In cases of artificial insemination is the conception of a child always performed in a test tube?

Assisted reproductive technology, known as artificial insemination, or ectopic, does not always mean that the child is conceived in a laboratory test tube. The aim is to help fertilize the egg artificially, when the natural way didn’t show positive results. Artificial insemination - is one of the treatments for infertility. Thanks to ART thousands of couples had the opportunity to become parents when they have already lost they hope to have a child.

When was the first in vitro fertilization performed?

In 1978 English gynecologist Patrick Steptoe and embryologist Robert Edwards successfully performed the procedure of artificial insemination for the first time in the history. Since that time thousands of children have been born due to the technology of reproductive medicine. Previously the experiments on ectopic fertility were conducted on animals and then the results allowed applying this technique on humans. In recent decades, reproductive medicine increased considerably, doctors have found new methods for solving the problems of infertility.

What are the most popular methods of in vitro fertilization today?

• artificial insemination (AI);
• In vitro fertilization (IVF) and embryo transfer into the uterine cavity (PE);
• intracytoplasmic sperm injection in the oocyte (ICSI).

Is it possible to choose the sex of a child by artificial insemination?

Prenatal sex selection during in vitro fertilization by sperm injection into the egg cell is theoretically possible in this case there is a special selection of sperm. But this method is only used when there is a necessity to avoid bad heredity - some diseases transmitted only to the children of a particular sex. Child's sex is never chosen without worthy reason, just for the parents' request.

Is there any health risk performed to mother and a child by artificial insemination?

Human artificial insemination is the process of implanting male sperm into a woman's cervix or uterus to impregnate the woman. This process is for women who either cannot or do not wish to get pregnant by natural means. There are two methods of artificially insemination: intrauterine insemination and intracervical insemination. As with with any other kind of medical procedure, artificial insemination has it's risks.

Multiple Births
When a woman gets artificially inseminated, she may also be using fertility drugs to increase the chance of getting pregnant. Treatment with these drugs increases the chance of conceiving multiple fetuses. Women carrying multiples are at an increased risk of experiencing pregnancy and birth complications, such as gestational diabetes, preeclampsia, anemia and postpartum hemorrhage. Other risks associated with multiple births include miscarriage, low birth weight and even premature birth.

Ovarian Hyperstimulation Syndrome
Ovarian Hyperstimulation Syndrome (OHSS) is a very uncommon but serious complication that can happen when fertility drugs are used along with artificial insemination. OHSS can cause the woman's ovaries to become swollen with the use of fertility drugs commonly used in combination with artificial insemination. Less severe symptoms of OHSS include bloating, mild abdominal pain and occasional nausea and vomiting. More severe symptoms of OHSS include chest pain, dehydration and shortness of breath. If you have any of these symptoms while in the process of getting artificially inseminated and using fertility drugs, see a doctor right away.

Infection
During artificial insemination, the mother-to-be can get an infection in the uterus or the fallopian tubes. The infection may be caused by the procedure being done with a non-sterile catheter or other medical instrument being used. After the procedure is done, there may also be vaginal bleeding, vaginal discharge and cramping or pain in the stomach.

Side Effects
There are occasionally mild side effects of getting artificially inseminated. These can include depression, hot flashes, headaches, mood changes and sleeplessness. These are very mild side effects, and may not occur in every woman after the procedure.

Sperm Risks
There may be risks associated with the sperm used also. If the sperm was not properly screened for sexually transmitted diseases and is used for artificial insemination, there is a chance the mother-to-be can get a sexually transmitted disease. This will only happen if the sperm is not properly checked and cleaned before placing it inside the woman's uterus or cervix.

Will the IVF technique damage my ovaries?

There is no evidence to suggest that either normal laparoscopy or ultrasound egg retrieval damages the ovaries. In fact, some reports in the medical literature suggest that following ovarian biopsy, pregnancies occur in couples with a long-term history of infertility.

Will scar tissue around my ovaries make it impossible to retrieve the eggs?

Not ordinarily. The surgeon must be able to see the follicles in order to guide the needle to the proper spot for retrieval of the eggs whether by sonographic (ultrasound) or surgical methods.

What if I ovulate before oocyte (also called egg or ovum) retrieval?

