Assisted Reproductive Technology (ART) – Infertility Treatment

Infertility is a common problem, and many couples find it difficult to conceive naturally. There are many factors that contribute to this issue, such as poor eating habits, lack of exercise, pollution, and lifestyle diseases like diabetes. But there are ways in which infertility can be treated. Assisted reproductive technology (ART) is one such method that can help treat infertility issues. Read on to learn about ART!

What Is Assisted Reproductive Technology?

The procedure or treatment that involves handling a woman’s eggs and a man’s sperm to make embryos is known as assisted reproductive technology (ART). Any couple who has trouble conceiving a child naturally can look towards assisted conception to help them. As science advances, the chances of success also increase.

Reasons for Performing Assisted Conception

There are many factors that contribute to the difficulty in conceiving a child. Here are the three main reasons for assisted conceptions:

• Ovulation and egg quality: Under this category are women who have polycystic ovaries, poor egg number and quality, irregular ovulation, or failure to ovulate due to hormonal imbalances. These problems are often age-related and affect women especially those above the age of 35.

• Blocked fallopian tubes: A woman could have blocked fallopian tubes due to a previous infection, endometriosis, scar tissue or adhesions that can damage the tubes. Since the egg cannot enter the tube, the sperm cannot get to the egg and fertilise it.
• Male factor problems: In men, there could be several factors that could affect fertility. Low sperm count, poor sperm quality, poor sperm motility, no sperm or blockages that prevent the delivery of sperm are some of the reasons.

Other reasons to opt for assisted conception include pelvic inflammatory disease, endometriosis, and other unexplained conditions.

What Are the Different Types of Assisted Reproductive Technology?

There are many treatments and procedures that come under the umbrella classification of assisted reproduction techniques.

• In Vitro Fertilization (IVF)

This is probably one of the best-known types of artificial reproductive treatment. Essentially, sperm and eggs are brought together in a petri dish in a lab. Embryologists will observe the fertilization of the eggs and the subsequent cell division. Healthy embryos are then inserted back into the uterus between day 2, 3 and day 5. IVF is best suited for women who have a blocked or damaged fallopian tube. Other reasons to use this method are endometriosis, problems with ovulation, and unexplained infertility issues.

There are many ways in which IVF is done. The most common types include Conventional IVF and Mild IVF. Natural Cycle IVF is when the woman is not given any medication to stimulate the ovaries.

• Intracytoplasmic Sperm Injection (ICSI)

This treatment is quite similar to the IVF treatment. However, in this case, the sperm is directly injected into the egg rather than placing the sperm next to the egg. This increases the odds of fertilisation. This procedure is best suited for couples who have a decreased sperm count, low sperm motility, and a high number of abnormal sperm. Other cases where ICSI works wonders are when there are no sperm in the semen, but sperm is found in the testes, high levels of antibodies in the male that affect the sperm’s ability to bind to the egg, and retrograde ejaculation where the sperm travels back to the male’s bladder.

• Intrauterine Insemination (IUI)

The sperm cells will be collected and then injected directly into the uterus when the woman is ovulating. Only strong sperm cells are selected for this method. This option is good for when you are having difficulties in intercourse, mild problems with semen, mild endometriosis, and when using a sperm donor.

• Frozen Embryo Transfer (FET)

When using artificial reproductive treatments like IVF/ICSI, a couple might be in the position of having more than one good quality embryo. This embryo could be frozen and used at a later date.

• Donor Sperm

If the sperm quality is not good enough or no sperms, a couple can opt for sperm from a donor. In India, the potential donor has to go through certain tests including family background checks, drug usage, semen analysis, and medical and genetic tests.

• Donor Eggs

Donor eggs can be combined with your partner’s sperm and the resulting embryo transferred inside your womb. The tests that a sperm donor goes through (excluding semen analysis) are similar for an egg donor as well.

How to Prepare for Assisted Reproductive Technology Procedure

Since ART procedures are expensive, you must make sure that you and your partner are prepared for it. Here are a few things you must keep in mind:

• Different tests are done during the second or third day of menstruation to measure the Follicle Stimulating Hormone (FSH is produced by the pituitary gland and plays a role in sexual development and functioning), estradiol (female sex hormone that is produced by the ovaries), and AMH (Anti-Mullerian hormone which is a substance produced by the granulosa cells. It is a marker for the ovarian reserve).
• Uterine cavity abnormalities like fibroids, polyps, etc., have to be checked for.
• Fallopian tube disorders must be corrected during a process called laparoscopy. Surgery can be done to treat fluid-filled and blocked tubes.
• The semen must be tested for quality.
• Certain lifestyle changes must be made for higher chances of success with ART. This means that you must work towards being close to your ideal weight, and quit smoking, alcohol, and excessive caffeine.

