Assisted Reproductive Technology for Infertility Treatment

When a person or couple is having difficulty becoming pregnant, they may need to see a fertility specialist or reproductive endocrinologist. Reproductive endocrinologists are gynecologists who specialize in the treatment of infertility.

Your doctor 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 doctor may recommend fertility drugs designed to induce ovulation, lifestyle changes, or other non-invasive treatment options. However, in some cases, these options may not help induce pregnancy, and further treatments may be needed.

What is ART?

Assisted reproductive technology (ART) are procedures or treatment options designed to help a person become pregnant. They may be used when first-line treatment options have not led to pregnancy. They may also be used when a person or couple wanting to become pregnant needs access to donor sperm or eggs.^1-5

ART is more expensive and invasive than other fertility interventions. Some interventions, such as in vitro fertilization (IVF), cost $10,000 or more per cycle. Becoming pregnant after IVF or other types of ART is not guaranteed. 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 doctor will help you determine which option is best for you, as well as the potential success rate for 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. This includes 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 from donors. Multiple fertilized eggs (embryos) are then implanted back into the uterus of the person they came from or into a gestational carrier or a surrogate.^1,2,7,8

From there, these embryos may 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 method 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:^7-9

• Taking drugs to induce ovulation
• Retrieving the eggs through a minimally invasive procedure
• Collecting a sperm sample
• Joining the egg and sperm in a lab to promote fertilization
• Transferring the embryos into the uterus

There are variations of this process that are used less often, including gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT). GIFT involves transferring eggs and sperm into a person's fallopian tubes. ZIFT involves transferring an already fertilized egg into a person'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. There are many reasons why donor sperm or eggs and/or a surrogate or gestational carrier may be used.

If a person has a condition that causes them to be unable to carry a baby, a surrogate or gestational carrier may be needed. If they have a condition that affects the quality of their eggs, they may need donor eggs. This may also be the case for male partners who have issues with the quality or quantity of their sperm. The process of IVF can be completed with biological or donor eggs and/or sperm and implanted back into the person 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 eggs are not being handled in any way. However, IUI is designed to help induce pregnancy for people 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 person is ovulating. When a person is ovulating, they release an egg, or eggs, from the 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 IUI, it is possible to increase a person's chances of becoming pregnant.^1,2,10,11

Even if a person is using IUI, the eggs still need to make it through the fallopian tubes and into the uterus to meet the inserted sperm and potentially implant into the uterine wall for pregnancy to occur. If a person has a condition that prevents this process from happening, IUI may not be an option. Other methods, such as IVF, may need to be considered. The critical piece of IUI is timing. It is important to inseminate a person while they are ovulating for the highest chance of becoming pregnant.^10,11

Things to know about ART

Each fertility treatment option and ART is used for different causes of infertility. Each also has its own benefits and drawbacks. Many factors, such as cost, emotional stress, and other personal situations, may greatly affect which ART option is right for you. If you are struggling to become pregnant and think one of these options may be right for you, talk to your doctor.