Effective medical alternatives to in vitro fertilization (IVF) may be possible for some infertility patients depending on their diagnosis. IVF was designed to help patients with blocked or missing fallopian tubes. Without fallopian tubes, the site of fertilization in the body, conception through natural intercourse or insemination is impossible. The process of IVF brings egg and sperm together in a culture dish, then transfers the resulting embryos to the intended mother's uterus for development to term. Alternatives to IVF may exist in cases where the fallopian tubes are intact or already fertilized embryos are used or other people donate their reproductive capacity to infertile couples.
Intrauterine Insemination (IUI)
Intrauterine insemination (IUI) may be an alternative to IVF if the fallopian tubes are open and at least 20 million motile sperm can be used for insemination. Sperm are injected directly into the uterus (IUI) at ovulation in either a natural cycle or an ovarian stimulation cycle. Sperm swim from the uterus to the fallopian tube to meet and fertilize the egg. Stimulating the ovaries to produce multiple eggs compared to the one to two eggs produced in a natural cycle also increases the chances for successful fertilization.
Egg Donor or Gestational Surrogate
Some patients may need an alternative to IVF because they are medically unable to participate in IVF. If you have lost your ovaries or uterus to cancer or cancer treatments, IVF is not an option. Without ovaries, ovarian stimulation and egg retrieval, the first steps in IVF, are not possible. Without a uterus, embryos can not be transferred to you. If needed, egg donors and gestational surrogates can perform these procedures in your place. An egg donor can be a family member (for example, a sister) or someone who is willing to donate eggs anonymously. Gestational surrogates are women who are willing to carry another person's embryos to term. The egg donor and gestational surrogate undergo the IVF procedures for the patient.
Gamete IntraFallopian Transfer (GIFT)
Gamete IntraFallopian Transfer (GIFT) is an alternative to IVF for patients who for religious reasons require that conception occur within the woman. Ovarian stimulation and egg retrieval are performed just as for the IVF procedure, but egg and sperm are not combined in a dish. Instead, the semen sample and eggs are injected separately into the patient's fallopian tubes so that fertilization occurs inside the woman. To locate the tubes and insert the catheter containing eggs and sperm, the patient is returned to the operating room after the egg retrieval is completed and an abdominal incision is made under general anesthesia.
Tubal Reversal Surgery
Tubal ligation is a permanent method of sterilization in which tubes are blocked, cut or burned, removing the natural site of fertilization. Sometimes the tubes can be re-connected in a procedure called tubal reversal surgery. Blocked or cut tubes are the primary reason that IVF is used, so a tubal reversal provides an alternative to IVF. A successful reversal can restore fertility through sexual intercourse or artificial insemination.
Embryo or Child Adoption
Adoption is another option for infertile patients who want to have a family but are not able to conceive naturally and have not conceived through insemination but want an alternative to IVF. As described in the April 19, 2009, "Washington Times" article"Embryo adoption becoming the rage," this alternative to IVF and traditional adoption is growing in popularity. Some IVF couples who have completed their family and still have embryos in storage choose to donate their embryos to other infertile women who are willing to "adopt" the embryo and bring it to term in their own uterus.
