutes. Next a fertility specialist called an embryologist injects sperm into the eggs in a lab dish. This process is called Intracytoplasmic Sperm Injection (ICSI). After fertilization, the embryos are cultured in a lab for an average of 3 to 5 days to make sure the embryos are of high quality.

• Transfer of embryos
  When it’s time for this part of the procedure, the doctor will insert a catheter with the embryo(s) into the woman’s uterus using an ultrasound device.

In general, it is best to have only one embryo placed (called elective single-embryo transfer or eSET) to decrease the risk of having a multiple gestation (more than one baby at a time). This entire procedure takes a matter of minutes. There are risks of having multiple gestations with every treatment, some riskier than others**.

Embryo cryopreservation

In conjunction with IVF, some families choose to freeze and store unused embryos for future use. This is called embryo cryopreservation. It is a common procedure that helps a woman preserve her chances of having a child at a later time. Benefits include:

• The potential to grow your family at a later date with embryos created at a younger ovarian age
• Easier cycle-less appointments and more flexibility of appointment dates
• No surgery or anesthesia needed
• Less costly and more successful alternative to a fresh IVF cycle

Frozen embryo transfer (FET)

A frozen embryo transfer (FET) is a process that involves thawing a frozen embryo from a previous in vitro fertilization (IVF) cycle and placing it in a woman’s uterus for implantation. FET has become a popular way to save time and reduce the cost of pursuing another fresh IVF cycle.

Preimplantation genetic testing (PGT)

This procedure is a test rather than a treatment. It is used to screen tests the embryos for genetic conditions before IVF takes place. Preimplanation genetic testing for a monogenic – or single gene – disorder is called PGT-M. PGT-M is commonly recommended for someone who has a genetic disorder, or who is a carrier of a genetic disorder when both partners are carriers. This is when the offspring are at risk for having a specific genetic disease such as cystic fibrosis or sickle cell disease.

PGT-A stands for preimplantation genetic testing for aneuploidy - an abnormal number of chromosomes. PGT-A does not test for specific diseases, it simply screens the number of chromosomes only. Though there is little evidence PGT-A improves the outcome , it may be considered in cases where a woman:

• Has had repeated miscarriages
• Is older or whose ovaries do not function well
• Has had many fertility treatments that have failed
• Wishes to select a single embryo for transfer (eSET)

*Not all treatments discussed in this article may be covered by your insurance. You are encouraged to confirm any and all service or treatment before undergoing it by calling the number on the back of your medical benefits card.

**See the Fertility Treatment and Multiples Risk article for a more indepth discussion of multiples risk for mother and baby.  

By Kristin Nelson, Contributing Writer

Sources

Mayo Clinic. In vitro fertilization. Accessed October 27, 2020.
Centers for Disease Control. Infertility FAQs. Accessed October 27, 2020.
Centers for Disease Control. Single Embryo Transfer. Accessed October 27, 2020.

Last Updated: November 17, 2020