What Are the Complications Associated With Assisted Reproductive Technology?

There is very little evidence to show that using assisted conceptions can have long-term health problems in the mother. Even the fertility drugs used in conjunction with these treatments are consumed under strict supervision for short periods of time.

However, there are risks associated with complications in pregnancy, labour, and birth. One of the main causes of this is that artificial reproductive treatment is mainly used by older women. Also, the chances of multiple pregnancies are much higher. Complications such as miscarriages, gestational diabetes, and pre-eclampsia are common in this demographic and many women may need to have a caesarean section.

Other complications include:

• Low birth weight and premature labour
• Perinatal morbidity
• Ovarian hyperstimulation syndrome is when the abdominal cavity is filled with fluid
• Very rarely, risk of damage to the bladder, bowel or artery during extraction of the eggs
• Increased stress and anxiety due to fear of failure and financial strain on the couple

What Happens During Female Infertility Treatment?

• Ovulation Induction

Essentially, this procedure stimulates the ovary to produce eggs. This is usually done by giving clomiphene or letrozole drug to the woman. It is usually prescribed for women with PCOD where the eggs are not being produced by the ovaries.

In IVF/ICSI treatments, hormonal injections are administered to have several ‘ripe’ eggs. The aim is to control the woman’s menstrual cycle so that multiple eggs can be removed on a particular day.

• Egg Collection

When the eggs are ripe, they have to be collected or removed from the body. The procedure is carried out in the operation theatre under short general anaesthesia. A transvaginal ultrasound probe is inserted into the vagina, and a needle attached to it collects the ripe eggs using a suction pump.

• In Vitro Fertilization

The ripe eggs are then placed in a petri dish along with sperm from your partner on the same day. An embryologist will check on them after 12-18 hours to check for fertilization. Once that is confirmed, the embryo is inserted back into the womb on day 2, 3 or 5 after the egg picks up. The pregnancy is confirmed after a pregnancy test 12 days later.

What Happens During Male Infertility Treatment?

If a man has a low sperm count or has poor motility, then the ICSI treatment is most suited. The ovulation induction and egg collection procedure are done as usual, but the sperm is injected into the ripe eggs using a thin glass needle. In case there is no sperm in the semen due to a blocked vas deferens or a vasectomy, the sperm can be directly extracted from the testes under local anaesthesia. The sperm collected can then be used to fertilise the ripe eggs using ICSI treatment.

There are methods such as IUI apart from IVF which can be tried to address male infertility.

In IUI, the sperms are placed in the uterus directly in order to facilitate fertilization. It is done to increase the number of sperms that eventually reach the fallopian tube to induce a higher chance of success.

In IVF, the egg is removed from the female’s body and is fertilized with the male sperm under specific, controlled conditions in a laboratory. The fertilised egg which is called an embryo is then returned to the mother’s body, and pregnancy is induced.

What Are the Chances of a Twin Pregnancy?

The procedure of ovulation induction increases the chances of multiple pregnancies. This is because a higher number of eggs are used to increase the chances of conceiving. However, please note that artificial reproductive treatment is not done with the view to have multiple pregnancies. The objective of these procedures is to be able to have one healthy baby. A multiple pregnancy is considered a complication as it can cause significant risks to the mother and baby.

The chances of a multiple pregnancy in natural conception are relatively low. It happens in every one in 65 pregnancies. The same odds are significantly better with artificial reproductive treatment. One in every four IVF deliveries is the case of a multiple conception.

Success Rates of ART

The success of the treatment you opt for is based on the cause of infertility and the woman’s age. Women younger than 35 years of age enjoy a higher success rate. Making sure that you lead a healthy lifestyle can go a long way in increasing your odds. When you consult with a fertility clinic, they will give you their success rate which you can then compare with the national average. However, do not base your decision entirely on this number. Some clinics focus only on women above 40, and others might be focused on treatments that address the very same fertility issues you have. Most experts will tell you that trying three times is the standard before you must look at other options. There is no need to feel disheartened, as reports suggest that there is a 40-45% chance of ART resulting in the birth of a live baby for women under 35 years. The success rate is around 30-35% for women from 35 to 39.

When you opt for artificial reproductive technology, be sure to give your doctor an exhaustive medical history of both of you. Once you conceive, be sure to track all the changes your body goes through and be diligent about going to all your appointments with your doctor.

Explore all the options you have by talking to experts and various fertility clinics. Artificial reproductive treatments can help most couples with their fertility issues and help those couples come closer to their dream of having a family.

Also Read: Best Ayurvedic Treatment to Cure Infertility