Current status of treatment of infertility with appreciation of high-tech technology

Infertility has been caused by abortion, late marriage, daily stress, environmental pollution, and competition at work.The percentage of infertile couples has increased from 10% 40 years ago to 20%, i.e., every two in ten couples are infertile. The pressure to have a son to carry on the family name has become an issue worthy of attention. At a time when medicine was less developed, people tend to place all blame for infertility on women and resulted in many social problems.Thanks to advances in reproductive technology, it has become possible to find the right antidote to infertility, and allow for successful pregnancy for most of the infertile couples.

The earliest and simplest artificial interventional reproduction is intrauterine insemination, in which the spermsare washed and then artificially placed (injected) in the cervix or uterus on the day of ovulation to facilitate natural fertilization and pregnancy. Test tube baby is required if the patient has received bilateral salpingectomy (removal of tubes) due to ectopic pregnancy or has bilateral fallopian tube obstruction caused by fallopian tube disorders. Test tube baby refers to children conceived with in vitro fertilization (IVF). After 2 to 3 days in vitro culture of embryos into 4- to 8-cell stage, the embryos are transferred into uterus for pregnancy. Tubal embryo transfer (TET) is when the embryos are transferred back into the fallopian tube. GIFT (gamete intrafallopian transfer) is another tool of assisted reproductive technology in which eggs are removed from a woman’s ovaries, and placed in of the Fallopian tubes, along with the man’s sperm (a healthy, unobstructed Fallopian tube is a prerequisite).

Because of the uncertainty of whether fertilization occurs in vivo, GIFT is currently surrendered. Generally speaking, the success rate of IUI, IVF, TET, and GIFT is 15-20%, 20-40%, 40-60% and 25-35%, respectively. Successful fertilization and pregnancy rate in women older than 35 years old decrease with age. For the men with extremely low number of sperms, a forced conception can be carried out by injecting an active sperm into the egg. For the embryos not develop well in vitro, ooplasm of a healthy egg can be injected to the embryo to improve the implantation rate.

Furthermore, when genetic diseases or gender preferences in the succession are encountered, “embryo biopsy” can be applied for the selection of embryos before transferring back into the uterus.With respect to the application of frozen sperms or frozen embryos, azoospermia can be overcome by donated sperms from sperm bank, lack of ovary can be overcome by egg donation, whereas lack of uterus can be overcome surrogate pregnancy (yet illegal). As for human cloning, the technology and equipment are not the limitation once the ethical and legal barriers are overcome. In summary, these are the current achievement in infertility treatment with advanced reproductive technology in the reproductive institute, Lee Women’s Hospital, Taichung.