Assisted Reproductive Technology

Introduction

Assisted Reproductive Technology (ART) has revolutionized the field of reproductive medicine, offering hope to millions of couples struggling with infertility worldwide. Assisted Reproductive Technology is defined by the World Health Organization (WHO) as “all treatments or procedures that include the in vitro handling of both human oocytes and sperm or embryos for the purpose of establishing a pregnancy”. As infertility rates continue to rise, ART has become an increasingly vital solution, helping couples overcome the physical and emotional challenges associated with infertility.

Statistics of People Who Got Pregnant via ART (Including Nigerian Statistics)

Globally, the use of assisted reproductive technology has grown exponentially, with millions of babies born through these methods since the first successful in vitro fertilization (IVF) in 1978. According to the European Society of Human Reproduction and Embryology (ESHRE), over 8
million babies have been born worldwide through ART by 2020. In Nigeria, ART has gained significant traction, with an increasing number of fertility clinics offering services to couples facing infertility.

Statistics of Successful ART

Success rates of assisted reproductive technology vary widely depending on factors such as age, the cause of infertility, and the specific ART technique used. According to the Centers for Disease Control and Prevention (CDC), the success rate of ART in the United States for women
under 35 is approximately 40% per cycle, while it drops to around 10% for women over 40. In Nigeria, success rates are slightly lower, with an average success rate of 30% per cycle for women under 35.

The Reasons for ART

There are numerous reasons why couples may turn to assisted reproductive technology, ranging from medical conditions to unexplained infertility:

1. Ovulatory Disorders:

Conditions like polycystic ovary syndrome (PCOS) and premature ovarian failure can lead to irregular or absent ovulation, making it difficult for women to conceive naturally. ART, particularly IVF, can bypass these challenges by directly fertilizing eggs in a laboratory setting.

2. Male Factor Infertility:

Low sperm count, poor sperm motility, or abnormal sperm morphology can significantly reduce the chances of natural conception. Intracytoplasmic sperm injection (ICSI), a form of ART, allows for the direct injection of a single sperm into an egg, increasing the likelihood of
fertilization.

3. Tubal Factor Infertility:

Blocked or damaged fallopian tubes can prevent sperm from reaching the egg or hinder the embryo’s journey to the uterus. IVF, which involves the retrieval of eggs and fertilization outside the body, can bypass the fallopian tubes entirely.

4. Endometriosis:

This condition, where tissue similar to the lining of the uterus grows outside the womb, can cause inflammation and scarring, leading to infertility. ART can help manage the effects of endometriosis by facilitating fertilization outside the body.

5. Unexplained Infertility:

In some cases, the cause of infertility cannot be determined despite thorough medical evaluations. ART offers these couples a chance to conceive when traditional methods have failed.

6. Genetic Disorders:

Couples with a history of genetic disorders may opt for ART combined with preimplantation genetic testing (PGT) to ensure the health of their offspring.

7. Advanced Maternal Age:

As women age, the quality and quantity of their eggs decline, making natural conception more difficult. ART, particularly egg donation, offers an alternative for older women seeking to conceive.

The Things You Need to Be Aware of Before Doing ART

1. Emotional and Psychological Impact:

The process of ART can be emotionally taxing, involving periods of hope and disappointment. Couples should be prepared for the psychological challenges and consider seeking counseling to navigate the emotional aspects of the journey.

2. Financial Costs:

ART can be expensive, with costs varying depending on the type of procedure and location. It’s essential to understand the financial implications and explore options for insurance coverage or financial assistance.

3. Physical Demands:

The procedures involved in ART, such as egg retrieval and hormone treatments, can be physically demanding. Patients should be aware of the potential side effects and the need for multiple clinic visits.

4. Ethical and Legal Considerations:

Depending on the country or state, there may be legal and ethical considerations surrounding ART, including issues related to embryo storage, surrogacy, and the use of donor gametes. Couples should be informed about the legal landscape and ensure they are comfortable with all
aspects of the process.

