a) Procedure overview

    Assisted reproductive technologies (ARTs) refers to all techniques used to retrieve and fertilize human oocytes. In vitro fertilization (IVF) is the most common technique used to artificially fertilize human oocytes.

    The procedure is performed by initially stimulating maturation of the follicle with a gonadotropin-releasing hormone agonist that induces pituitary gland suppression and creates quiescent ovaries to prevent the production of a single dominant follicle. Follicle-stimulating hormone (FSH) and human menopausal gonadotropin are then administered, which induces 10 to 15 ovarian follicles. The patient is then given human chorionic gonadotropin (hCG), which induces the follicle to then mature and move into the follicular fluid. The oocyte is retrieved transvaginally, transabdominally, or via laparoscopy with an ultrasonically guided probe 34 to 36 hours after hCG administration. All visible follicles are collected, washed, incubated for 4 to 6 hours in a culture medium, and examined microscopically. Most follicles contain only one oocyte. Fertilization occurs in the IVF laboratory. The oocyte is identified and has minimal exposure to ambient room temperature, room air, and especially any chemical odors. Sperm are washed and centrifuged. Fresh media is added next to the centrifuged sperm, and those sperm that swim to the media, which can number 50,000, are placed with the oocyte. Timing must be coordinated with proper maturation of the uterine endometrium. ART is found to increase the risk of multiple gestations. Also, it has been reported that atypical implantations of the fertilized ovum or zygote, such as abdominal, cervical, ovarian, or tubal pregnancy, occur more frequently with ART. Common ART techniques are listed in the table on pg. 413.