Once ovulation has occurred it is impossible to retrieve the eggs. The entire team of physician, nurse and embryologist will monitor your cycle very carefully to avoid premature ovulation.

If an egg is not retrieved or if the technique does not produce a pregnancy on the first attempt, how soon can the procedure be repeated?

This depends on the individual. The primary reason for delay is to allow the patient's normal menstrual cycle to resume, which may take 2 to 3 cycles.

How many times will IVF be repeated per couple?

There is no specific number. This is determined by the couple together with the physician.

Can we have intercourse during the two-week period before an IVF procedure is performed?

Most definitely. We recommend that the husband refrain from ejaculation for at least 48 hours, but for no more than 5 to 6 days preceding egg retrieval. This precaution assures that the semen sample obtained for IVF will contain a maximum number of healthy, motile sperm.

After the IVF procedure, how long must we wait to have intercourse?

Although a definite time of abstinence to avoid damage to the pre-embryo has not been determined, most experts recommend abstinence for two to three weeks. Theoretically, the uterine contractions associated with orgasm could interfere with the early stages of implantation. However, intercourse the night before pre-embryo transfer is acceptable. Some physicians will advise intercourse before transfer as they feel that this will improve the chances of a pregnancy.

What about other activities? How soon can I resume my normal routine?

The IVF team recommends that the patient be sedentary for a full 24 hours following pre-embryo placement in the uterus. Strenuous exercises such as jogging, horseback riding, swimming, etc. should be avoided until pregnancy is confirmed. Otherwise, the patient is free to return to her regular activities.

How soon will I know if I'm pregnant?

Pregnancy can be confirmed using blood tests about 13 days after egg aspiration. Pregnancy can be confirmed by ultrasound 30 to 40 days after aspiration.

I had my tubes tied (tubal ligation) several years ago. Would I be a candidate for IVF?

Perhaps, in certain situations, IVF may be cheaper and physically less demanding than surgery to repair you fallopian tubes.

What drugs are given to stimulate the ovarian follicles and to maintain the lining of the uterus prior to implantation of the pre-embryo?

Four to five medications normally are given:

1. Leuprolide acetate (Lupron), an injectable drug that blocks secretions of the pituitary gland, thereby optimizing the number of oocytes retrieved;
2. Human menopausal gonadotropin (Pergonal or hMG) or Follicle Stimulating Hormone (Metrodin or FSH), hormones that stimulate ovarian activity, are injected daily for about 6-10 days prior to the procedure;
3. Human chorionic gonadotropin (hCG), a hormone that mimics the action of the hormone which naturally induces ovulation, is injected 34 to 36 hours before retrieval and may be used after retrieval to supplement natural progesterone production;
4. Progesterone, a natural hormone that enables the uterus to support pregnancy, may be used as a daily injection after egg retrieval; and

What side effects, if any, can these drugs cause?

No pronounced side effects have been associated with any of these drugs. However, the patient should inform the physician of ANY allergies she has or of any previous adverse reactions to drugs.

Will I have an egg in every follicle?

It varies from patient to patient . As many as half of the follicles may not contain an egg in some patients.

Is there a possibility of multiple births with IVF?

Yes, when multiple pre-embryos are transferred. 25%. of pregnancies with IVF are twins. (In normal population, the rate is one set of twins per 80 births.) Triplets are seen in approximately 2-3% of pregnancies.

Is there an increased chance of birth defects if I become pregnant through IVF?

There are no known ill effects. Abnormal pre-embryos, even those produced through normal fertilization, do not seem to mature. However, any long-term effects of IVF remain to be determined.

How much time does the entire procedure require?

Approximately three weeks (all as an outpatient). Fertility drugs are administered to stimulate the ovaries. Then during the four to six days prior to ovulation, the patient is monitored by ultrasound as well as by hormone levels.

What happens to any extra pre-embryos?

A maximum of four pre-embryos will be transferred to the uterus for possible implantation. Patients will have several other options regarding the disposition of the remaining pre-embryos. One option is to freeze pre-embryos for your later use. Other options are to donate or simply dispose of them. Excess pre-embryos, if any, belong to you, and you will determine what is to be done.

Should We tell our child?