5. Success Rates and Risks:

Understanding the success rates and potential risks associated with ART is crucial. Couples should have realistic expectations and be aware of the possibility of multiple births, miscarriage, and other complications.

6. Long-Term Health of Offspring:

While ART is generally considered safe, some studies suggest a slightly increased risk of certain health conditions in children conceived through these technologies. It’s important to discuss these potential risks with a healthcare provider.

Types of ART

Assisted reproductive technology encompasses a variety of procedures, each with specific indications and techniques:

1. In Vitro Fertilization (IVF):

IVF is the most common form of assisted reproductive technology. It involves the stimulation of the ovaries to produce multiple eggs, which are then retrieved and fertilized with sperm in a laboratory. The resulting embryos are cultured for several days before being transferred to the
uterus. IVF is used for a wide range of infertility issues, including tubal factor infertility, male factor infertility, and unexplained infertility .

2. Intracytoplasmic Sperm Injection (ICSI):

ICSI is a specialized form of IVF where a single sperm is injected directly into an egg. This
technique is particularly useful for male factor infertility, where sperm count or motility is compromised. ICSI has significantly improved the success rates of assisted reproductive technology for couples facing male infertility.

3. Gamete Intrafallopian Transfer (GIFT):

GIFT involves placing both eggs and sperm directly into the fallopian tubes, where fertilization occurs naturally. This technique is less commonly used today but may be an option for couples with certain types of infertility.

4. Zygote Intrafallopian Transfer (ZIFT):

Similar to GIFT, ZIFT involves the transfer of a fertilized egg (zygote) into the fallopian tube. This method is also less commonly used, as IVF has largely replaced it.

5. Egg Donation:

For women who cannot produce viable eggs, egg donation offers an opportunity to conceive using eggs from a donor. The donated eggs are fertilized using IVF, and the resulting embryos are transferred to the recipient’s uterus.

6. Surrogacy:

In cases where a woman cannot carry a pregnancy to term, surrogacy involves another woman (the surrogate) carrying the pregnancy. The embryo, created using IVF, is implanted into the surrogate’s uterus.

7. Preimplantation Genetic Testing (PGT):

PGT is often used in conjunction with IVF to screen embryos for genetic disorders before implantation. This technique is particularly useful for couples with a history of genetic conditions.

Reasons Why ART May Fail

Despite advancements in assisted reproductive technology, ART does not guarantee success, and there are several reasons why it may fail:

1. Embryo Quality:

Poor embryo quality is a common reason for ART failure. Factors such as chromosomal abnormalities and genetic defects can prevent the embryo from developing properly, leading to failed implantation or early miscarriage.

2. Uterine Environment:

The condition of the uterus plays a crucial role in the success of ART. Issues such as uterine fibroids, polyps, or an abnormal endometrial lining can hinder embryo implantation.

3. Age of the Woman:

As a woman ages, the quality and quantity of her eggs decline, reducing the chances of a successful ART cycle. Women over 40 often face lower success rates due to these age-related factors.

4. Ovarian Response:

Some women may not respond well to the hormone stimulation required for egg retrieval, resulting in a lower number of eggs being available for fertilization.

5. Sperm Quality:

Poor sperm quality, including low motility and abnormal morphology, can affect fertilization and embryo development, leading to ART failure.

6. Lifestyle Factors:

Factors such as smoking, excessive alcohol consumption, and obesity can negatively impact ART outcomes by affecting egg and sperm quality, as well as the overall health of the reproductive system.

7. Unknown Factors:

In some cases, ART may fail for reasons that cannot be easily identified. These unexplained failures can be particularly frustrating for couples and may require further investigation or alternative treatments.

