1. Treatment Options for Infertility
Association of Reproductive Health Professionals

2. Learning Objectives
State at least three infertility treatment options available for females.
State at least three infertility treatment options available for males.
List two available ovulation-inducing drugs.

3. Basic Services for Infertile Couples
Talking Points
This presentation is one in a series of four, based on these basic services that should be offered to couples facing the possibility of infertility. The goal is to help couples improve fertility, where possible, and to expedite further evaluation and treatment. Providers should begin with the first 4 items below and, where resources and training permit, include all of the following in their infertility services:
Educate patients on infertility and its prevention.
Gather pertinent historical information to establish a diagnosis.
Offer information on diagnosis-dependent treatment alternatives.
Provide a resource for reassurance, counseling, and emotional support, including referral as needed.
Basic services begin with educating patients about the causes of infertility and the factors that may be within their control to improve their chances of conceiving.
This curriculum focuses on treatment options available for infertility.
Treatment options for infertility are diagnosis dependent.
Reference
Stewart GK. Impaired fertility. In Hatcher RA, Trussell J, Stewart F, et al., eds. Contraceptive Technology. 17th revised ed. New York, NY: Ardent Media; 1998.
Basic Services for Infertile Couples
3. Offer information on treatment options
4. Provide resources for counseling and emotional support
1. Educate on infertility causes and prevention
2. Conduct appropriate diagnostic workup
2. Conduct appropriate diagnostic workup
Stewart GK. 1998
Slide 3

4. Fertility Treatments Can Work
Talking Points
“With thorough evaluation and application of current treatments short of IVF, embryo transfer, or GIFT, 50–60% of infertility couples will conceive.”
Reference
Meldrum DR. Infertility. In Hacker NF, Moore JG, eds. Essentials of Obstetrics and Gynecology. 3rd ed. Philadelphia, PA: WB Saunders; 1998.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
Fertility Treatments Can Work ‘ ‘
“…With thorough evaluation and application of current treatments short of IVF, embryo transfer, or GIFT, 50–60% of infertility couples will conceive.”
Meldrum DR
1998
Meldrum DR
Slide 4

5. Causes & Treatments for Male Infertility
Talking Points
Treatment for men who have azospermia (no sperm) with inadequate gonadotropin levels includes injections of FSH and LH.
Men who have undergone surgical sterilization can have a vasectomy reversal.
Repairing a varicocele can treat oligospermia or abnormalities of sperm form or motility.
Reference
Nelson AL, Marshall JR. Impaired fertility. In Hatcher R, Trussell J, Stewart F, et al. (Eds.) Contraceptive Technology. 18th Revised Ed. New York, NY: Ardent Media, Inc.; 2004.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
Causes & Treatments for Male Infertility
Azospermia
Inject FSH and LH
Surgical sterilization
Reverse vasectomy
Impaired sperm motility
Repair varicocele
Nelson AL, Marshall JR
Slide 5

6. Main Causes of Female Infertility
Talking Points
Treatment for female infertility will also depend on the identified cause.
The main causes of female infertility include:
Ovulation disorders
Tubal abnormalities
Endometriosis
Other causes of female infertility include cervical or uterine factors or remain unexplained.
Reference
Nelson AL, Marshall JR. Impaired fertility. In Hatcher R, Trussell J, Stewart F, et al. (Eds.) Contraceptive Technology. 18th Revised Ed. New York, NY: Ardent Media, Inc.; 2004.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
Main Causes of Female Infertility
Ovulation
disorders
Tubal
abnormalities
Endometriosis
Nelson AL, Marshall JR
Slide 6

