By Andrea Rodrigo BSc, MSc (embryologist), Dr. Ana Mª Villaquirán Villalba MD, MSc (gynecologist) and Blanca Paraíso MD, PhD, MSc (gynecologist).
Last Update: 10/06/2016

Assisted Reproductive Technology (ART) refers to a set of techniques used for the purpose of achieving a pregnancy by addressing fertility problems. Even though the characteristics of each infertility treatment vary, all of them have something in common: the manipulation of egg and sperm cells (gametes).

Main fertility methods

The most common fertility treatments are:

To these basic fertility treatments, we should add other methods that altogether bring closer the possibility of achieving parenthood/motherhood to patients who cannot have a baby naturally.

We are talking about egg and embryo vitrification, sperm cryopreservation, preimplantation genetic diagnosis (PGD), egg and/or sperm donation, embryo donation and adoption, embryo culture and surrogacy.

Artificial insemination (AI)

Artificial insemination is not only a simple infertility treatment which involves little risks, but a quick, painless and simple technique. A semen sample is placed inside the female’s uterus by passing a cannula through the cervical canal when the woman is ovulating.

For artificial insemination to be successful, the patient should meet the following requirements:

  • Tubal patency, that is, functioning Fallopian tubes.
  • Sperm quality: The general recommendation is to have a sperm concentration of above 3-5 million spermatozoa with progressive motility per milliliter.
  • Maternal age: AI is unadvisable for women at 36 or older, as egg quality is lower at this point.
  • Normal ovarian function: Having normal reserve levels and regular menstrual cycles is essential.

Two options are available when it comes to undergoing AI: artificial insemination by husband (AIH) and artificial insemination by donor (AID). In both cases, semen samples are previously washed via sperm capacitation, which helps select only the sperms with the highest quality. Also, mild ovarian stimulation is required so that ovulation can be monitored, thereby increasing the chances for pregnancy.

Should you need more information about this method, please visit this post: Definition of artificial insemination (AI).

In vitro fertilization (IVF)

In vitro fertilization or IVF involves a series of complex steps, including procedures that are undertaken in the laboratory or the operating room. Moreover, it is associated with certain risks and side effects.

It is used to deal with infertility in those cases where AI is expected to be or has been unsuccessful.

The first step is to collect the eggs and the sperms for fertilization to take place at the laboratory. Secondly, the new embryos are transferred to the patient’s womb, waiting for them to be able to attach. It can be done using the egg cells produced by the woman or, conversely, from an egg donor.

Broadly speaking, the following is a step-by-step summary of the IVF process:

  • Ovulation induction: Drugs to induce ovulation are administered to the patient in order to trigger egg production and monitor the menstrual cycle.
  • Ovum pick-up: With this surgical intervention, the eggs that have developed are removed from the patient’s ovary.
  • Sperm capacitation: In this phase, the semen sample is collected for being analyzed and washed, so that it is ready to fertilize the egg. This process is known as sperm capacitation.
  • Egg insemination: This step can be defined as fertilization itself, that is to say, here takes place the sperm-egg binding.
  • Embryo culture: Once fertilization has occurred, embryo development is monitored.
  • Embryo transfer: Best quality embryos are selected to be inserted into the woman’s uterus, waiting for them to implant into the endometrium. The endometrium should have been previously prepared through hormone therapy.
  • Embryo cryopreservation: High quality embryos that haven’t been transferred can be frozen (cryopreservation) to be used in further fertility treatments.

If you need to undergo IVF to become a mother, we recommend that you use "The Calculator". 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.

Also, the report will inform you about the promotions or special prices that the clinics selected offer so you can benefit from them as well.

Difference between ICSI and IVF

As stated earlier, there exist two types of IVF: conventional IVF and ICSI. The difference between them both is the way in which the egg is fused with the sperms. The remaining steps, however, work exactly the same.

  • Conventional IVF: The egg and the spermatozoa are put together in the same culture medium. Just one sperm will be able to penetrate the egg coat and get inside the egg.
  • ICSI: It stands for Intracytoplasmic Sperm Injection. In this case, it is the embryologist who manually introduces the sperm into the oocyte with an injection needle.

As can be seen, choosing between IVF with or without ICSI depends on the cause of infertility, and the criteria followed by each fertility clinic.

If you require any further information, do not miss this post: In vitro fertilization (IVF).

What is third-party reproduction?

Most fertility problems can be addressed through infertility treatments using the gametes of the couple. Nonetheless, in many other cases, it is poor-gamete quality what causes sterility in both males and females.

