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Doctors estimate half of infertile couples can be helped by conventional treatments. Half need help from New Reproductive Technologies (NRTs). The costs (US$) and numbers of procedures are shown for the U.S. in 1993. (From the New York Times, Jan. 7, 1996)
Conventional treatmentsDrug therapy. Fertility drugs like Clomid and Pergonal stimulate ovulation.
Intrauterine insemination (IUI). The most common procedure, often used with drug therapy: sperm from the husband or a donor is placed with a catheter into the uterus, bypassing the upper vagina and cervix. 600,000 procedures.
Surgery. Surgery on women clears blocked fallopian tubes or reduces endometriosis (abnormal blood-rich tissue that grows around the reproductive organs, causing pain and interfering with reproductive function). Surgery on men repairs a varicocele (a varicose vein in the testicle, causing reduced sperm count).
New Reproductive TechnologiesIn vitro fertilization (IVF). Eggs produced using fertility drugs are removed from a ripe follicle, fertilized by sperm in a laboratory dish and allowed to divide for about two days. Resulting embryos are placed in the uterus. $7,800 for one cycle; 32,000 procedures.
Gamete intrafallopian transfer (GIFT). A mixture of sperm and eggs is inserted into the fallopian tubes, where fertilization may occur. Resulting embryos move into the uterus. 4,992 procedures.
Zygote intrafollopian transfer (ZIFT). Eggs are fertilized by sperm in a lab dish. Resulting embryos are placed in a fallopian tube and move into the uterus. 1,792 procedures.
Intracytoplasmic sperm injection (ICSI). In a laboratory dish under a microscope, a single sperm is inserted into an egg (increases the chance of fertilization for men with poor quality sperm). The embryo is then placed in the uterus.
Cryopreserved embryo transfer (CPE). Embryos frozen after a previous NRT procedure are thawed and placed in the uterus. 6,672 procedures.
Egg donation. Eggs are removed from the ovaries of a donor, fertilized in a lab dish and placed in the uterus of an infertile woman. 2,766 procedures. Donor is paid $1,500 to $3,000. The procedure, with treatment of donor and recipient, costs $14,000 to $20,000.
Surrogacy. A woman is implanted with an embryo and is paid to carry the child to term. The egg may come from the surrogate mother or the legal mother, the sperm from the legal father or a donor. Surrogate's fee may run $10,000 to $20,000. Extra costs may include surrogate's prenatal care and fertility drugs for the legal mother.
INFERTILITY DRUGSbromocriptine mesylate
Counters elevated level of prolactin hormone (which results in failure to ovulate).
gonadotropin, human menopausal (hMG)
gonadotropin releasing hormone (GnRH)
gonadotropin releasing hormone agonist
gonadotropin, human chorionic (hCG)
HORMONESFSH: follicle stimulating hormone, from the pituitary, stimulates the ovary to ripen a follicle for ovulation.
LH: luteinizing hormone, from the pituitary. Secretions increase in mid-cycle to induce release of an egg.
GnRH: gonadotropin releasing hormone, from the hypothalamus, controls the synthesis and release of FSH and LH.
hCG: human chorionic gonadotropin, a hormone from the placenta during pregnancy which prolongs the life of the corpus luteum and hence progesterone production, thus preserving the pregnancy.
Progesterone: secreted by the corpus luteum of the ovary after ovulation, and also by the placenta during pregnancy.
Sources: Canadian Adverse Drug Reaction Newsletter, Oct. 1995.