Achieving a pregnancy
There are 4 general modalities of achieving a pregnancy:
Natural conception: Also known as the “old-fashioned way”. This involves helping couples to time their intercourse to the female partners ovulation. If she does not know when she ovulates, using ovulation predictor kits may help. These are available over the counter. Sperm live for 48 hours, so we suggest having intercourse the day before ovulation, on ovulation day and the day after ovulation. This ensures that when the egg is present, sperm are also present to fertilize it. Natural conception is generally considered an option for fertility when the male partner has greater than 15 million sperm per milliliter.
Intrauterine Insemination (IUI): The female partner’s ovaries are monitored, and when she is ovulating the male makes a semen sample into a cup. This is spun down so the sperm are concentrated into a small drop of fluid. This fluid is then placed in a small plastic syringe, which is placed through the cervix and directly in to her uterus. The sperm swim toward (and hopefully fertilize) the egg. This a potential option when sperm counts are 5-15×106 sperm/mL. This is a procedure performed by a Gynecologist specializing in Female Fertility (“Reproductive Endocrinology and Infertility”, or REI Gynecologist).
In Vitro Fertilization (IVF): The female partner receives injections to stimulate her ovaries to produce more than one egg for the desired month. These eggs are then retrieved from her body at a small surgical procedure. The male partner then makes a sample. The sperm are placed in the vicinity of the egg and they said actually swim to (and hopefully fertilize) the egg. The resultant embryos are then placed back into the female uterus for development. This is typically done when small numbers of sperm are present, generally less than 5×106 sperm/mL, when sperm are of a poor quality, or when there are female factors involved. This is a procedure performed by a Gynecologist specializing in Female Fertility (“Reproductive Endocrinology and Infertility”, or REI Gynecologist).
Intracytoplasmic Sperm Injection (ICSI): This is a very similar process to IVF for couples. However, there is an added step at the lab level. Instead of just letting the sperm swim toward the egg to fertilize it, the sperm are injected directly into the eggs individually. This is done when there are very low numbers of sperm, and every one is needed to fertilize an egg.
While IVF and ICSI are the most expensive and the most involved of these procedures, for many couples it is their only option. IVF and ICSI have made parenthood an option for millions of couples since their advent. These procedures are now quite commonly used and have excellent success rates.