7. Treatments for Female Infertility
Talking Points
Treatment for female infertility due to ovulation disorders can include the following:
Maintenance of normal body weight. Being severely overweight or underweight can contribute to infertility problems
Clomiphene for women who have withdrawal bleeding with progestin challenge
Metformin for women with PCOS, to lower testosterone levels
Gonadotropin therapies for women with low estrogen levels who do not have withdrawal bleeding with progestin challenge
Laparoscopic ovarian drillling for PCOS patients who do not respond to clomiphene
Reference
Nelson AL, Marshall JR. Impaired fertility. In Hatcher R, Trussell J, Stewart F, et al. (Eds.) Contraceptive Technology. 18th Revised Ed. New York, NY: Ardent Media, Inc.; 2004.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
Treatments for Female Infertility
Maintain normal body weight
Clomiphene
Metformin
Gonadotropin therapies
Laparoscopic ovarian drilling
Ovulation
disorders
Tubal
abnormalities
Endometriosis
more…
Nelson AL, Marshall JR
Slide 7

8. Treatments for Female Infertility (continued)
Talking Points
Treatment for female infertility due to tubal abnormalities can include the following:
In vitro fertilization (IVF) to bypass the tubal abnormality altogether
IVF is combined with salpingectomy when tubal abnormality is due to PID or endometriosis.
Tuboplasty for tubal ligation reversal
Reference
Nelson AL, Marshall JR. Impaired fertility. In Hatcher R, Trussell J, Stewart F, et al. (Eds.) Contraceptive Technology. 18th Revised Ed. New York, NY: Ardent Media, Inc.; 2004.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
Treatments for Female Infertility (continued)
In vitro fertilization
With or without salpingectomy
Tuboplasty (tubal ligation reversal)
Tubal
abnormalities
Tubal
abnormalities
Endometriosis
more…
Nelson AL, Marshall JR
Slide 8

9. Treatments for Female Infertility (continued)
Talking Points
Treatment for female infertility due to endometriosis can include the following:
Laparoscopic ablation of endometriosis implants followed by intrauterine insemination with controlled hyperstimulation
In-vitro fertilization if simpler therapy isn’t successful
Reference
Nelson AL, Marshall JR. Impaired fertility. In Hatcher R, Trussell J, Stewart F, et al. (Eds.) Contraceptive Technology. 18th Revised Ed. New York, NY: Ardent Media, Inc.; 2004.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
Treatments for Female Infertility (continued)
Laparoscopic ablation
Intrauterine insemination with controlled hyperstimulation
In vitro fertilization
Endometriosis
Tubal
abnormalities
Endometriosis
Nelson AL, Marshall JR
Slide 9

10. Ovulation-Inducing Drugs: Clomiphene
Talking Points
Ovulation-Inducing Drugs: Clomiphene
Chemically stimulates the pituitary gland to produce hormones that trigger ovulation process
Usually 50mg/day for 5 days. A physician may increase the dose in increments in future cycles if ovulation does not occur; maximum does is usually 200mg daily.
Numerous side effects, including: Nausea, vomiting, visual problems, headache, insomnia, hot flashes, breast tenderness, heightened emotional sensitivity, painful ovulation, decreased menstrual flow
10% chance of twins
Reference
Harkness C. The Infertility Book. Berkeley, CA: Celestial Arts; 1992.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
Ovulation-Inducing Drugs: Clomiphene
Chemically stimulates pituitary gland to produce hormones that trigger ovulation process
Usual dosage: 50 mg/day for 5 days
Numerous side effects
May not be appropriate for patients with:
Large fibroid tumors
Ovarian cysts
Liver problems
more…
Harkness C. The Infertility Book
Slide 10

11. Ovulation-Inducing Drugs: Bromocriptine
Talking Points
Ovulation-Inducing Drugs: Bromocriptine
Reduces pituitary’s production of prolactin hormone
May not be appropriate for patients with pituitary tumors larger than 1 cm
2.5mg 1-3 times/day; however, this dosage is reached slowly and patients generally start at one-half a tablet (1.25 mg)/day
Side effects: Nausea, nasal stuffiness, dizziness, low blood pressure, headache
Reference
Harkness C. The Infertility Book. Berkeley, CA: Celestial Arts; 1992.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
Ovulation-Inducing Drugs: Bromocriptine
Reduces production of prolactin hormone
Dosage: 2.5 mg 1–3 times/day
Some side effects
May not be appropriate for patients with pituitary tumors >1 cm
Harkness C. The Infertility Book
Slide 11

