Assisted reproductive technology (ART) is used to address infertility problems among both men and women. ART is mainly associated with the field of reproductive endocrinology and infertility. Some forms of ART are also used with regards to fertile couples for genetic reasons such as preimplantation genetic diagnosis. The most common complication of ART arises in the case of multiple pregnancies. However, it can be prevented or reduced by limiting the number of embryos that are put into the woman's uterus. (1)

Process of ART

The process of ART involves surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s uterus or donating them to another woman. Assisted reproductive technology may not include treatments in which only sperms are handled such as intrauterine or artificial insemination or procedures in which a woman takes medicine only to stimulate egg production without the motive of having eggs retrieved. The most common and effective type of ART is IVF (In vitro fertilization). ART procedures may sometimes use donor sperms and eggs or previously frozen embryos. It may also involve a gestational carrier or a surrogate. A surrogate is one who agrees to carry and give birth to a baby for another person. In case of a gestational carrier, a woman becomes pregnant with the embryos formed using sperms from the male partner or with an egg from the female partner or with both. (2)

Different types of ART

Some of the common methods of ART include the following:

1. IVF (In Vitro Fertilization):

IVF is by far one of the most commonly used forms of ART. In Vitro Fertilization is a type of assisted reproductive technology used for treating infertility and gestational surrogacy. The process of IVF involves stimulating and monitoring a woman's ovulatory process, removing an ovum or ova (egg or eggs) from the woman's ovaries and letting sperm fertilize them in a liquid in a laboratory. After the fertilized egg undergoes embryo culture for two to six days, it is implanted in the same or another woman's uterus, with the intention of establishing a successful pregnancy. A fertilized egg may be implanted into a surrogate's uterus, where the resulting child is genetically unrelated to the surrogate mother. Some countries have banned or otherwise regulated the availability of IVF treatment, giving rise to fertility tourism. Restrictions on the availability of IVF include age and costs, in order for a woman to carry a healthy pregnancy to term. In Vitro Fertilization is generally used in cases when invasive or expensive options have failed or been determined unlikely to progress. IVF is often used in for women whose fallopian tubes are blocked. Sometimes multiple embryos may develop, which can be frozen for use in later transfer procedures. (3)

2. Gamete Intrafallopian Transfer (GIFT)

GIFT was launched as a more ‘natural’ version of In Vitro Fertilization (IVF). In this method, instead of fertilization occurring in a culture dish in a laboratory, eggs are retrieved from the ovaries and inserted between two layers of sperm in fine tubing. This tubing is then fed into one of the woman’s fallopian tubes, where the egg and sperm are left to fertilize naturally. GIFT may be used as an option for couples who do not want to use IVF but avoid conception outside the body. The eggs are harvested and stimulated in a similar fashion to IVF. With the increasing success rate of In Vitro Fertilization (IVF), GIFT is rarely done nowadays. (4)

3. Intracytoplasmic Sperm Injection (ICSI)

ICSI is a special form of In Vitro Fertilization technique that helps in the formation of an embryo by injecting a single sperm directly into the mature egg or ovum. ICSI is useful in the preparation of sperms and formation of embryos which are finally transferred into the uterus or fallopian tube. ICSI is often used for couples when there are serious problems with the sperms. Sometimes it may also be used for older couples or for those with failed IVF attempts. (5)

4. Artificial Insemination( IUI)

Artificial insemination (AI) is also known as Intrauterine Insemination (IUI). Artificial Insemination (AI) involves the deliberate introduction of sperms into a female's cervix or uterine cavity for the purpose of achieving a pregnancy. Artificial Insemination comes under ART (Assisted Reproductive Technology) and may employ sperm donation techniques. Some of the available AI (Artificial Insemination) techniques include intracervical insemination and intrauterine insemination. The main beneficiaries of Artificial Insemination are single mothers, women who are in a lesbian relationship or women who are in a heterosexual relationship but with a male partner who is infertile. Intracervical Insemination (ICI) is one of the easiest and most common AI (Artificial Insemination) techniques that can be used at home for self-insemination without the assistance of a medical practitioner. If a pregnancy is not achieved after a few Artificial Insemination attempts, the use of IVF or ICSI may be recommended. (6)

5. Ovulation Induction (OI)

Ovulation Induction (OI) is the stimulation of ovulation by medication. Ovulation Induction (OI) may be used by women who are not ovulating at all or are not ovulating regularly. Ovulation Induction involves taking a hormone medication such as a tablet or injection, which stimulates the production of follicle-stimulating hormone. This induces the development of one or more follicles. When the follicles are large enough, another hormone is administered which helps in releasing egg from the follicle. If the couple has intercourse around this time, there are more chances of conception. (7)

6. Pre-implantation genetic diagnosis

A pre-implantation genetic diagnosis procedure may be conducted on embryos before implantation and sometimes even on oocytes prior to fertilization. One of the main advantages of conducting PGD is that it avoids selective pregnancy termination as the technique makes it highly likely for the baby to be free of the disease under consideration. PGD is an addition to ART procedures and requires In Vitro Fertilization to obtain oocyte or embryos for evaluation. Preimplantation genetic diagnosis (PGD) is also used to reduce the risk or avoid transmission of a chromosomal abnormality or a genetic disease. PGD can be useful for couples who have a family history of a genetic disease or chromosomal abnormality that they risk passing on to their children. It is also useful when there are repeated miscarriages or repeated IVF failure or for women over 36-38 years of age. (8)

Risk of ART

Some of the risks associated with ART are as follows:

An increased risk for medical complications with both the mother and baby such as low birth weight, placental insufficiency, chromosomal disorders, preterm deliveries, gestational diabetes, and pre-eclampsia

Risk of heterotopic pregnancy (simultaneous intrauterine and extrauterine pregnancy)

Genetic disorders and preterm birth (visual impairment and cerebral palsy)

Membrane damage (9) (10)

Nowadays, ART may also be used in surrogacy arrangements, although not all surrogacy arrangements involve ART. This method is most suitable for people who have already gone through various infertility treatment options but who still have not achieved pregnancy.

For more information on IVF and fertility treatments, you can follow OVO Fertility blog. If you are looking for treatments like IVF, ICSI, and IUI, OVO Fertility can help you in finding the best doctors according to your needs and fixing appointments. You can contact us at +918268260808.