Chapter 165 Assisted Reproduction
THE CHALLENGE
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.
TACTICS
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.
| Abbreviation | Technique |
|---|---|
| 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) |
| IVF/ET |