One of the biggest questions that couples who have gone through egg donation in the past have is whether or not they should tell their child about the procedure. Many couples feel that it is their child's right to know about their biological background. But other couples often feel that telling their child about ovum donation is unnecessary. Some common reasons that you may have for worrying about disclosing egg donation information include:

• Fear of your child's emotional reaction.
• Fear of the reaction from your other relatives, friends, or colleagues.
• Fear that your child will feel violated or betrayed.
• Fear that your child will no longer trust you.

Despite these valid fears, most therapist and the American Infertility Association recommend that parents discuss egg donation with their child.

Why Should You Tell?

There are a variety of good reasons to inform your child that she was conceived through an egg donation procedure.

• Children have the ability to "sense" out secrets that may be present in a family.
• Secrets rarely stay secrets forever.
• If a child finds out accidentally, he could experience a lot of trust and betrayal issues.
• A child's genetic background may need to be released in the future for certain medical procedures.

How Much Should You Tell Your Child?

There are different levels of information disclosure that you and your partner may settle upon when talking to your child. Depending upon your child's emotional and intellectual development, as well as your own feelings, one type of disclosure may be more suitable for you.

Are there any restrictions on physical or personal activities during an IVF cycle?

Smoking: Stop smoking before ovulation induction begins. It is best to discontinue tobacco at least 2 months prior to an IVF cycle. If you cannot stop “cold turkey”, make an effort to stop at least two weeks prior to the egg aspiration. By products of tobacco have been demonstrated to be toxic to the oocyte (egg). Numerous studies have also demonstrated that smoking during pregnancy results in reduced birth weight and fetal compromise. There is some data that smoking can also lower pregnancy rates. We strongly recommend that all women, especially those undergoing fertility treatment, cease smoking

Drinking: Alcohol is a drug, and should be avoided during infertility treatment and pregnancy. Please do not drink alcohol from the time fertility medications are initiated until the pregnancy test.

Medications: If you are taking any medication, prescription or over-the-counter, please inform your physician. Some medications may interfere with the fertility medications prescribed, some are not safe to use before an operation or medical procedure, and others might interfere with ovulation or pregnancy implantation. A prenatal or multivitamin will be prescribed; if you are not taking a vitamin with folic acid, please inform the ART nurses.

An IVF cycle can be an emotional and stressful time for you and your partner. It may be helpful to have supportive personnel to speak to, such as friends and family, a clergy member, or a psychologist/therapist.

Heavy exercise such as aerobics, jogging, weight lifting etc. are prohibited during ovarian stimulation and until the pregnancy test results are known.

When is the pregnancy test performed?

The blood pregnancy test is performed 14 days after the embryo transfer.

What happens if I become pregnant?

If pregnant, the patient is asked to return to the office for repeat blood work and ultrasounds to ensure an ongoing successful pregnancy. After a fetal heartbeat has been confirmed, patients are referred to an obstetrician for the remainder of the pregnancy.

If I am not pregnant, when can we try again?

Usually we ask that patients wait one or two complete menstrual cycles before beginning another ART cycle. Sometimes tests are required that may delay subsequent cycles.

Will I need a high risk OB because I conceived with an ART procedure?

A high risk OB is only needed when there are complications that put the mother or baby at increased risk, or in the case of multiple births. Other than a higher incidence of multiple births, ART does not increase the risk to the fetus.

Is there a higher miscarriage rate for ART patients?

The miscarriage rate is about the same for ART as the general population. Many times older females undergo ART and their miscarriage rates are naturally higher. Since pregnancy testing is done two weeks after embryo transfer, we often know about spontaneous miscarriages in the very early stages of pregnancy. These miscarriages would probably go unnoticed in the general population.

What can be done to improve sperm quality?

Sperm quality on the day of egg retrieval is often related to what happened in the male’s body 3 months ago. This is because sperm development takes 3 months. Listed below are guidelines to help ensure the semen specimen is of the best possible quality.