What to Do When ART Fails

When assisted reproductive technology fails, it can be a deeply emotional and challenging experience. However, there are several steps couples can take to evaluate their options and decide on the best course of action moving forward:

1. Consult with Your Fertility Specialist:

After a failed ART cycle, it is essential to have a detailed consultation with your fertility specialist. This discussion should involve a thorough review of the cycle, including the quality of eggs, sperm, and embryos, as well as the uterine environment. Your specialist may recommend
additional tests or modifications to your treatment plan based on these findings.

2. Consider Additional Testing:

If ART has failed, it might be necessary to conduct further testing to identify any underlying issues that were not previously detected. This could include genetic testing, immunological assessments, or a more in-depth evaluation of the uterine environment. Identifying and addressing these factors can increase the chances of success in subsequent cycles.

3. Evaluate Lifestyle Changes:

Sometimes, simple lifestyle modifications can significantly impact the success of ART. If you smoke, drink alcohol, or have a poor diet, consider making changes to improve your overall health. Weight management, stress reduction, and regular exercise can also play a role in enhancing fertility.

4. Consider Alternative ART Methods:

If one type of ART has failed, your specialist may suggest trying a different approach. For example, if standard IVF was unsuccessful, techniques like ICSI, PGT, or the use of donor eggs or sperm might be recommended. Each method has its own set of advantages and may offer a better chance of success depending on your specific circumstances.

5. Take a Break if Needed:

The physical, emotional, and financial stress of ART can be overwhelming. Taking a short break between cycles may help you and your partner regain strength, both mentally and physically. Use this time to focus on self-care and consider counseling to help manage the emotional toll.

6. Explore Third-Party Reproduction Options:

If repeated ART cycles using your own eggs or sperm have been unsuccessful, you may want to explore third-party reproduction options, such as egg or sperm donation, or surrogacy. These options can significantly increase the likelihood of a successful pregnancy and are worth
considering if traditional ART methods have not worked.

Conclusion

Assisted Reproductive Technology offers a range of options for couples struggling with infertility, providing hope where natural conception may not be possible. However, the journey through ART can be complex and challenging, with varying success rates influenced by numerous
factors. Understanding the intricacies of assisted reproductive technology, from the reasons for its use to the potential for failure, is crucial for making informed decisions. Whether ART succeeds or fails, it is essential to remain informed, seek support, and consider all available options to achieve your desired outcome.

FAQs

Q1. What is Assisted Reproductive Technology (ART)?

Ans. Assisted Reproductive Technology (ART) refers to medical procedures used to help individuals or couples conceive when they are unable to do so naturally. This includes treatments like in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and egg donation.

Q2. Who can benefit from ART?

Ans. ART is beneficial for individuals or couples facing infertility due to factors like ovulatory disorders, male factor infertility, tubal blockages, endometriosis, and unexplained infertility. It is also used by same-sex couples and single individuals wishing to conceive.

Q3. What are the success rates of ART?

Ans. Success rates of ART vary based on factors like age, underlying health conditions, and the specific ART method used. For example, IVF success rates are around 40% for women under 35, but decrease with age.

Q4. Is ART safe?

Ans. ART is generally safe, but like any medical procedure, it carries some risks, including ovarian hyperstimulation syndrome (OHSS), multiple births, and potential long-term health impacts on the child. It’s important to discuss these risks with your healthcare provider.

Q5. How many ART cycles are typically needed?

Ans. The number of ART cycles needed can vary. Some couples achieve success on the first cycle, while others may require multiple cycles. On average, it may take 3-4 cycles to achieve a successful pregnancy.

Q6. Can lifestyle changes improve ART outcomes?

Ans. Yes, lifestyle factors such as maintaining a healthy weight, quitting smoking, reducing alcohol intake, and managing stress can improve the chances of success with ART.

Q7. What should I do if ART fails?

Ans. If ART fails, it’s important to consult with your fertility specialist to review what went wrong and discuss potential next steps. These might include trying a different ART method, making lifestyle changes, or exploring alternative family-building options like adoption.