January 24, 2018

The spectrum of fertility treatment: From the severe to the minimal

  1. Fifth-Party Reproduction: Utilize a sperm donor. Utilize an egg donor. Utilize a surrogate to carry the baby.
  2. Fourth-Party Reproduction: Utilize two out of the three (egg donor, sperm donor, surrogate)
  3. A) Third-Party Reproduction: Utilize either one of a sperm donor, egg donor or surrogate
    B) In-Vitro-Fertilization with PGD: Take the wife’s own eggs and the husband’s own sperm and fertilize together. Analyze the embryos and transfer only those which are likely to produce the healthiest children.
  4. In-Vitro-Fertilization with ICSI: Take the wife’s own eggs and the husband’s own sperm and inject the sperm directly into the eggs. Transfer the “best looking” embryos.
  5. Standard In-Vitro-Fertilization: Take the wife’s own eggs and “sprinkle” the husband’s sperm over them, allowing them to competitively battle to fertilize the egg without assistance.
  6. Intrauterine Insemination: Wash and concentrate the husband’s sperm, separating out the best swimmers. Then, physically transport the sperm exponentially closer to the target destination where the eggs are hoped to be waiting, usually done in conjunction with drugs to boost egg quantity and quality.
  7. Ovulation assistance: Administration of medication to increase the number and/or the quality (probability of healthy conception) of the eggs, while allowing the couple have sex naturally.
  8. Restoration of hormonal imbalances: Give medications to correct hormonal defects, such as an underactive thyroid or excess insulin production.
  9. Counseling: Pointing out to the couple ways they can change their lifestyle habits and sexual practices to boost their chances of conceiving naturally.

When patients come to us, we seek the balance between starting low on the list and moving up as high as necessary and as high as the patient wishes to go in order to have a baby. The sequence is not a pure progression as there is overlap between some of them. For example, 3A and 3B are listed in parallel because they are different branches of increased severity, but not necessarily mutually exclusive, meaning you could do PGD AND do IVF with ICSI AND utilize an egg donor.

I use this list to help patients see the overall “big picture” of what their options are.