Assisted Reproductive Technology (ART), also referred to as assisted reproduction or assisted conception, can be defined as the set of techniques and medical treatments that allow individuals and couples to start a family when it cannot be achieved naturally due to infertility problems.
Nowadays, between 12% to 18% of couples willing to create a family suffer from infertility, with 50% of the cases due to male factor infertility, and the remaining 50% caused by female infertility. It can also occur that both members of the couple are childless.
There exist another group that has no alternative but to turn to fertility treatment to have babies: single males and females, as well as same-sex couples.
Currently, the main fertility treatments available for these patients to fulfill their dreams are, on the one hand, intrauterine insemination (IUI) and in vitro fertilization (IVF), which can be combined with other options such as third-party reproduction, also known as donor-assisted reproduction, or PGD (Preimplantation Genetic Diagnosis).
The different sections of this article have been assembled into the following table of contents.
Meaning of 'Assisted Reproductive Technology'
The term Assisted Reproductive Technology, which medical abbreviation is ART, and is often referred to as medically assisted reproduction, assisted conception of fertility care, can be defined as the set of techniques and procedures that replace the natural process of conception.
The types of methods used depend on the what is causing infertility, and the type of infertility the patient suffers from. Broadly speaking, with assisted reproduction we can intervene at any point of the reproductive process, being the following the most common ones:
- Development of ovarian follicles
- Transportation of human gametes: egg and sperm cells
- Fertilization: when sperm meets the egg
- Selection of high-quality embryos
To overcome the barriers that can be found naturally in any of the processes listed above, we use fertility medications in combination with different methods, such as IUI and IVF. Moreover, there exists another method that provides even higher success rates: Intracytoplasmic Sperm Injection (ICSI).
To date, great advancements have been achieved in the field of assisted reproduction, to the point that today patients can have access to donated eggs and sperm in case they are unable to have biological children when they are at risk of transmitting a disease or because they lack gamete production function.
Obviously, a major benefit associated with infertility treatment is that, for some people, it is the only way to overcome infertility and/or sterility. In other words, it gives families who are unable to achieve so naturally the chance to have a child.
Also, IVF makes it possible for us to select the best embryos, with the best chances to implant. This makes it for the woman to be more likely to become pregnant than she would have been naturally, and also to select out embryos that carry genetic diseases or abnormalities.
One very-well known drawback of IVF procedures is the fact that the patient has to take fertility drugs, with the subsequent side effect and risks associated.
Although medications for ovarian stimulation help the woman be "more fertile", the main disadvantage is that it increases the risk of getting pregnant with twins. Also, common side effects include headaches, mood swings, hot flushes, or even ovarian cysts.
On the other hand, a major con associated with fertility procedures is the cost involved, as it is uncommon that they are covered by health insurance in the majority of the cases.
History of assisted human reproduction
Until late 20th Century, people who experienced trouble with fertility had to resign or turn to adoption if they wanted to become parents.
After 1978—year in which Louise Brown, the first «test-tube baby», was born—everything changed and assisted reproduction became the perfect solution for childless people.
The technique used was IVF. An egg was taken from the mother and its union with the sperm took place in a plate at the laboratory. After that, the resulting embryo was cultured until it divided into four cells, and then it was transferred back for implantation in the intended mother's womb.
The success of the first IVF cycle led to the development of the set of techniques that are now commonly known as assisted reproduction.
At the beginning, the estimated chances of success were rather low, but they were further improved over the years, since a greater number of well-trained professionals in the field of reproductive medicine were incorporated progressively. Nowadays, thousands of children are born year after year thanks to assisted reproduction techniques.
Recently, Louise Brown has had children of her own naturally, which has proved that the use of assisted reproduction for conceiving a child does not translate into the baby born as a result being childless by default.
When to go see a fertility specialist
For a couple to be diagnosed with infertility or sterility problems, firstly at least one year of unprotected intercourse without success in achieving a pregnancy is necessary. This period of time is usually shortened to 6 months when the woman is aged 36 years or over. In cases where infertility is manifest, as when uterine malformations are present, these guidelines have no sense.
In these cases, couples are recommended to visit a fertility clinic to undergo a fertility evaluation firstly, and learn about the potential causes that are preventing them from having a child.