• A fever of 101 degrees Fahrenheit or higher within 3 months prior to ART treatment may adversely affect sperm quality. Sperm count and motility may appear normal, but fertilization may not occur. If you become sick during the ART cycle, please notify the ART nurse, and take Tylenol to keep your temperature below 101 degrees Fahrenheit.
• Keep the use of alcohol and cigarettes to a minimum before and during ART treatment. Do not use any “recreational” drugs.
• If any prescription medication has been taken during the last 3 months, notify the ART nurse.
• Do not sit in hot tubs, spas, Jacuzzis, or saunas during or 3 months prior to the ART cycle.
• Do not begin any new form of endurance exercise during or 3 months prior to the ART cycle. Physical activity at a moderate level is acceptable and encouraged.
• Avoid all testosterone, DHEA, and Androstenedione/Androstanediol hormone containing supplements.
• Tell your infertility physician if you have ever had genital herpes, or suspect you may have been exposed to genital herpes in the past. Also tell your physician if you have pre lesion symptoms, develop a lesion, or have healing lesions before or during the ART cycle.
• Refrain from ejaculation for 2-3 days, but not more than 5 prior to collecting the semen sample for the ART cycle. The ART nurse will have your specific instructions from the Andrologist.

We want to try Gestational Surrogacy, how much will this cost?

Each clinic has different set fees but the cost of a cycle with a surrogate will be slightly more than that of a standard IVF cycle as both Intended Mother and Surrogate Mother will need to be treated.

How much are Surrogate Mothers' expenses?

There is no set amount of expenses for a Surrogate. Each case is different as each Surrogate Mother has different expenses. The expenses must be justified to the courts and they will ask for proof if the expenses are too high. These expenses are to cover everything that a Surrogate Mother would have to pay for while she is pregnant with your baby. These include maternity clothing, vitamins, travel, time off work, take aways, childcare, cleaner etc.

Do we have to use a clinic for Straight Surrogacy Inseminations?

Some people prefer to use a clinic for Intra Uterine Inseminations (IUI) and there may be clinical reasons for this but it is more usual for inseminations to be carried out in the home of either the Surrogate Mother or Intended Parents. Surrogacy UK sells insemination kits to both members and non members.

I am single, can I look for a Surrogate Mother to help me?

Unfortunately the answer to this is no. Legally in the UK you can only carry out a Surrogacy Arrangement if you can apply for a Parental Order. For more information on Parental Orders press on this Link.

Who can be a Surrogate Mother?

We take every situation on its own merits. Ideally a Surrogate Mother would have completed her own family. If doing Host Surrogacy she would have to comply with the rules of the clinic they are using. Clinics' rules vary as they take a lot of elements into consideration, such as health issues, age, weight etc. If carrying out a Straight Surrogacy Arrangement, the Surrogate should ideally be under 35 years of age, since the chance of Downs Syndrome is higher after this age. However, this is not essential. In fact, we have many ladies up to the age of 40 being Straight Surrogates. What matters most is that the Surrogate Mother and the Intended Parents are completely honest with each another.

I am not a British Citizen but I would like to be a Surrogate for a couple in the UK, is this possible?

This is possible and has been done. Treatment could be conducted either in the UK or abroad. However, we would strongly recommend that you are based in the UK for the pregnancy and birth (and legally entitled to be here) to avoid problems with crossing borders after the birth, and legal difficulties over nationality and immigration law. If you have children and family commitments, it may be very difficult to either leave them behind or to bring them over to the UK to live with you while you are awaiting the birth. This type of surrogacy arrangement can be very complicated and costly, and most people who undergo such an arrangement are usually family members i.e. a sister to sister surrogacy arrangement.

We are lucky enough to have found our Surrogate, what tests do we need?

We would always recommend all parties have a police check, ask for details at your local station. If you are doing straight surrogacy it is also strongly recommended that everyone has STD (STI) tests performed. To include:

a) HIV
b) Chlamydia
c) Gonorrhoea
d) Hepatitis B
e) Hepatitis C
f) Syphilis

Intended Fathers that will be doing Straight Surrogacy must have a full sperm test which includes a MAR test.

There are other relevant tests depending on you nationality/religion and your local GP or clinic will be able to advise you.

Are there any risks involved in becoming a Surrogate Mother?

Potential Surrogates should be aware that there are risks in every pregnancy. Most pregnancies are uneventful, however, complications may occur such as pre-eclampsia, high blood pressure, ectopic pregnancy, diabetes, thrombosis, miscarriage and haemorrhage. It should also be noted, that it is possible to lose your own fertility as a result of a pregnancy complication such as ectopic pregnancy or miscarriage. Finally, there is a risk of maternal death of 1 in 10,000 pregnancies.