Assisted Reproductive Technology (ART) is a series of complex procedures and treatments that aim to achieve pregnancy. These procedures are an option for people who are struggling with infertility or who might have tried other infertility treatments without getting pregnant.
According to the Center of Disease Control and Prevention (CDC), ART includes all fertility treatments in which either eggs or embryos are handled. The National institute of health (NIH) defines ART as a procedure that is used to help people conceive and could include the use of donor eggs, donor sperm, or previously frozen embryos.
In general, ART is used to treat infertility in couples who are unable to get pregnant or those who have already undergone other fertility treatments but have had no success with pregnancy. The CDC estimates that about 330,000 ART cycles are performed yearly in about 450 fertility clinics in the United States. The numbers doubled over the last decade and are steadily increasing. About a third of these completed ART cycles (124,000) involved previously frozen eggs and embryos.
Over the past few years, ART cycles have resulted in approximately 80,000 live infants, which represent about 2.1% of all infants born in the U.S. every year. Although babies born via ART represent a small portion of babies born yearly in the U.S., ART accounts for about 10.6% of multiple pregnancies – pregnancy with more than one fetus, such as twins, triplets, etc.
Types of Assisted Reproductive Technology
The three major types of assisted reproductive technology include intrauterine insemination (IUI), In Vitro Fertilization (IVF), and third-party assisted ART.
Intrauterine Insemination (IUI)
IUI is the placement of sperm directly into the uterus with a long, thin device. IUI can be used in combination with fertility drugs that stimulate ovulation. IUI can be performed as often as monthly with a success rate of up to 20% depending on the age of the female partner, the type of infertility, and whether or not fertility medications are used. IUI is typically effective for men with low sperm count or low motility. It is also beneficial in situations where a couple are unable to have intercourse for various reasons, or where the man cannot get an erection. Women who have cervical defects or scarring have also found IUI treatments effective.
In Vitro Fertilization (IVF)
IVF is the most common and most effective type of ART. The first step of IVF is superovulation or ovarian induction where a woman is given medications to stimulate the ovaries to make multiple mature eggs at the same time. Then the eggs are surgically removed from the woman’s ovaries and fertilized with sperm in a laboratory to produce an embryo. The fertilized egg is then injected into the uterus from the vagina using a long narrow tube. The injected/transferred embryo typically implants within a week to ten days of being injected into the uterus. Most women time IVF implantation for when they are ovulating to increase the chances of pregnancy. Estrogen and progesterone medication can also be used to stimulate and prepare the uterine lining for embryo implantation. Sometimes, a woman’s prior frozen eggs are used in the IVF process.
Third Party-Assisted ART or Reproduction
This is when a person or couple is unable to get pregnant from traditional ART or other fertility treatments and opts for help that might include egg donation, sperm donation, embryo donation, use of surrogate carriers, or use of gestational carriers. It refers to involving someone else other than the intended parents. Third party reproduction can be emotionally, ethically, legally, and socially complex.
For persons or couples choosing to use a third party for reproduction, egg and sperm donation is often an option when the man’s sperm is insufficient or the woman’s egg cannot be fertilized for many reasons. Depending on the couple’s fertility issues, a donated egg can be fertilized by sperm from the woman’s partner and then injected into the partner looking to get pregnant. Alternatively, a donated sperm can be used to fertilize the woman’s eggs through IUI or IVF.In situations where a woman is unable to carry a pregnancy to term, she can opt to use a traditional surrogate or gestational carrier. Surrogacy is an agreement, often legally-binding, where a woman (a surrogate) agrees to bear a child on behalf of another person or people who will become the child’s legal parents after birth. Basically, surrogacy is where a woman carries the pregnancy for another couple.
A traditional surrogate
Something I am sure most of us are familiar with, a traditional surrogate is a woman artificially inseminated with the sperm of the baby’s father or sperm from a donor. A surrogate is biologically related to the baby. A surrogate is often used when the female cannot produce enough eggs to be harvested for fertilization. Surrogacy is also referred to as a traditional gestational carrier.
A gestational carrier
A little different from a traditional surrogate in that a woman is impregnated with a fertilized embryo (egg and sperm) from a couple or from egg/sperm donors. This is typically an option for women who produce healthy eggs but cannot carry the baby to term. A gestational carrier has no biological relationship with the baby, which makes it a preferred option for most parents looking for third party-assisted ART.
Another type of third party-assisted ART. This method allows a recipient mother to adopt an embryo, get pregnant, and give birth to her child. This is typically an option when IVF has failed, couples are looking for other alternatives to ART, or there is concern about passing on some genetic abnormalities to the child. The adopted embryos are typically donated from a couple who might have frozen their embryo but now have completed their family and do not want any more kids.
Risks of Artificial Reproductive Technology
Assisted reproductive technology can be emotionally, physically, and financially challenging. It can be frustrating and isolating, especially with failure in any ART cycle. Couples who plan to use ART should consider psychological counseling for emotional support, anxiety management, and stress management.
Apart from the psychological considerations for ART, the procedure can also cause some medical complications including ovarian hyperstimulation and multiple pregnancies with associated health risks. According to the American College of Obstetricians and Gynecologists (ACOG), multiple/multifetal pregnancy is the highest risk of ART and efforts should be made to achieve a singleton gestation. Women who undergo ART treatment are more likely to have multiple-birth deliveries compared to women who get pregnant naturally. This is because ART sometimes involves transferring more than one embryo with the hope of at least one becoming viable and leading to a successful pregnancy and birth. The American Society of Reproductive Medicine (ASRM) and the Society of Assisted Reproductive Technology also advocate for single-embryo transfer (SET) where feasible and when the woman is younger than 35 years old. About 83.2% of all ART infants are singletons, while about 16.8% are multiples.
Multiple pregnancy poses a risk to both mother and child. About 60% of all twins are premature, and the higher the number of fetuses being carried by the woman, the more preterm the baby will be born. Premature babies, especially very premature babies, are often born before their organs have completely developed and may need care in a neonatal intensive care unit.
Other complications of multiple pregnancy include preterm labor and birth, abnormal amount of amniotic fluid, anemia, cesarean delivery, birth defects, miscarriage, low birth weight, preeclampsia (severe and potentially fatal hypertension), gestational hypertension, placental abruption, postpartum hemorrhage/bleeding, birth defects, and twin-to-twin fusion (rare but serious condition that can be fatal to one or both twins).
Considerations for Artificial Reproductive Technology
Prior to initiating ART or any fertility treatment, the doctor will complete a thorough medical examination to make sure the woman is healthy enough to undergo the process. Where applicable, the doctor may treat any medical conditions that could interfere with the ART process as well as discuss any genetic conditions that might be passed on to the offspring. Since the goal of assisted reproductive technology is to have the best possible pregnancy outcome, the patient and doctor should discuss multifetal reduction or other plans for ensuring the safety of the mother and fetuses in multiple pregnancy, especially in triplets and more. If a mother chooses to carry the multiple pregnancy to term, they should be referred to a doctor or facility equipped to handle a pregnancy with multiple fetuses.
Lifestyle issues should also be reviewed and addressed prior to starting any ART procedure. Alcohol, use of recreational drugs, some medications, excessive caffeine, smoking, and obesity can reduce the effectiveness of ART. Women who are thinking of ART should take a daily dose of 400 mcg of Folic Acid to reduce the chances of neural birth defects such as spina bifida, which happens before most women even know they are pregnant.