Many traditional infertility treatments are prohibitively expensive and often result in high risk pregnancies due to multiple fertilized eggs. However, a new and still experimental treatment called FASIAR (follicle aspiration, sperm injection, and assisted follicular rupture) may offer hope for infertile couples deterred by these issues.
"The new procedure falls mid-way between artificial insemination and the more high-tech IVF methods in terms of complexity, and we anticipate, in terms of efficacy," said Richard J. Paulson, professor and director of the Division of Reproductive Endocrinology and Infertility at University of Southern California, who developed the procedure. FASIAR may benefit "women who fail with insemination but are reluctant to go to the next level, to IVF, either because of the expense or for other personal reasons."
FASIAR begins as other ART (assisted reproductive technology) methods do, with the administration of fertility medications to stimulate egg development. However, just before ovulation, the doctor uses ultrasound to locate egg-containing follicles, and a thin needle to puncture the follicles and suction fluid and eggs into a syringe that already contains sperm. The sperm and egg mixture is then immediately injected back into the woman's body near the ruptured follicle, requiring the eggs to be outside her body for mere seconds. The procedure can be performed during a simple office visit with minimal discomfort for the woman.
Traditional ART procedures, such as insemination, rely on a woman's body to release eggs from her ovaries and for fertilization to occur on its own; but in some cases, eggs can be trapped in the ovaries or the woman's immune system can interfere with fertilization. FASIAR eliminates both of these obstacles by removing the eggs directly from the ovarian follicles and giving the sperm and egg ample opportunity to mix (although the woman's immune system may still prevent implantation). And if many follicles develop, the doctor can remove the extra eggs, thereby reducing the risk of a multiple pregnancy. According to Paulson, "It's simpler than IVF, which involves not only extracting eggs, but culturing the eggs in an embryology lab, and then transferring the fertilized egg back into the woman." Not only does this absence of lab time make FASIAR simpler, it also means the procedure is less expensive.
While preliminary data suggests that FASIAR may be twice as successful as insemination alone, the number of procedures performed is still too small to consider the data conclusive. In addition, the results have not been published in a peer-reviewed medical journal, meaning the research has not been critically evaluated. As a result, FASIAR is still considered experimental and very few clinics offer the procedure.