Reproductive medicine covers a broad range of services designed to help people conceive, preserve their fertility, or diagnose conditions affecting reproduction. These services range from relatively simple procedures like insemination to complex lab-based techniques like IVF and genetic testing of embryos. Here’s what each major service involves and who it’s designed for.
Intrauterine Insemination (IUI)
IUI is typically the first procedure offered to couples dealing with fertility challenges. A processed sperm sample is placed directly into the upper uterine cavity, bypassing natural barriers that can slow or block sperm from reaching the egg. It works best for women under 35 with functional fallopian tubes, and for couples dealing with cervical factors, ovulation problems, mild to moderate male infertility, or unexplained infertility. Clinical pregnancy rates per cycle range from 10 to 20%.
IUI can be done with or without ovarian stimulation (medication to encourage the ovaries to release eggs). Most doctors recommend trying three to six IUI cycles before moving on to more advanced options. For women over 35, or those with severe male factor infertility, blocked tubes, or advanced endometriosis, a direct referral to IVF is usually more appropriate.
In Vitro Fertilization (IVF)
IVF is the most well-known assisted reproductive technology. The process starts with fertility medications that stimulate the ovaries to produce multiple eggs instead of the single egg released in a normal cycle. Your doctor monitors egg development with ultrasound imaging, then collects mature eggs using a thin needle guided through the vagina into the ovarian follicles. Those eggs are fertilized with sperm in a lab, and after the resulting embryos develop for several days, one is selected and transferred into the uterus.
A full IVF cycle, from the start of medication to embryo transfer, typically takes about two to three weeks of active treatment. Embryos that aren’t transferred during the initial cycle can be frozen for future use, which means you may not need to repeat the full stimulation and egg retrieval process if a second transfer is needed.
Intracytoplasmic Sperm Injection (ICSI)
ICSI is a specialized fertilization technique used during IVF. Instead of placing sperm and eggs together in a dish and letting fertilization happen on its own, an embryologist injects a single sperm directly into each mature egg. It was originally developed for severe male infertility, but it’s now used in a variety of situations: unexplained infertility, low egg yield, prior fertilization failure with standard IVF, use of frozen eggs, and cases where genetic testing of embryos is planned.
For unexplained infertility, ICSI produces fertilization rates around 65% compared to roughly 48 to 52% with conventional insemination. More importantly, total fertilization failure (where zero eggs fertilize) is over eight times more likely with conventional insemination than with ICSI. That said, pregnancy and live birth rates between the two methods end up similar in many studies, so the main advantage of ICSI is reducing the risk that a cycle produces no usable embryos at all.
Preimplantation Genetic Testing (PGT)
Genetic testing of embryos happens during an IVF cycle, before an embryo is transferred. A few cells are biopsied from each embryo and analyzed, and only embryos that pass screening are selected for transfer. There are three distinct types, each looking for something different.
- PGT-A (aneuploidy screening) checks whether an embryo has the correct number of chromosomes. Embryos with extra or missing chromosomes are the most common cause of miscarriage and failed implantation. Selecting embryos with the right chromosome count can improve pregnancy rates and reduce miscarriage risk.
- PGT-M (monogenic disorders) screens for a specific inherited disease that one or both parents carry, such as cystic fibrosis or sickle cell disease. The goal is to transfer only embryos that are unaffected or, in the case of recessive conditions, are healthy carriers.
- PGT-SR (structural rearrangements) identifies embryos with chromosomal rearrangements like translocations, deletions, or duplications. This is relevant for couples where one partner is known to carry a balanced chromosomal rearrangement, which can cause repeated miscarriages.
Fertility Preservation
Fertility preservation allows people to store reproductive cells or tissue for future use. The most common reasons include upcoming cancer treatment that could damage fertility, medical conditions requiring ovarian surgery, or simply wanting to delay childbearing for personal reasons.
Egg freezing (oocyte cryopreservation) follows the same stimulation and retrieval steps as the first half of an IVF cycle. After collection, eggs are rapidly frozen using a process called vitrification. When thawed later, about 78.5% of frozen eggs survive. Age at the time of freezing matters enormously: women who freeze eggs at 35 or younger have a live birth rate of approximately 52% per patient when they eventually use those eggs, while women who freeze at 40 or older see that rate drop to about 19%.
Sperm freezing is far simpler, requiring only a semen sample that is processed and stored. Ovarian tissue freezing is a newer option, sometimes used for young cancer patients who don’t have time for a full egg retrieval cycle before starting treatment. A small piece of ovarian tissue is surgically removed and frozen, then transplanted back after treatment is complete.
Third-Party Reproduction
When a person or couple cannot conceive using their own eggs, sperm, or uterus, third-party reproduction brings in a donor or carrier. Donor egg cycles follow the standard IVF process: the donor takes stimulation medication, her eggs are retrieved, and those eggs are fertilized with sperm from the intended parent or a sperm donor. The resulting embryo is then transferred to either the intended parent or a gestational carrier. Sometimes eggs from a single donor cycle are split among several recipients to share costs.
Gestational surrogacy involves a woman (the gestational carrier) who carries a pregnancy for someone else. The carrier has no genetic connection to the baby. The embryo is created through IVF using eggs and sperm from the intended parents or donors, then transferred to the carrier’s uterus. Sperm donation is the most straightforward form of third-party reproduction and can be used with IUI or IVF.
Reproductive Surgery
Some fertility problems are structural, meaning there’s a physical issue in the uterus or pelvis that needs to be corrected before conception can happen. Two minimally invasive surgical approaches are commonly used in reproductive medicine.
Hysteroscopy involves inserting a thin, lighted scope through the cervix to examine and treat conditions inside the uterus. It can remove polyps, fibroids (a procedure called hysteroscopic myomectomy), and uterine adhesions. Adhesions are bands of scar tissue, sometimes called Asherman’s syndrome, that can alter menstrual flow and cause infertility. Most hysteroscopic procedures are outpatient, with recovery measured in days rather than weeks.
Laparoscopy uses small incisions in the abdomen to insert a camera and surgical instruments, allowing doctors to diagnose and treat conditions like endometriosis, ovarian cysts, or blocked fallopian tubes. Both surgeries can be diagnostic (to identify a problem) or operative (to fix it in the same session).
Risks of Ovarian Stimulation
Any procedure involving fertility medication to stimulate the ovaries carries some risk of ovarian hyperstimulation syndrome (OHSS), a condition where the ovaries overreact and swell, sometimes causing fluid buildup in the abdomen. Moderate OHSS occurs in roughly 3 to 6% of IVF cycles, while severe OHSS affects 0.1 to 2%. The incidence has been declining in recent years thanks to updated medication protocols and the growing use of egg freezing strategies that allow doctors to avoid triggering ovulation with certain hormones. Your fertility team monitors your response to medication closely with blood tests and ultrasounds to catch early signs and adjust your treatment accordingly.