12. Ovulation-Inducing Drugs
Talking Points
Ovulation-Inducing Drugs: hMG, FSH
Stimulates ovary to develop follicles; injection of human chorionic gonadotropin required
Controlled doses are given in ampules of 75–150 IU per day, given by injection
There is a 20-40% possibility of multiple births with these medications, as well as a small risk of hyperstimulation syndrome.
May not be appropriate in cases of pituitary tumor or ovarian cysts
Reference
Harkness C. The Infertility Book. Berkeley, CA: Celestial Arts; 1992.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
Ovulation-Inducing Drugs
Human Menopausal Gonadotropins (hMG)
Follicle-Stimulating Hormone (FSH)
Stimulate ovary to develop follicles
75–150 IU/day (with hCG)
20–40% possibility of multiple births
May not be appropriate in cases of pituitary tumor, ovarian cysts
more…
Harkness C. The Infertility Book
Slide 12

13. Ovulation-Inducing Drugs (continued)
Talking Points
Ovulation-Inducing Drugs: GnRH
Triggers normal pituitary hormonal activity so ovulation can occur
Effective in women with hypothalamic amenorrhea
Ovulation pump administers injections every 90 minutes
User has to carry pump attached IV tubing for 1-2 weeks or until ovulation occurs
No known physical side effects
Reference
Harkness C. The Infertility Book. Berkeley, CA: Celestial Arts; 1992.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
Ovulation-Inducing Drugs (continued)
Gonadotropin-Releasing Hormone (GnRH)
Triggers normal pituitary hormonal activity so ovulation can occur
Effective in women with hypothalamic amenorrhea
No known physical side effects
Ovulation pump administers injections every 90 minutes
User must carry pump with attached IV tubing for 1–2 weeks or until ovulation occurs
Harkness C. The Infertility Book
Slide 13

14. Endometriosis: Treatment with Surgery
Talking Points
Endometriosis: Pregnancy rates after surgical treatment
45–75% after Stage 1 or 2 endometriosis, if no impairment of the ovaries or tubes is present
Up to 60% for Stage 3 disease
35–48% for Stage 4 disease
References
Jennings VH, Lamprecht VM, Kowal D. Fertility awareness methods. In Hatcher RA, Trussell J, Stewart F, et al, eds. Contraceptive Technology, 17th Ed. New York, NY: Ardent Media, Inc.; 1998.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
Endometriosis: Treatment with Surgery
Pregnancy rates after surgery
45–75%
≤60%
35–48%
After Stage 1 or 2
Stage 3
Stage 4
Jennings VH, et al
Slide 14

15. Endometriosis: Drug Therapies
Talking Points
Endometriosis: treatment with drug therapies
Gonadotropin-releasing hormone (GnRH) agonists
Birth control pills
Danazol, but it has largely been replaced by GnRH therapy
Reference
Jennings VH, Lamprecht VM, Kowal D. Fertility awareness methods. In Hatcher RA, Trussell J, Stewart F, et al, eds. Contraceptive Technology, 17th Ed. New York, NY: Ardent Media, Inc.; 1998.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
Endometriosis: Drug Therapies
GnRH agonists
Birth control pills
Jennings VH, et al
Slide 15

