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Assisted reproductive techniques such as in vitro fertilization (see right) are the most stressful of all infertility treatments. The woman must give herself frequent injections of drugs and have blood tests and ultrasound scans regularly. Both partners usually approach each attempt with hope and can be disappointed if the procedure fails. Feelings of depression, frustration, and hopelessness are common after a failed in vitro fertilization. Then the process starts over again the next month, and may be repeated several times. Before undergoing assisted reproductive techniques, educate yourself about them thoroughly, ask for support from your family and friends, and take good care of yourself by getting enough rest and exercise and by eating well. It can be helpful to talk to a mental health professional who has been recommended by your infertility clinic.

Intrauterine insemination

In intrauterine insemination, often called artificial insemination, a doctor uses a thin tube (catheter) and syringe to introduce sperm from the woman’s partner (or from a donor) directly into the uterus, close to the time of ovulation. Intrauterine insemination is designed to make it easier for sperm to reach the fallopian tubes to fertilize an egg. It is used when the man’s sperm count is only marginally low or when the woman’s cervical mucus prevents sperm from entering the uterus.

Donor Sperm

Couples sometimes choose to use donated sperm if the man cannot produce enough normal sperm to fertilize his partner’s egg. Single women who want to conceive also may choose to use sperm from a donor. Sperm donation is extremely safe when it is done at a reliable infertility center by an experienced and board-certified reproductive endocrinologist and following the established national guidelines. Sperm donors are carefully screened for medical problems and STDs before they can donate. Anonymous donors are registered by age, race, hair and eye color, and build so that women or couples can choose a preferred genetic background. If the donor is known, a couple should consult an attorney before undergoing insemination with donated sperm to resolve any potential paternity issues.

In vitro fertilization

In vitro fertilization (IVF) is the most widely used assisted reproductive technology. It is the standard treatment for women with obstructed fallopian tubes. During IVF, the ovaries are stimulated to produce multiple eggs, which are removed from the ovaries through the vagina, with ultrasound guidance. The eggs are then fertilized in a laboratory by sperm from the male partner or from a donor. The fertilized eggs are allowed to undergo cell division until they are viable enough to be introduced into the woman’s uterus and possibly to produce a pregnancy.

The IVF process consists of four stages: ovulation induction, egg retrieval, fertilization in a laboratory, and embryo transfer (into the uterus). At the beginning of an IVF cycle, you will be asked to give yourself injections of a drug that stops your body’s production of estrogen, allowing the doctors to create a new monthly cycle in which they can control exactly when ovulation will occur. Then you will take other drugs to stimulate multiple ovulation. During this time you will need to undergo regular vaginal ultrasound scans to monitor the progress of your ripening ovarian follicles.

When it is time to retrieve your eggs, you will go to a hospital or outpatient facility for the procedure. You will be given a light sedative and pain medication. Guided by vaginal ultrasound, the doctor harvests your eggs using a long, thin needle inserted through the vagina and into each of your ovaries. After your partner provides a fresh semen sample, his sperm (or sperm from a donor) is mixed with your eggs in a plastic dish and allowed to incubate for 14 hours or more. Then the fertilized eggs are examined, and the most viable ones are implanted in your uterus within a few days. Some couples who produce a large number of embryos can choose