WOMEN’S BODIES: TREATMENTS OF SUBFERTILITY – II
Assisted conception In some cases the cause can’t be corrected, but pregnancy may still be possible using a technique of assisted conception such as artificial insemination or in-vitro fertilisation. If any of these treatments are suggested, the medical, emotional, social and financial aspects should be fully explained and you’ll have plenty of time to think it over before deciding whether or not to go ahead. Because assisted conception has had some sensational publicity, it’s worth briefly describing the procedures here.
Artificial insemination (AI) This may be tried when the woman’s reproductive system is normal. Semen is introduced into the cervix or uterus through a tube. Concentrated husband’s semen (AIH) may be tried when the sperm count is low, but the success rate of this procedure is poor. Donor insemination (DI) uses semen from a fertile donor, anonymous or known. It is a simple procedure but the emotional and legal aspects are very complex. Careful counselling and consideration are essential. Legally, the partner is the father. He is also the birth and social father, but not the genetic parent. The mother is the genetic, birth and social parent of any child born from donor insemination.
IVF
In-vitro (in glass) fertilisation (IVF) means that fertilisation takes place in a glass dish instead of in the fallopian tube. It is tried when something interferes with the passage of the ovum from the ovary through the tube to the uterus. IVF involves taking eggs from the ovary, adding semen in the laboratory and then placing one or more fertilised eggs into the uterus. All the processes of pregnancy happen inside the mother except fertilisation and the journey through the tube.
It is now a number of years since IVF resulted in the birth of a human baby (and the technique had been used for decades in domestic animals). In the early days the headlines cried ‘Test-tube Baby’, a description that is not only false but that has created a rather nasty, inhuman, ‘science fiction’ aura about IVF. This unfair and totally unjustified reputation can be an extra source of distress for couples who have children with the help of IVF.
GIFT is short for gamete intrafallopian transfer (gamete is a general term for a reproductive cell, either ovum or sperm). Eggs are taken from the ovary and immediately placed with sperm in the fallopian tube in the hope that fertilisation will take place. GIFT seems to have a much kinder public image than IVF. I believe that this is because it was introduced later, when assisted conception had become more accepted. As it is offered to women who have normal tubes and often no other discoverable cause of infertility, it has had a better success rate. Because fertilisation occurs in the normal place, GIFT is approved by the Catholic Church. Also, the word ‘gift’ has good associations.
PROST, ZIFT, TEST and MIFT These are treatments that start with IVF but transfer the fertilised egg to the tube rather than to the uterus. They differ from GIFT because the ovum is known to be fertilised before transfer. In PROST (pro-nuclear stage transfer) the fertilised egg is transferred at the earliest stage, after the sperm has penetrated the ovum but before the nuclei of the ovum and sperm have united. ZIFT (zygote intrafallopian transfer) is the transfer of a single-cell embryo. TEST (tubal embryo stage transfer) means the embryo is transferred to the tube at the 2-, 4- or 8-cell stage. MIFT stands for microinjection fallopian transfer. Sperm can be injected into the egg under the microscope, and the resulting fertilised egg is transferred to the fallopian tube.
These are just outlines of the techniques of assisted conception. Let me repeat that if you consider any of them you will be thoroughly counselled on every aspect of the procedure, including its and the chances of success.
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