Assisted Reproductive Technology (ART) – Infertility Treatment

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Many couples today suffer from the inability to conceive naturally. There are many factors contributing to this issue like poor eating habits, lack of exercise, pollution, and lifestyle diseases like diabetes. Many women are now choosing to have children later in life as they concentrate on their careers. Contrary to popular belief, both men and women are experiencing a significant increase in the cases of infertility. Infertility is also no longer an urban phenomenon. It is seen in tier 2 and tier 3 cities too.

What is Assisted Reproductive Technology?

Any procedure or treatment that involves handling eggs, sperm, or embryos outside the body for issues with fertility is known as assisted reproductive technology or 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 quality, irregular ovulation, or failure to ovulate due to hormonal imbalances. These problems are often age-related and affect women especially above the age of 37.

Blocked fallopian tubes: You could have blocked fallopian tubes due to a previous infection, endometriosis, scar tissue, adhesions, or Fimbria which is damage to the ends of the tubes. Since the egg cannot reach the uterus, the sperm cannot get to the egg and fertilise it.

  • Male factor problems: In men, there could be several ways that could affect the fertility. Low sperm count, poor sperm quality, poor sperm motility, semen deficiency or a blocked epididymis 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.

  • IVF – In Vitro Fertilization

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 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. Natural Cycle IVF is when the woman is not given any fertilization treatment. Other types include Conventional IVF and Mild IVF.

  • ICSI – Intracytoplasmic sperm injection

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 decreased sperm count, low motility of the sperm, and high numbers 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.

  • IUI – Intrauterine Insemination

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

  • GIFT – Gamete intrafallopian transfer

The sperm and the eggs are combined outside the body and then directly inserted into the fallopian tube via a small incision. The fertilization happens inside the body.

  • FET – Freezing embryo transfer

When using other artificial reproductive treatments, 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.

  • Donated sperm

If the sperm quality is not good enough, a couple can opt for sperm from a donor. In India, the potential donor will be required to go through certain tests including family background checks, drug usage, semen analysis, and medical and genetic tests.

  • Donated eggs

Donated eggs can be combined with your partner’s sperm and then implanted in 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:

  • The eggs must be tested for quality, quantity, and reproductive potential. Different tests are done during the second or third day of menstruation to measure the Follicle Stimulating Hormone (FSH is present in the pituitary gland and plays a role in sexual development), estradiol (female sex hormone that is produced in 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 processes such as laparoscopy and hysteroscopy. Surgery too can be done to solve any issues that may arise. These disorders include 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 need to have a caesarean. As per the statistics published on Oxford Academic:

  • Miscarriages occur in 18% of all ART pregnancies
  • 31% of all ART deliveries are multiple pregnancies
  • 9% result in ectopic pregnancies

Other complications include:

  • Low birth weight and premature labour
  • Perinatal mortality
  • Ovarian hyperstimulation syndrome is when the abdominal cavity is filled with fluid
  • A 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 the woman the clomiphene drug. It is usually prescribed for women with PCOD where the eggs are not being produced by the ovaries.

This step is common for IVF treatments. Three hormones are administered to have several ‘ripe’ eggs. The aim is to control the woman’s menstrual cycle so that the eggs can be removed on a particular day. Unlike the regular cycle, this method has more than one egg to use.

  • 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 but under local anaesthesia. A speculum is inserted into the vagina, and a needle attached to it collects the ripe eggs.

  • 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. This is done 36 hours after fertilisation. 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 tube. 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 and IVF as well which can be tried to address mail infertility.

In IUI, the sperm is placed in a uterus 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 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 as a complication as it can cause significant risks to the mother and baby.

The chances of multiple pregnancies 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 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 40 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 25% chance of ART resulting in the birth of a live baby for women under 35 years. The success rate is around 18% for women from 35 to 39.

When you opt for artificial reproductive technology, be sure to give your doctor an exhaustive medical history of the 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