Assisted Reproductive Technology - Indications, Contraindications, and Procedure

What Is Assisted Reproductive Technology?

Assisted reproductive technology is a medical procedure or technique used to attain pregnancy in individuals who face difficulty in becoming pregnant naturally. ART involves using medical procedures to tackle infertility. Basically, ART addresses reproductive endocrinology and infertility.

Infertility is the inability to become pregnant for more than a year without the use of contraception. Both males and females can have infertility issues. The procedures like IVF (in vitro fertilization), cryopreservation of embryos or gametes, ICSI (intracytoplasmic sperm injection), use of fertility medication, etc., are common ART. This can also be used to avoid pregnancy complications or for genetic purposes.

What Are the Indications for Assisted Reproductive Technology?

The assisted reproductive technology is indicated in the following conditions:

• Patients with tubal factor infertility (blockage in the fallopian tube).

• Male factor infertility can be caused by numerous factors like abnormal sperm function, low sperm production, or any blocks that prevent the delivery of sperm.

• Diminished ovarian reserve occurs when the ovary loses its normal reproductive potential.

• Ovarian failure.

• Ovulatory dysfunction.

• Individuals for whom pregnancy is relatively contraindicated.

• Unexplained infertility.

• Before gonadotoxic therapy.

In What Conditions Is Art Contraindicated?

ART is contraindicated in cardiopulmonary conditions such as heart failure and pulmonary hypertension. Preconception counseling and evaluation for such conditions should be conducted. In such patients, options like gestational carrier can be utilized.

What Preparations Should Be Done Before ART?

Assisted reproductive technology is expensive, so one must thoroughly prepare before the procedure to get positive results. So the health care professionals and the couples should remember a few facts before starting the procedure.

• Ovarian reserve testing measures egg quantity, quality, and reproductive potential. Levels of estradiol, follicle-stimulating hormone (FSH), and AMH (antimüllerian hormone) should be taken on the second or third day of the period. The Clomiphene citrate challenge test is done (CCCT), and the number of small follicles in the ovary is counted (antral follicle count) before the procedure.

• Fallopian tube disorders like blocked tubes and fluid-filled fallopian tubes must be removed or clipped before IVF.

• A Hysteroscope test along with a sonogram should be done to view and check the uterine cavity abnormalities like polyps, fibroids, or septum.

• Consult a specialist on male infertility and take a semen test before ART. If there are any underlying health concerns or correctable problems, take proper treatment.

• Lifestyle modifications should be done, like smoking should be quit because it may decrease a woman’s chance of success to about 50 %. Care should be taken to reduce weight before undergoing ART treatment. Alcohol, excessive caffeine consumption, and recreational drugs should be avoided.

What Are the Different Types of ART?

There are different types of ART procedures. Each procedure involves different techniques and reproductive cells. Depending on their circumstances, a healthcare professional can advise the best ART suitable for an individual. The following are the most common types of ART.

1) In Vitro Fertilization (IVF) -

This is one of the most common ART techniques. In this technique, a woman’s egg and a man’s sperm are taken and combined in the laboratory to form an embryo. Then the embryo is safely transferred inside the woman’s uterus.

The procedure starts with keeping track of the woman’s ovulation period and stimulating it to remove the ovum (egg) from the woman’s ovaries. Then the taken eggs and sperm are kept for fertilization in a liquid inside a laboratory. This results in the formation of a zygote which then undergoes embryo culture for a period of 2 days to 6 days. Finally, the embryo culture is transferred to the same or another woman’s uterus to establish a successful pregnancy.

In some cases, it can take more than one IVF cycle to result in a successful pregnancy. In the worst cases, some people may not conceive with IVF. The advantage of IVF is an increased chance of fertilization and pregnancy. However, its complications may include the following:

• Multiple pregnancies.

• Side effects from fertility drugs like ovarian hyperstimulation syndrome.

• Ectopic pregnancy (the embryo settles outside the uterus).

2) Intracytoplasmic Sperm Injection - It is a special form of in vitro fertilization technique. This technique can be performed alongside IVF to help fertilize an egg. An embryo specialist uses a small needle to inject sperm directly into the center, which is the cytoplasm of an ovum (egg). This technique helps form embryos which are then transferred into the woman's uterus. The success rate of this method is similar to those of IVF. ICSI is a more effective method for people with sperm-related infertility. This technique will be costlier than IVF since this is an add-on procedure. The following things should be considered before the procedure:

• This procedure might damage some or all of the eggs.

• Even after being injected with sperm, the egg may not grow into an embryo.

3) Intrauterine Insemination (IUI) - This technique involves transferring a man’s sperm into a female uterus with the help of a long narrow instrument similar to a straw. This method should be applied in combination with stimulation of ovulation. When combined, the processes can sometimes enhance the chances of pregnancy.

Intrauterine Insemination can be done in women who have defects or scars in the uterus and in men with low sperm count and low mobility of sperm. This is also effective for men who cannot get erections, retrograde ejaculation (when sperm is ejaculated into the bladder rather than ejaculating out of the penis), and couples facing difficulties having sex.

The success rate of IUI depends upon the reason for infertility. The success rate can be increased to 20 %by inseminating every month with frozen or fresh sperm. A woman’s age, infertility diagnosis, fertility medications, and many other reasons also play a key role in the success of this treatment.

4) Third-Party ART - When pregnancy is not achieved from traditional ART or fertility treatment, a third-party ART can be chosen to become pregnant. The third-party ART includes:

• Egg donation.

• Sperm donation.

• Embryo donation.

• Surrogacy.

The third-party ART can be indicated in the following conditions.

• When IVF fails repeatedly.

• For women who produce healthy eggs but face difficulty carrying a pregnancy to term.

• For individuals who have difficulty producing sperm or an egg.

• If there are specific medical conditions that may be transferred to the baby.

5) Frozen Embryo Transfer - Frozen embryo transfer is becoming common in many parts of the world. This procedure involves thawing previously frozen embryos. Then it is inserted into a woman’s uterus. This technique is safe and similar to using fresh embryos in treatment. However, this method has an increased risk of preterm birth, and all frozen embryos may not survive the thawing-out process.

Conclusion:

Artificial reproductive technology is a procedure that helps in addressing infertility. There are different methods of ART treatment available for treating infertility. The success rate of ART varies depending on factors like age, medical condition, the underlying cause of infertility, and the treatment chosen. A specialist can suggest the best treatment options for a couple facing infertility.