Assisted reproduction techniques: definition, types and ethics

Assisted Reproductive Technologies (ART) refers to fertility treatments and procedures that can help with difficulty or inability to conceive children. ART techniques involve the manipulation of eggs, sperm, or embryos to increase the chances of a successful pregnancy.

Infertility is when people cannot conceive after a period of regular sex without the use of birth control. The evidence suggests that roughly ten% of women aged 15 to 44 in the United States have difficulty conceiving or staying pregnant. Research Also states that globally 8-12% of couples experience fertility issues and 40-50% of cases may be caused by factors affecting men.

According to the CDC, about 1.9% of all American infants are born on ART. While the technology can be effective, it can also be expensive. People wishing to conceive a child on ART in the United States can check their infertility coverage by state.

In this article, we’ll discuss some of the different types of ART, including their success rates, benefits, risks, costs, and the ethics of the technology.

ART refers to medical procedures aimed at achieving pregnancy. These complex treatments involve influencing the gametes, or eggs and sperm, to increase the chances of fertilization. ART is usually an option for people for whom other infertility treatments may not work or for those who have tried treatment before but did not become pregnant.

People considering ART will often discuss options with a healthcare professional and may need a consultation with a fertility specialist.

While people primarily use ART to treat infertility, others may use it for genetic purposes or to prevent pregnancy complications. Some people may also talk about ART as a treatment for fertility or assisted reproduction.

It can be difficult for many people to access fertility services such as ART due to its high cost and limited coverage by private insurance and Medicaid.

There are several types of ART procedures that involve different techniques and reproductive cells. A doctor can advise which ART will be most appropriate depending on the circumstances. The most common type is in vitro fertilization (IVF).

IVF

IVF involves a doctor who extracts the eggs and fertilizes them in a special laboratory. Specialists can combine this with embryo transfer (IVF-ET) and transfer the resulting embryos to a person’s uterus. The Society for Assisted Reproductive Technology states that IVF-ET accounts for 99% of ART procedures.

The Centers for Disease Control and Prevention (CDC) lists the 2018 success rates of IVF treatments for egg retrieval in people using their own eggs as:

  • 52% for people aged 35 or under
  • 38.1% for 35-37 year olds
  • 23.5% for 38-40 year olds
  • 7.6% for those over 40

A person can also use a tool called a IVF success estimator to estimate their chances of having a baby using IVF.

It may take more than one IVF cycle to become pregnant, and some people may not conceive at all with IVF. The benefits of IVF are an increased chance of fertilization and pregnancy. Potential complications can include:

The National Conference of State Legislatures indicates that the average cost of a single cycle of IVF is $ 12,000 to $ 17,000.

Click here to learn more about IVF.

Intrafallopian transfer

Some methods of ART are similar to IVF but use laparoscopic surgery to deliver gametes directly into the fallopian tube. Some people may choose this method for religious reasons, or their insurance may only cover this type of ART.

Like other forms of ART, the risk of multiple pregnancy is increased. In addition, due to laparoscopy, there is a risk of complications from the surgery, such as infection, organ puncture, or side effects of anesthesia. Intrafallopian transfers are generally more expensive than IVF.

Due to the higher costs and risks of this type of ART, specialists rarely use these procedures. As such, there isn’t a lot of data available on their success rates.

The types include:

  • Intrafallopian gamete transfer (GIFT): The GIFT involves collecting eggs and sperm in a tube before a doctor places the gametes directly into the fallopian tubes using laparoscopic surgery. Since there is no IVF procedure, a person does not have to choose which embryo to transfer.
  • Zygote intrafallopian transfer (ZIFT): ZIFT is a combination of IVF and GIFT. Specialists stimulate and remove the eggs using IVF methods and mix the eggs with sperm in the lab before putting the fertilized eggs or zygotes back into the fallopian tubes. One of the benefits of ZIFT is that it can help people with damaged fallopian tubes or severe infertility problems get pregnant.
  • Tubal transfer at the pronuclear stage (PROST): PROST is similar to ZIFT but involves the transfer of a fertilized egg into the fallopian tube before cell division occurs.