What follows is a summary of the most common infertility or sterility problems that make conception difficult or prevent it:
- Male infertility
- poor sperm quality or zero sperm count.
- Female infertility
- alterations in the menstrual cycle, diminished egg quantity and/or quality, and problems that affect embryo implantation or the normal development of the embryo.
Should there exist a disease that could lead to the birth of an ill baby, couples are recommended not to try to conceive naturally, and rather visit a fertility clinic to have a genetic screening done.
Regarding single males and females, lesbian couples, or gay couples, they are advised to get as much information as possible beforehand about their options according to the regulations governing assisted conception in their countries, and use it whenever it is possible.
Types of assisted reproduction techniques
The main goal of assisted reproduction in humans is to achieve a successful pregnancy that leads to the birth of a healthy baby.
Progress made in reproductive sciences, along with the emergence of new technologies, allows the continuous growth in number of assisted reproduction techniques, while at the same time helps improve the existing protocols and methods.
Artificial insemination and in vitro fertilization are the most widely used assisted reproduction techniques, each one of them with a series of advantages and disadvantages that one should be aware of.
The use of one technique or another depends on the existing type and cause of infertility, as well as on medical recommendations. Fertility specialists will always try to use the simplest and least invasive method in the first place.
If the expected chances of getting pregnant are lower than normal for a particular case, or if a pregnancy has not been achieved after several attempts, you will be encouraged to move to another technique.
Artificial Insemination (AI)
It is the fertility treatment involving the lowest complexity, and the most similar one to natural conception. It involves the insertion of sperm directly into the female reproductive system, usually in the womb, to ease make it easier for the sperm to reach the egg in the Fallopian tube, as it happens when pregnancy is achieved naturally.
Intrauterine insemination (IUI) can be done using the husband's sperm (AIH) or donor sperm (AID), which means that both opposite-sex and same-sex couples, as well as single females, can benefit from this fertility treatment.
This reproductive method requires a low degree of complexity, and involves three basic steps:
- Ovarian stimulation to trigger follicle growth, and ovulation induction
- Preparing the semen sample in the lab
- Inserting the sample with a catheter to inseminate the patient
To learn more about IUI, see also: Artificial insemination (AI): process, cost and types.
In Vitro Fertilization (IVF)
This assisted reproductive technology involves fusing an egg cell with a sperm cell in the laboratory. The resulting embryo is then transferred back to the uterus of the patient. Contrary to what happens with IUI, IVF is considered a fertility treatment of high complexity.
There exist two types of IVF depending on fertilization process followed at the lab:
- Classical IVF
- the egg comes into contact with the sperms in a culture plate so that fertilization occurs without manipulation.
- a sperm is selected and inserted into the egg cell with an injection needle.
In both cases, the IVF procedure involves the following steps:
- Controlled ovarian stimulation (COS) so that multiple eggs mature in a single cycle
- Follicle puncture (ovum-pick up) to collect the eggs produced from the ovary
- Preparation of the semen sample at the laboratory
- Fertilization in the laboratory (by means of classical IVF or ICSI)
- Embryo culture and development
- Embryo transfer into the patient's womb
The sperm used in IVF procedures can be donated by either the husband/partner or a sperm donor. And the same applies in the case of the oocytes: if the patient is unable to use her own egg cells, egg donation might be an option.
Learn more about the IVF process, its success rates and more in the following post: What is in vitro fertilization (IVF)?
Lesbian couples can also benefit from IVF in spite of the absence of a male partner by an exclusive method called reciprocal IVF. It consists in using the eggs of one member of the couple, and transferring the resulting embryos to the other woman. By doing this, both women can participate actively in the journey towards having a baby: one as the genetic mother, and the other as the birth mother.
Preimplantation Genetic Diagnosis (PGD)
Nowadays, the wide range of options available to deal with infertility issues allows also for the use of methods for testing the genetics of embryos in combination with IVF. This technique is known as preimplantation genetic diagnosis (PGD), and involves the removal of some cells from the embryo for a biopsy. It allows us to identify the presence of chromosomal alterations, or to discover whether there exists any genetic alteration.
With PGD, the specialist can select only those embryos that are genetically healthy, and use them for the embryo transfer to the patient's womb.
