Chapter 165 Assisted Reproduction
Scope of the Problem: Ten percent to fifteen percent 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 (see Table). Among infertile couples seeking treatment, 85% to 90% can be treated with conventional medical and surgical procedures and do not require assisted reproductive technologies such as in vitro fertilization.
Relevant Pathophysiology: The success of treatment depends to a great extent on the identified cause of infertility because some problems are more easily overcome than others. It must be recognized that success is also a function of the age of the woman. It is also true that the rate of spontaneous pregnancy loss increases rapidly after age 35, adversely affecting success.
|AID||Artificial insemination, donor (using donor sperm, occasionally referred to as TDI or therapeutic donor insemination)|
|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 husband sperm directly into the uterine cavity)|