Frozen embryo transfer

Frozen Embryo Transfer (FET) has become increasingly common in the United States. It involves thawing embryos previously frozen by IVF and inserting them into a person’s uterus. A 2017 study found that 52% of people with FET had ongoing pregnancies.

According to the United Kingdom’s Human Fertilization and Embryology Authority, FET is as safe as using fresh embryos in processing. However, some evidence suggests an increased risk of preterm delivery with FET. Another possible risk of FET is that not all frozen embryos survive the thawing process.

The estimated cost of FET varies but can go up to $ 6,000.

Intracytoplasmic sperm injection

Intracytoplasmic sperm injection (ICSI) is a procedure that specialists can perform alongside IVF to help fertilize an egg. An embryologist, or embryo specialist, uses a small needle to inject a single sperm directly into the center of an egg.

ICSI fertilizes between 50 and 80% of the eggs. The success rate of ICSI is similar to that of IVF, and it may be an effective method of antiretroviral therapy for people with sperm-related infertility. ICSI is usually a complementary procedure to IVF, so it will be more expensive than IVF alone.

Things to consider about ICSI are:

  • The procedure may damage some or all of the eggs.
  • The egg may not become an embryo even after receiving a sperm injection.
  • If a person becomes pregnant naturally, there is a 1.5 to 3% chance that the baby will have a major birth defect. However, the underlying infertility, rather than the treatment, may be the cause of the birth defect.

Third-party ART

Third-party ART it is when another person donates eggs, sperm or embryos to a person or a couple. It can also include surrogates and gestational carriers. This is when another person is either inseminated with the sperm of the couple using ART or implanted with an embryo of those using ART.

Evidence suggests that 50% of donated frozen embryo transfers result in pregnancy and 40% result in a live birth. The other advantages of third-party ART are as follows:

  • It can work when IVF has repeatedly failed.
  • This can help avoid passing on specific conditions.
  • It can help a person who is producing healthy eggs but has had difficulty carrying a pregnancy to term.
  • It can help those who have difficulty producing an egg or sperm.

Depending on the type of people chosen, third-party ART can be very expensive. Sperm donation is usually the cheapest option, costing around $ 1,000 per vial.

The cost of other options may vary for a single vial, and many cycles will require multiple vials. The estimated costs are:

Preparing for antiretroviral therapy includes practicing behaviors that can help improve the chances of success of ART. This may involve dietary changes, such as taking supplements recommended by a healthcare practitioner and reducing alcohol and caffeine intake.

It could also involve regular exercise and stopping smoking. Once ART is successful, prenatal care and testing can keep the pregnant person and baby healthy during pregnancy.

Many aspects of ART raise ethical questions, such as:

  • Does an individual or a couple need ART?
  • Who owns the stored gametes and embryos?
  • Is it ethical for people to donate eggs to a clinic for free or low cost treatment?
  • How do a person’s religious beliefs align with different ART procedures?
  • Should there be age limits for ART?
  • Do children born by donation of gametes have the right to know their conception and their genetic parents?
  • Are all requests for antiretroviral therapy treated the same, regardless of relationship status or sexual orientation?
  • Is it ethical to use frozen embryos or sperm from a deceased person?

There are no simple answers to the ethical questions of ART. The American Society for Reproductive Medicine has a collection of ethical documents available here.

People considering antiretroviral therapy can review the laws in their state or call the Women’s health office Help line at 1-800-994-9662.

There are many types of ART available to treat infertility. ART success rates vary depending on the type of ART chosen and factors such as a person’s age and health.

A specialist will suggest ART based on an individual’s or couple’s preferences and type of infertility while weighing the risks, benefits, and costs.


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