Assisted Reproductive Technology for Infertility Treatment
When a woman or couple is having difficulty becoming pregnant, it may be necessary to see a fertility specialist or reproductive endocrinologist. Reproductive endocrinologists are gynecologists who specialize in the treatment of infertility. If you visit your provider for infertility, they may run a variety of tests or take ultrasound images of your reproductive system to try to determine the cause of your infertility. They will also do the same for your partner. Depending on the cause of your infertility, your provider may recommend fertility medications designed to induce ovulation, lifestyle changes, or other non-invasive treatment options. However, in some cases, these options may not help to induce pregnancy, and further interventions may be needed.
What is ART?
Assisted reproductive technology (ART) are procedures or treatment options designed to help a woman become pregnant. They may be utilized when first-line treatment options have not led to pregnancy, or when a woman or couple wanting to become pregnant needs access to donor sperm or eggs. ART is more expensive and invasive than other fertility interventions, with some interventions, such as in vitro fertilization (IVF), costing $10,000 or more per cycle.1 Despite the price, becoming pregnant after IVF or other types of ART is not guaranteed, and success rates depend on a variety of factors, including maternal age, cause of infertility, lifestyle factors, and more. Each type of ART carries its own success rate and is used to treat various causes of infertility. Your provider will help you determine which option is most suited for you, and what the potential success rate is in your situation.1-5
The Centers for Disease Control and Prevention (CDC) considers ART to be any intervention used to treat infertility that involves the handling of both eggs and sperm, such as IVF or third-party assisted ART with a surrogate or gestational carrier and/or donor eggs and sperm. However, some outlets consider interventions that handle sperm only, such as intrauterine insemination, an example of ART. Below are some of the most commonly used types of ART.1,2,6
In vitro fertilization (IVF)
Figure 1. In vitro fertilization procedure
During IVF, multiple eggs are fertilized by sperm outside of the body in a lab. These eggs and sperm cells can come from the couple trying to give birth or they can come from donors. Multiple fertilized eggs, also called embryos, are then implanted back into the uterus of the woman in which they came from or into a gestational carrier or a surrogate. From there, these embryos can lead to pregnancy. In some cases, IVF may be used as a means of preserving fertility. Eggs and sperm can be harvested from the body and frozen in order to store them for later use. This technique may be used for those who might be undergoing treatment that may impact their fertility, eggs, or sperm, such as chemotherapy or radiation therapy for cancer.1,2,7,8
The main steps in IVF involve taking medication to induce ovulation, retrieving a woman's eggs through a minimally-invasive procedure, collecting a sperm sample, joining the egg and sperm in a lab to promote fertilization, and transferring the embryos into the uterus. There are variations of this process that are used less frequently, including gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT). GIFT involves transferring eggs and sperm into a woman's fallopian tubes while ZIFT involves transferring an already fertilized egg into a woman's fallopian tubes. Both of these options require normally functioning fallopian tubes that can pass the egg into the uterus where it will hopefully implant and lead to pregnancy.7-9
Third party-assisted ART
In some cases, a donor or gestational carrier may be needed for pregnancy. If a woman has a condition that causes her to be unable to carry a baby, a surrogate or gestational carrier may be needed. If she has a condition that affects the quality of her eggs, she may need donor eggs. This situation can also be the case for male partners who may have issues with the quality or quantity of their sperm. There are a variety of reasons why donor sperm or eggs and/or a surrogate or gestational carrier may be used. The process of IVF can be completed with biological or donor eggs and/or sperm and implanted back into the mother trying to give birth, or they can be transferred into a carrier.1
Intrauterine insemination (IUI)
Figure 2. Intrauterine insemination procedure
As mentioned, not all outlets agree as to whether IUI is considered a true ART, since the inseminated woman's eggs are not being handled in any way. However, IUI is designed to help induce pregnancy for individuals or couples struggling to become pregnant or who need donor sperm. IUI, also called artificial insemination, involves delivering sperm directly into the uterus while a woman is ovulating. When a woman is ovulating, she releases an egg, or eggs, from her ovaries. This egg then travels through the fallopian tubes and into the uterus. If the egg is fertilized by a sperm, pregnancy could result. By delivering sperm directly into the uterus around the time of ovulation via intrauterine insemination, it is possible to increase a woman's chances of becoming pregnant.1,2,10,11
Even if a woman is using IUI, it is still necessary for her eggs to make it through her fallopian tubes and into her uterus to meet the inserted sperm and potentially implant into the uterine wall for pregnancy to occur. If a woman has a condition that prevents this process from happening, IUI may not be an option, and other methods, such as IVF, may need to be considered. The critical piece of IUI is timing. It is important to inseminate a woman while she is ovulating for the highest chance of becoming pregnant.10,11
Benefits and drawbacks
Each fertility treatment option and ART is indicated for different causes of infertility, and has its own benefits and drawbacks. Various factors, such as cost, emotional stress, and other personal situations, may greatly affect which ART option is most suitable for you. If you are struggling to become pregnant and think that one of these options may be right for you, contact your healthcare provider.