16. Polycystic Ovarian Disease: Treatment
Talking Points
Polycystic ovarian disease: Treatment
Ovulation induction
Clomiphene
HMG, FSH, GnRH
Insulin sensitizers (e.g. metformin, rosiglitazone)
Medical treatment if pregnancy is not desired
Low dose oral contraceptives
Reference
Jennings VH, Lamprecht VM, Kowal D. Fertility awareness methods. In Hatcher RA, Trussell J, Stewart F, et al, eds. Contraceptive Technology, 17th Ed. New York, NY: Ardent Media, Inc.; 1998.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
Polycystic Ovarian Disease: Treatment
Ovulation induction
Clomiphene
HMG, FSH, GnRH
Insulin sensitizers (e.g. metformin, rosiglitazone)
Jennings VH, et al
Slide 16

17. ART Treatments for Infertility
Talking Points
A variety of ART have been developed to treat infertility that has not been successfully addressed using traditional treatments.
ART treatments include the following:
IVF with embryo transfer: The egg and sperm are retrieved from the couple or donors or some combination of both and are then combined in a Petri dish and incubated for 2 to 5 days. If fertilization and cleavage occurs, the embryo is transferred through a catheter to the uterus for the embryo to implant in the uterus. This treatment is best for fallopian tube disorders, unexplained infertility, peritoneal and male factors.
Gamete intrafallopian transfer (GIFT): Oocytes are retrieved via laparoscopy, and oocytes and sperm are placed in the same catheter and injected directly into the fallopian tube via laparoscopy. The embryo travels through the fallopian tube to the uterus for implantation.
Zygote intrafallopian transfer (ZIFT): Combines the techniques used in IVF and GIFT. The ova are placed in a Petri dish with sperm, and if fertilization occurs, the zygote is injected into the fallopian tube, travels through the tube to the uterus, and implants in the uterus.
Cryopreservation: Sperm or embryos are preserved by freezing for replacement in subsequent cycles.
Intracytoplasmic sperm injection (ICSI): A single sperm is injected directly into the cytoplasm of the oocyte. This procedure increases the probability of fertilization when there are abnormalities in the number, function, or quality of sperm.
References
American Society for Reproductive Medicine. Assisted Reproductive Technologies: A Guide for Patients. Birmingham, AL: American Society for Reproductive Medicine; Available at Accessed June 18, 2007.
American Society for Reproductive Medicine. Patient’s Fact Sheet: Intracytoplasmic Sperm Injection (ICSI). Birmingham, AL: American Society for Reproductive Medicine; Available at Accessed June 18, 2007.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
ART Treatments for Infertility
IVF with embryo transfer A
Gamete intrafallopian transfer (GIFT) R
Zygote intrafallopian transfer (ZIFT)
Cryopreservation T
Intracytoplasmic sperm injection (ICSI)
American Society for Reproductive Medicine
American Society for Reproductive Medicine
Slide 17

18. IVF with Embryo Transfer
Talking Points
IVF with embryo transfer:
The egg and sperm are retrieved from the couple or donors or some combination of both and are then combined in a Petri dish and incubated for 2 to 5 days.
If fertilization and cleavage occurs, the embryo is transferred through a catheter to the uterus for the embryo to implant in the uterus. This treatment is best for fallopian tube disorders, unexplained infertility, peritoneal and male factors.
Reference
Clapp DN. Assisted Reproductive Technology. Fact Sheet 33. Somerville, MA: RESOLVE: The National Infertility Association; 2002.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
IVF with Embryo Transfer 1
Egg and sperm are retrieved from couple, donor(s), or both 2
Combined in a petri dish, incubated for 2–5 days
If fertilization and cleavage occurs, embryo is transferred through a catheter to uterus 3
Clapp DN
Slide 18

19. Gamete Intrafallopian Transfer (GIFT)
Talking Points
Gamete intrafallopian transfer (GIFT):
Oocytes are retrieved via laparoscopy
Oocytes and sperm are placed in the same catheter and injected directly into the fallopian tube via laparoscopy
The embryo travels through the fallopian tube to the uterus for implantation
Reference
Clapp DN. Assisted Reproductive Technology. Fact Sheet 33. Somerville, MA: RESOLVE: The National Infertility Association; 2002.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
Gamete Intrafallopian Transfer (GIFT)
Oocytes retrieved via laparoscopy
Oocytes and sperm placed in same catheter
Injected directly into the fallopian tube via laparoscopy
Embryo travels through the fallopian tube to the uterus for implantation
Clapp DN
Slide 19

