In this section, you will find some information on different assisted reproductive technologies. IVFHK patients will receive more detailed information before their treatment begins. However, as each patient's condition is different, please consult your doctor about most suitable treatment, or if you have any questions.

What is ART?

Assisted Reproductive Technology (ART) refers to special techniques used in the treatment of infertile couples. These technologies may involve complex laboratory procedures and the use of highly trained staff. ART is offered when the primary fertility treatment fails or when other treatments are unsuitable.

Simple forms of ART include ovulation induction (OI) with or without intrauterine insemination (IUI). More sophisticated forms include in-vitro fertilization (IVF) (test-tube baby) with or without intracytoplasmic sperm injection (ICSI). IVF literally means fertilization of the egg with the sperm outside the human body (in a test-tube or a dish in the laboratory). The fertilized egg (embryo) is later transferred back to the uterus.

ART is complex, time consuming, physically and emotionally stressful and it is also costly. Before the procedure starts, each patient should be informed about the indications, the procedures involved and the possible complications and outcome. Couples are required to sign consent forms before treatment. We understand that this is a stressful situation and please do not hesitate to contact your doctor if you have any queries.

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Who Needs What?

ART is usually offered when simpler forms of treatment fail or are unsuitable. This section is a very simplistic display of treatment options. As each patient's condition is different, please consult your doctor for the most suitable treatment.

The commonly practiced infertility treatments and their indications

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Ovulation Induction (OI)

Ovulation induction with gonadotropins can be used for the treatment of ovulation disorders in patients with normal fallopian tubes. It is commonly offered when the female partner fails to achieve ovulation or a pregnancy with simpler treatments, such as clomiphene citrate. Together with intrauterine insemination (IUI), it is also used in couples with mild endometriosis and unexplained infertility.

The usual steps for OI:

1. Ovarian Stimulation & Monitoring
2. Induction of Ovulation
3. Approximation of Female and Male Gametes
4. Luteal Phase Support

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Intrauterine Insemination (IUI)

This is a simple procedure suitable for couples with borderline sperm abnormalities, sexual dysfunction, cervical or immunological factors.

The IUI procedure is performed 24-36 hours after the spontaneous Lutening Hormone (LH) surge or after ovulation trigger using human chorionic gonadotropin (hCG). The male partner is asked to come in on the day of the IUI procedure and provide a semen sample. The semen is processed in the laboratory to increase the number of normal, motile sperm. The sperm is then transferred back to the uterus via the cervical canal using a fine catheter.

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In-Vitro Fertilization (IVF)

In-vitro fertilization is included in the most complicated treatments for infertility. The indications for IVF include:

• Damage, blockage or absent fallopian tubes
• Moderate to severe endometriosis
• Severe male factor
• Unexplained infertility or an ovulation problem with repeated failure of OI/IUI

A typical IVF treatment cycle can be divided into 8 parts:

1. Down Regulation in the Pre-Treatment Cycle
2. Ovarian Stimulation & Monitoring
3. Induction of Ovulation
4. Oocyte Retrieval (Egg Collection)
5. Semen Collection
6. In-Vitro Fertilization
7. Embryo Transfer
8. Luteal Phase Support

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Cryopreserved (Frozen) Embryos

When more embryos are produced than are needed in one cycle (surplus embryos) or when a fresh embryo transfer is not suitable (as in risk of ovarian hyperstimulation syndrome, OHSS), the embryos can be frozen and stored in liquid nitrogen at -196°C. The frozen embryos can then be thawed and transferred later. This saves having to go through another full cycle of IVF treatment. Unfortunately not all couples get a sufficient number of healthy embryos to allow freezing.

Frozen-Thawed Embryo Replacement

For patients with a normal menstrual cycle, the embryos can be transferred back soon after the time of ovulation. During the frozen- thawed embryo replacement cycle, the female partner is monitored until ovulation is evident. The embryos are then thawed before embryo transfer. For patients with an ovulation problem, some form of ovarian stimulation may be required before the embryos can be thawed.

Freezing and thawing may cause some damage to the embryos. Only 60-70% of embryos that are thawed are suitable for transfer.

What happens if you don't use your embryos?

Legislation in Hong Kong regulating IVF units permits the storage of embryos for a maximum of 10 years. Storage of frozen embryos will cease under the following circumstances:

• upon the couple's use in a frozen thawed embryo replacement cycle
• upon the couple's request to discard the embryos

Excess embryos can also be donated for research purposes or donated to other infertile couple if agreed to by the couple.

If you have embryos stored, you must renew your consent form for continuing storage every 2 years.

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