Get more info about this advanced technique by visiting this post: What is PGD or Preimplantation Genetic Diagnosis?
Surrogacy or surrogate motherhood, commonly referred to as womb for rent or womb to rent, is another infertility treatment that involves a woman (the gestational carrier or surrogate), who carries someone else's child.
This fertility option is recommended for the following family types:
- Opposite-sex couples who cannot have a child naturally as a consequence of uterine problems, or after several failed IVF attempts.
- Lesbian couples and single females who cannot carry a pregnancy to term for the same reasons.
- Gay couples (man and man) and single males who wish to have a biological child.
The ethics of surrogacy have been widely questioned, especially in the field of bioethics. For this reason, there are still many countries where the law expressly forbids its application.
Those who have no alternative but to use a surrogate to have offspring often choose to travel abroad to undergo surrogacy there, given that it is prohibited in their home country.
We recommend that you read the following post to learn about this phenomenon: IVF treatment abroad: costs, benefits and best countries.
How much does ART cost?
The cost if infertility treatments depends mainly on the technique used, the country, and the fertility clinic chosen.
On average, the price of intrauterine insemination (IUI) can start at $700 and can come to $1,600, while the costs of IVF can range from $3,500 to $5,000.
It should be noted that, if you are carrying your IVF treatment in the United States, the cost might be even higher, as the healthcare system is privately funded. Moreover, fees can vary by state. So, broadly speaking, the cost of IVF can be as high as $10,000-$20,000.
The rates mentioned above can increase if additional procedures are needed, such as PGD or egg and/or sperm donation. For this reason, we strongly recommend that you ask various clinics for estimates or detailed quotes to find out what is included and what is not.
If you need to undergo IVF to become a mother, we recommend that you generate your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.
The cost of fertility drugs is not usually included in the general quote for fertility treatments. So, you should keep in mind that you will have to add them to your budget.
Some clinics and agencies collaborate with medical insurance companies that can help you to reduce the costs associated with your treatment. In some countries such as the UK, some patients can get IVF treatment on the NHS.
The fact that infertility started to became more common in our society a few decades ago translated into the need for solutions from fields of medicine, and that is how reproductive medicine was born.
The creation of ways to solve infertility issues came hand in hand with the establishment of new policies to regulate the use of fertility treatments with the goal of ensuring that their use is based on moral and ethical grounds.
New methods available nowadays, along with new family types, have forced our society to expand the definition of family as a concept. To date, it was defined as a structure made up of a father, a mother, and one or several children. There is no need for a blood relation to exist anymore, as in the case of adopted children, thanks to egg, sperm, and embryo donation.
IVF and PGD in particular have created a broad discussion concerning the beginning of human life, and the moral and ethical implications derived from the manipulation of human embryos. Religious beliefs, cultural traditions, and social perspectives play a major role in this.
FAQs from users
IVF pregnancy vs. natural pregnancy, is there any difference?
There exist no differences between a natural pregnancy and a pregnancy that has been achieved using reproductive technologies such as IVF. After the embryo transfer, fetal development will be the exactly the same.
Neither the risk of malformations nor the risk of miscarriage increase when using a fertility treatment. Some studies have discovered a slightly higher risk of preterm birth or low birth weight. Anyway, these complications do not seem to be directly linked to the use of fertility treatments, but with the cause of infertility: women aged 40 or older, uterine anomalies and other pathologies... This type of pregnancies must be monitored very closely.
Why is assisted human reproduction an ethical issue?
ART can raise a number of ethical challenges for the individuals involved, especially when third-party reproduction is involved. This is basically due to the fact that infertility treatments give raise to new definitions of parents and children—the so called new family types. In this sense, decisions about family building can become rather complex. Also, the manipulation of embryos has been a quite controversial debate from the very beginning.
What are the potential risks associated with assisted reproductive technology?
There is an increased risk of multiple births, especially with multiple-embryo transfers. This can occur with IUI if multiple eggs are produced in a single cycle as well.
To date, no study has confirmed that the use of assisted reproductive treatments increases the risk of fetal malformation, children born with diseases such as autism or other anomalies, etc. Apparently, no substantial differences with a natural pregnancy can be found.