In these cases, egg cell donation and/or sperm cell donation can help patients solve their fertility problems and have a baby. The presence of inherited diseases in the female, the male or both is another reason leaving no alternative but to turn to third-party assisted reproduction.

Donor conception has allowed the creation and integration of new family types in our society. Now, single women and gay couples can become parents thanks to techniques such as AI or IVF with donor eggs and/or sperm.

FAQs from users

IVF pregnancy vs. natural pregnancy, is there any difference?

By Blanca Paraíso MD, PhD, MSc (gynecologist).

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.

What is PGD used for?

By Dr. Ana Mª Villaquirán Villalba MD, MSc (gynecologist).

Preimplantation Genetic Diagnosis (PGD) is a technique that complements IVF/ICSI and helps us detect the presence of genetic abnormalities in embryos before their transfer to the maternal uterus.

Currently, it is done by performing an biopsy to the trophoblast of a blastocyst embryo, that is, on days 5-6 of embryo culture. The cells removed can be examined to detect the presence of chromosomal abnormalities using PGS (Preimplantation Genetic Diagnosis), or genetic diseases, such as Duchenne muscular dystrophy (DMD).

When is it time to see a fertility specialist?

By Andrea Rodrigo BSc, MSc (embryologist).

A couple is considered infertile/sterile if they have been trying to conceive for over 12 months with no luck or in cases of recurrent pregnancy loss (RPL).

In general, it is at that point when you are recommended to see a fertility doctor and undergo all the necessary tests to detect what is causing infertility/sterility. Once done, the specialist will be able to determine what would be the best infertility treatment for you.

When the woman is over 37, this period of time trying to conceive is reduced to 6 months. Third-party assisted reproduction is usually advisable for women aged 40 to 50 or over.

What are the pros and cons of assisted reproductive technology (ART)?

By Andrea Rodrigo BSc, MSc (embryologist).

Obviously, the main advantage of ART is that it gives you the chance to have a baby. On the other hand, the most common disadvantage is associated with fertility drugs, due to the side effects it can cause: headache, bloating, nausea, vaginal bleeding/spotting…

However, fertility drugs are commonly the first choice because of their relative convenience, especially for IVF.

Secondly, reproductive surgery, required to correct anatomical abnormalities or clear blockages in the man or the woman, are usually too invasive, which increases their risk, recovery time and cost. On the other hand, they help increase the chances of getting pregnant.

Perhaps the main disadvantage of all infertility treatments is related to the financing options, since they are always covered by insurance everywhere. Also, in the case of IVF, the likelihood of having twins is higher if multiple embryo transfers are chosen.

How long after fertility treatment can you adopt?

By Andrea Rodrigo BSc, MSc (embryologist).

Traditional adoption is an option for individuals or couples suffering from unexplained infertility after several repeated fertility treatment cycles.

Many couples ask themselves at what point do they stop pursuing infertility treatments and start considering adoption, but there is no specific period of time, as it depends on the particularities of each case.

However, it should be taken into account that surrogacy may be another option for these patients. Choosing one or another is a very personal decision, and both are long processes from start to finish.

What are the long-term side effects of fertility treatments?

By Andrea Rodrigo BSc, MSc (embryologist).

To date, the long-term side effects of IVF treatment have not been studied to a large extent. However, they can be classified into two main types: effects on women and effects on babies.

There has been considerable discussion on whether IVF medications (especially Clomid) are liked to cancer, including ovarian cancer and breast cancer.

According to the HFEA, the potential short-term side effects of fertility treatment are: drug reaction, multiple births, ovarian hyperstimulation syndrome (OHSS), ectopic pregnancy and birth defects.

What types of fertility treatments for males exist?

By Andrea Rodrigo BSc, MSc (embryologist).

On the one hand, when a man is diagnosed with some kind of fertility issue after a semen analysis, the doctor may prescribe vitamin supplements or a special diet to be followed before turning to infertility treatments.

While trying to boost sperm quality through natural remedies, avoiding the consumption of saturated fats is of utmost importance. In case there exist one or various seminal alterations (low sperm count, low sperm motility…), multivitamin supplements is recommended.

In case it is caused by an infection (presence of leukocytes in the semen sample), antibiotics may be prescribed as well. If it does not work or is a case of non-obstructive azoospermia, maybe you should consider IVF/ICSI.

To learn more about this topic, do not miss this post: Foods to boost sperm quality.

Can fertility treatments be done at home?

By Andrea Rodrigo BSc, MSc (embryologist).

