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:
- Artificial insemination (AI)
- In vitro fertilization (IVF), whether it is conventional IVF or ICSI (intracytoplasmic sperm injection)
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.
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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?
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?
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?
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)?
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?
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?
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.
What types of fertility treatments for males exist?
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?
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.
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