• Classic IVF: in vitro fertilization. With in vitro fertilization, or IVF, a woman is given fertility drugs in order to produce a large number of eggs all at once. On the day of egg retrieval, the man provides a semen sample. The eggs are then removed from the mother by placing a needle through the vaginal wall and, using ultrasound to see the ovaries, drawing out the egg from each follicle. Intravenous pain medication or anesthesia typically is administered.
  
  The eggs are then brought to the lab and fertilized by the sperm. A few days later, some of the early embryos are taken from the incubator and placed into the woman's uterus through her cervix, in a procedure that feels similar to a Pap test. It is hoped that at least one of the embryos will implant and survive to produce a healthy baby. Embryos that are not used in the first attempt at implantation may be frozen for later use.



• GIFT and ZIFT. It took a lot of research to learn how to create embryos in the lab. The conditions and timing have to be just right. In some IVF programs, the eggs and sperm (often referred to as gametes) or the fertilized eggs (zygotes) may be placed directly into the fallopian tube, using a surgical telescope (laparoscope) through the mother's navel. This is called gamete intra-fallopian transfer (GIFT) or zygote intra-fallopian transfer (ZIFT), respectively.
  
  These procedures are used so that the woman's body provides the conditions for fertilization and early embryo growth and less dependence is placed on the lab conditions. Most IVF programs don't use these procedures anymore, since the standard IVF treatment produces such good results. GIFT may be used if religious considerations prevent the creation of an embryo outside of the woman's body.



• ICSI: intra-cytoplasmic sperm injection. ICSI has been an incredible breakthrough in the treatment of male infertility. With classic IVF, numerous functional sperm are needed to fertilize the egg. But in ICSI, only one sperm is needed for each egg. Many men with extremely low sperm counts or obstruction to sperm flow can produce the small number of sperm needed for ICSI.
  
  Under a microscope, one sperm is injected directly into each retrieved egg. The zygote is then incubated and subsequently transferred back to the woman's body like any other IVF embryo.



• Egg donation. A couple in which the woman has a uterus but doesn't have eggs--for example, due to premature menopause--or whose eggs aren't fertilizing well (for whatever reason), can obtain eggs from a donor and then carry the pregnancy herself. The egg donor takes fertility drugs to produce lots of eggs, just like the woman who participates in a classic IVF program. Once doctors retrieve the donor eggs and fertilize them with sperm in the lab, the early embryos are then placed in the egg recipient's uterus. This technique is used by many of the older women who are having children by IVF.



• The gestational carrier. A woman who either doesn't have a uterus or for medical reasons can't carry a pregnancy can still have biological children if she has eggs. In this case, the woman takes fertility drugs to make lots of eggs, which are then removed from her body and fertilized with her partner's sperm. Since the lab can't grow an embryo past the early stages, the embryo is then placed in the uterus of a gestational carrier (also known as a surrogate mother), who carries the pregnancy until birth. The legal lines are clearly drawn here: The baby belongs to the biological parents.
  
  For a couple in which the woman has neither a uterus nor eggs, the gestational carrier's eggs may be used and fertilized by the biological father's sperm (perhaps by artificial insemination), and then grown in the gestational carrier's uterus. However, when the gestational carrier is also the biological mother, "ownership" issues are more likely to arise, involving both legal and ethical considerations. That usually wouldn't be the case if the egg donor and the gestational carrier are two different people. For this very reason, most couples choose to use eggs donated by someone other than the gestational carrier.
  
  Many emotional, legal, and ethical considerations about surrogacy can create practical problems for the infertile couple and the other involved parties. But there are thousands of cases that don't make the news where these arrangements work very well and a couple gets to welcome a baby into the world and into their family who otherwise would never have been born.

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