What is assisted reproductive treatment?
Assisted reproductive treatment, officially known as Assisted Reproductive Technology (ART), refers to the set of fertility treatments that allow childless patients who are unable to have a child naturally achieve pregnancy.
What assisted reproduction techniques take place in the lab?
Except for timed intercourse, the rest of assisted reproduction techniques take place outside the woman's body, in the lab. IUI, IVF, IVF/ICSI, PGD... In the case of IUI, even though fertilization occurs inside the patient's body, the lab is necessary for the semen sample to be prepared (sperm capacitation).
When was intracytoplasmic sperm injection first used?
The first child conceived thanks to the use of IVF/ICSI was born in January 14, 1992, after being conceived in April 1991. However, the first baby born from gamete micro-manipulation was a child in Singapore (1989).
When is IVF recommended?
IVF can be used in cases of either male and female infertility, depending on what is causing infertility. In the case of male infertility, men are referred to IVF treatment in cases of oligozoospermia, teratozoospermia, asthenozoospermia, cryptozoospermia, or a combination of all these pathologies.
As for female infertility, several factors can lead to the use of IVF with the purpose of achieving pregnancy, including problems with ovulating, tubal factor infertility, endometriosis, uterine factor infertility, and cervical factor infertility.
Suggested for you
You can learn more about the details of each infertility treatment and the costs associated by visiting this post: Guide to infertility treatments.
Also, if you want to learn more about the concepts of infertility, sterility, and subfertility, you are invited to delve deeper into it by reading this interesting article: What is the difference between infertility, sterility and subfertility?
Finally, we have made reference here to third-party reproduction, but... do you know what does it exactly refer to and what is involved? Learn about it with our comprehensive guide: Definition, costs, and options for third-party reproduction.
Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.
The ESHRE Capri Workshop Group. Intrauterine insemination. Human Reproduction. 2009; 15 (3): 265 -277.
Hull MG, Glazener CM, Kelly NJ, Conway DI, Foster PA, Hinton RA, Coulson C, Lambert PA, Watt EM, Desai KM. (1985). Population study of causes, treatment, and outcome of infertility. Br Med J (Clin Res Ed); 291(6510):1693-7
Jones H. W. and Schrader C. (1988). In-Vitro Fertilization and Other Assisted Reproduction. Annals of The New York Academy of Sciences, Vol. 541, New York.
Pellicer A, Alberto Bethencourt JC, Barri P, Boada M, Bosch E, Hernández E, Matorras R, Navarro J, Peramo B, Remohí J, Riciarelli E, Ruiz A y Veiga A. Reproducción Asistida. En: Documentos de Consenso SEGO 2000:9-51.
Santamaría Solís, L. (2000). Técnicas de reproducción asistida. Aspectos bioéticos. En: Cuadernos de Bioética 2000/1ª. Asociación Española de Bioética y Ética Médica (AEBI).
Sociedad Española de Fertilidad (SEF) (febrero de 2012). Saber más sobre fertilidad y reproducción asistida. En colaboración con el Ministerio de Sanidad, Política Social e Igualdad del Gobierno de España y el Plan de Calidad para el Sistema Nacional de Salud.
WHO Laboratory Manual of Examination of Human Semen and Semen-Cervical Mucus Interaction. Cambridge: Cambridge University Press, 1999.
WHO Manual for standardized investigation and diagnosis and management of the infertile male. Cambridge: Cambridge University Press, 2000.
Zegers-Hochschild F. et al. (2010). Glosario de terminología en Técnicas de Reproducción Asistida (TRA). Versión revisada y preparada por el International Committee for Monitoring Assisted Reproductive Technology (ICMART) y la Organización Mundial de la Salud (OMS). Red Latinoamericana de Reproducción Asistida en 2010. Organización Mundial de la Salud 2010.
FAQs from users: 'IVF pregnancy vs. natural pregnancy, is there any difference?', 'Why is assisted human reproduction an ethical issue?', 'What are the potential risks associated with assisted reproductive technology?', 'What is assisted reproductive treatment?', 'What assisted reproduction techniques take place in the lab?', 'When was intracytoplasmic sperm injection first used?' and 'When is IVF recommended?'.