20. Zygote Intrafallopian Transfer (ZIFT)
Talking Points
Zygote intrafallopian transfer (ZIFT):
Combines the techniques used in IVF and GIFT
The ova are placed in a Petri dish with sperm
If fertilization occurs: the zygote is injected into the fallopian tube, travels through the tube to the uterus, and implants in the uterus
Reference
Clapp DN. Assisted Reproductive Technology. Fact Sheet 33. Somerville, MA: RESOLVE: The National Infertility Association; 2002.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
Zygote Intrafallopian Transfer (ZIFT)
Combines techniques used in IVF and GIFT 1
Ova are placed in a petri dish with sperm 2
If fertilization occurs, the zygote:
Is injected into fallopian tube
Travels through tube to uterus
Implants in uterus
Clapp DN
Slide 20

21. Talking Point
Cryopreservation: Sperm or embryos are preserved by freezing for replacement in subsequent cycles.
Reference
Clapp DN. Assisted Reproductive Technology. Fact Sheet 33. Somerville, MA: RESOLVE: The National Infertility Association; 2002.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
Cryopreservation
Sperm or embryos are preserved by freezing for replacement in subsequent cycles
Clapp DN
Photo source:
Slide 21

22. Intracytoplasmic Sperm Injection (ICSI)
Talking Points
Intracytoplasmic sperm injection (ICSI):
A single sperm is injected directly into the cytoplasm of the oocyte
This procedure increases the probability of fertilization when there are abnormalities in the number, function, or quality of sperm.
Reference
American Society for Reproductive Medicine. Patient’s Fact Sheet: Intracytoplasmic Sperm Injection (ICSI). Birmingham, AL: American Society for Reproductive Medicine; August Available at Accessed June 28, 2004.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
Intracytoplasmic Sperm Injection (ICSI)
A single sperm is injected directly into the cytoplasm of the oocyte
Increases probability of fertilization
American Society for Reproductive Medicine
Photo source:
Slide 22

23. ART Options for Same-Sex Couples
Talking Points
Although ART was developed to treat infertility, it has also offered new options in parenthood for same-sex couples.
For decades, single women, gays, and lesbians have made special arrangements to become parents and have created new forms of parental relationships with their children. ART has made these options more attractive, private, and feasible for many.
Same-sex couples may use a combination of their own and donor sperm and eggs through IVF and may also choose surrogacy.
ART has allowed single women and same-sex couples to parent biological children and in some cases to experience pregnancy and childbirth.
Reference
Bateman S. When reproductive freedom encounters medical responsibility: changing conceptions of reproductive choice. In: Vayena E, Rowe PJ, Griffin PD, eds. Current Practices and Controversies in Assisted Reproduction: Report of a meeting on “Medical, Ethical and Social Aspects of Assisted Reproduction.” Geneva, Switzerland: World Health Organization, September 17–21, Available at Accessed January 16, 2004.
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Original content for this slide taken from the Reproductive Health Model Curriculum, 2nd Edition [March 2004]. Original funding received from the John Merck Fund, the Mary Wohlford Foundation, the Naomi and Nehemiah Cohen Foundation, the William and Flora Hewlett Foundation, and Marjorie Braude, MD. Funding for the 2008 update received from Ferring Pharmaceuticals. Last reviewed/updated by Carolyn Coulam, MD, Elizabeth Grill, PsyD, and Karen Hammond, MSN, CRNP, in May This slide is available at
ART Options for Same-Sex Couples
Combination of their own and donor sperm and eggs through IVF
Surrogacy
Can parent biological children
Bateman S
Slide 23