No, fertility treatments are carried out at a fertility clinic or medical facility. In the case of AI, it can be done at the gynecologist’s office, due to the simplicity of the technique. Conversely, special equipment is required for all of the IVF steps involved to be carried out properly.

There is, however, an alternative to artificial insemination which is known as at-home artificial insemination. It is mainly a do-it-yourself version of AI in which the woman can get herself inseminated with donor or partner sperm by just buying an insemination kit at the pharmacy.

It should be taken into account that its chances of success are exactly the same as those you would achieve through natural conception. Besides, it involves a series of health risks, as the equipment has not been previously sterilized and therefore the risk of introducing germs into the vaginal tract is higher.

References

Edwards, RS (1995). Principles and practice of Assisted Human Reproduction. Brody SA eds. Philadelphia: W.B. Saunders Co.

Grupo de Interés de Centros de Reproducción Humana Asistida del Sistema Nacional de Salud (2002). Criterios para la utilización de los recursos del Sistema Nacional de Salud Español en técnicas de reproducción humana asistida Rev Iberoam Fertil; 19(1): 5-31.

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.

Ley 14/2006, de 26 de mayo, sobre técnicas de reproducción humana asistida. Jefatura del Estado «BOE» núm. 126, de 27 de mayo de 2006 Referencia: BOE-A-2006-9292

Matorras R. (2002). La reproducción asistida en el sistema sanitario público español. Rev Iberoam Fertil; 19 (2): 103-108.

Matorras R, Hernández J (eds) (2007). Estudio y tratamiento de la pareja estéril: Recomendaciones de la Sociedad Española de Fertilidad, con la colaboración de la Asociación Española para el Estudio de la Biología de la Reproducción, de la Asociación Española de Andrología y de la Sociedad Española de Contracepción. Adalia, Madrid.

National Callaborating Center for Women’s and Children’s Health. Fertility: assessment and treatment for people with fertility problems. Clinical Guideline February 2004. Recuperado el 22 de agosto de 2018 de http://www.rcog.org.uk

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 (2000). Reproducción Asistida. En: Documentos de Consenso SEGO; 9-51.

Santamaría Solís, L. (2000). Técnicas de reproducción asistida. Aspectos bioéticos. En: Cuadernos de Bioética/1ª. Asociación Española de Bioética y Ética Médica (AEBI).

Schmidt L, Münster K. Infertility, involuntary infecundity, and the seeking of medical advice in industrialized countries 1970-1992 (1995): a review of concepts, measurements and results. Hum Reprod; 10: 1407-18.

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.

The ESHRE Capri Workshop Group. Intrauterine insemination. Human Reproduction Update, 2009; 15 (3): 265–277.64

Vayena E, Rowe PJ, Griffin PD, (eds.) (2002). Current Practices and Controversies in Assisted Reproduction. Report of a meeting on "Medical, Ethical and Social Aspects of Assisted Reproduction", World Health Organization, Geneva.

W.N. Spellacy, S.J. Miller,A. Winegar (1986). A pregnancy after 40 years of age. Obstet Gynecol, 68, pp. 452-454

Zegers-Hochschild F, Adamson GD, de Mouzon J, Ishihara O, Mansour R, Nygren K, Sullivan E, Vanderpoel S, for ICMART and WHO. 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.

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Authors and contributors

 Andrea Rodrigo
BSc, MSc
Embryologist
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia. Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia along with the Valencian Infertility Institute (IVI). Postgraduate course in Medical Genetics. More information
Dr. Ana Mª Villaquirán Villalba
Bachelor's Degree in Medicine from the University of Valle, Colombia. Specialist in Obstetrics & Gynecology. Master's Degree in Human Reproduction from the University of Valencia and IVI. Currently, she is the medical director of Tahe Fertilidad. More information
License: 303007571
 Blanca Paraíso
MD, PhD, MSc
Gynecologist
Bachelor's Degree in Medicine and Ph.D from the Complutense University of Madrid (UCM). Postgraduate Course in Statistics of Health Sciences. Doctor specialized in Obstetrics & Gynecology, and Assisted Procreation. More information
License: 454505579

One comment

    1. vanessa williams

      Hello, wondering if anybody has experienced more or less the same as I do… I started an IVF treatment using my own eggs two years ago and it was unsuccessful, so I’m considering starting a repeated IVF cycle by using donor eggs, but I wonder if maybe there is some country where success rates of IVF with donor eggs are higher, does anyone have the slightest idea? Thanks!!