Infertility : Newer Techniques, Infertility Tests

by Food and Drug Administration (FDA)

(Page 3 of 4)

Still Newer Techniques

Newer still than in vitro fertilization are several other techniques that also require the use of fertility drugs. They are:

Gamete Intrafallopian Transfer (GIFT): Similar to IVF except that sperm and eggs are collected and immediately inserted into one or both fallopian tubes, where conception occurs. Unlike IVF, GIFT requires that the woman have at least one healthy fallopian tube. Success rates are similar to those of IVF.

Tubal Ovum Transfer: The woman's eggs are retrieved and put into the fallopian tube close to where it opens into the uterus. The couple then has intercourse or the woman is artificially inseminated. Since this method allows the eggs to be placed beyond the parts of the tube that may be damaged or blocked, it can often be used when GIFT cannot.

Embryo Lavage: A fertile female donor provides the eggs. At the proper time in her menstrual cycle, she is artificially inseminated with the would-be father's sperm. If the donor conceives, the early embryo is washed out of her reproductive tract and transferred to the uterus or a fallopian tube of the woman who is to bear the child. The recipient, meanwhile, has been hormonally treated with fertility drugs to make her uterus receptive to the embryo. This technique allows women who have no eggs of their own to become pregnant — provided they have a uterus.

Surrogate Motherhood: This is an option for women who do not respond to ovulation induction therapies or who have no ovaries or lack a uterus. It also may be an option for those for whom pregnancy might be life threatening or have good reason to worry that they might transmit a serious genetic disorder to the child.

A healthy, fertile woman agrees to be artificially inseminated and also agrees to let the infertile couple adopt the baby. If the female member of the infertile couple can safely provide eggs of her own, these can be fertilized by the IVF process and then transferred to the surrogate woman who carries the fetus to term. In that case, the surrogate mother takes fertility drugs to prepare her uterus. Surrogate motherhood is controversial and has resulted in court cases about custody and parentage, which is rare with other forms of fertility treatment.

When to Stop?

If efforts to have a baby are unsuccessful, the question ultimately arises, "When do we stop trying?" Though it may not be easy, giving up the effort can have a happy ending, as is clear from the stories of two couples who met through a small social group in a distant suburb of Washington, D.C., and learned about their mutual interest during casual conversation.

The first couple had tried almost everything, including IVF, and, after 10 years of getting nowhere, gave up medical interventions. Two cycles later the woman conceived and — after a difficult pregnancy — bore a healthy baby girl. The other couple took a different route that is available to many couples who abandon hope for a child of their own. They adopted a newborn baby and now wish they had done it a lot sooner.

Judith Randal, a freelance writer in Lovettsville, Va., writes a weekly health feature for Newsday and has published widely on health and science subjects in other newspapers and magazines.

Infertility Tests

Some infertility tests are for women only, others are for men only, and still others cannot be done without the cooperation of both partners.

An initial workup for a woman can take as little as six to eight weeks, or as much as three months or longer because some of the tests may have to be repeated for verification at different specific times in her menstrual cycle.

The initial workup of a man usually can be done faster both because men have no monthly cycles — and because there are fewer tests for men. Diagnostic surgical procedures may be suggested for both men and women to look directly at reproductive structures and to obtain small tissue samples for laboratory analysis.

His

A semen analysis is almost always the first test done on men and is usually repeated several times. After abstaining from intercourse for about 48 hours, the man collects a sperm sample in a container.

The sample is microscopically examined to determine the number, activity and shape of individual spermatozoa (sperm cells) and the characteristics of the fluid part of the semen.

A healthy, potent ejaculate typically contains 1.5 to 5 cubic centimeters (5 cc = 1 teaspoon) of semen and each cc will contain an average of 70 million sperm that look to be of normal size, shape and behavior. If the specimen markedly differs on any of these factors, further tests may be done to determine whether infection, hormonal imbalance, or another problem could be the culprit.

Among these tests may be a testicular biopsy, a minor operation — performed with a local or general anesthetic — in which a small amount of tissue from the testes is removed for laboratory studies. Since even men with sperm counts well below 70 million per cubic centimeter sometimes father children, this test is ordinarily done only when the count is zero.

If damage to one or both of the vas deferens, is known or suspected, an x-ray examination may also be ordered. As an iodine-containing solution has to be injected into the tubes to make them visible on x-rays, the patient is first given local or general anesthesia. If the examination discloses damage, surgical repairs are often attempted at the same time the diagnosis is made.

Other special tests may be ordered if none of the tests already mentioned seems to explain the man's infertility. The most common of these tests are the bovine mucus test and the hamster-oocyte penetration test.

In the first, bovine (cow) mucus (from the cervix, or neck of the uterus where it opens into the vagina) is placed in a special glass column. Samples of the man's semen are applied to the column, and measurements are made of how well the sperm are able to enter and swim through the mucus, giving some indication of their ability to swim through human cervical mucus.

In the hamster-oocyte penetration test, some of the man's semen is mixed with hamster egg cells that have had their outer shells (membranes) removed. If the sperm are functioning normally, they will penetrate the hamster eggs, an indication that they are also capable of fertilizing human eggs. However, failure of the sperm to penetrate the hamster eggs does not always mean that they are incapable of fertilizing human eggs.

Hers

Women-only tests, more varied and extensive, generally begin with a determination of if and when the woman is ovulating. One of the most popular techniques for pinpointing ovulation relies on the typically slight rise in resting body temperature midway in the menstrual cycle, signaling that ovulation has recently occurred.

A woman's body temperature fluctuates throughout her menstrual cycle, and she is instructed to record these fluctuations on a chart after taking her temperature each morning before getting out of bed. If the chart — called a basal body temperature or BBT chart — indicates that the woman has been ovulating, it can often be used to predict when ovulation will happen during subsequent menstrual cycles. The couple can then use the information to attempt to time conception. Several urine test kits, approved by the Food and Drug Administration for sale over the counter, can be used by consumers to supplement the temperature chart.

About the Author

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