Definition & Overview
In the past, the only way infertile couples were able to have a child of their own was through adoption or surrogacy. With advances in medical technologies, such as different assisted reproductive technology (ART) techniques, the chances of having a child of their own flesh and blood has greatly improved.
ART refers to a group of medical techniques designed to induce pregnancy. The procedures are primarily for couples who have problems with their reproduction systems, but women without partners who would also like to conceive a child can also benefit from the said techniques.
Among the most popular methods of ART is in vitro fertilization or IVF. This involves surgically removing a female egg (oocyte) from the ovary and fertilizing it in a laboratory environment. IVF was first introduced in 1978. At that time, only women with blocked fallopian tubes were considered as good candidates for the procedure. However, improvements in technology and processes have enabled doctors to perform such procedure on women with other infertility problems as well.
Other methods of ART include intrauterine insemination (IUI) and third party-assisted ART. IUI is ideal for cases wherein the male partner has problems, such as a low sperm count, ejaculation problems, or cannot get or maintain an erection. The procedure is also recommended for women who have cervix defects or who prefer to conceive without a male partner.
Meanwhile, third party-assisted ART is recommended for couples who cannot produce a healthy egg or sperm. In such cases, sperm or egg is obtained from a donor.
Who should undergo and expected results
In vitro fertilization and other forms of ART are usually recommended for women who have reproductive problems. However, none of the procedures can guarantee positive results.
The success of any assisted reproductive technique relies heavily on several factors, such as age, the cause of infertility, the clinic performing the procedure, the type of ART, and the quality of egg and sperm. In the United States, the Centers for Disease Control and Prevention (CDC) estimates that the success rate is only 39% for women under the age of 35. This percentage decreases as women get older.
Aside from having a relatively low success rate, ART procedures tend to be expensive. Nevertheless, these procedures have helped countless women all over the world conceive children of their own.
How the procedure works
Prior to any form of ART, candidates will undergo an infertility test to determine the exact problem and the form of treatment that will deliver the highest percentage of success.
Infertility testing includes several different procedures, such as an examination of the uterine cavity via a sonohysterogram or hysterosalpingogram. Blood tests and semen analysis will also be performed. Any abnormalities of the uterus that are revealed during the tests will need to be corrected prior to performing any form of ART.
An IVF procedure will typically involve the following steps:
- The first step is to stimulate the ovary or to induce ovulation. This is achieved through medications that are injected for one or two weeks. The clinic will monitor the development of the eggs closely, and once they mature, the process will move to step two.
- In step two, the mature egg is retrieved by suctioning it from the ovary using a needle. This procedure is performed using a mild sedative and will usually take around half an hour to complete.
- In step three, the retrieved egg is fertilized in a laboratory environment by introducing a healthy sperm. If a sperm is unable to fertilize the egg without any assistance, it will be injected directly into the egg. However, before performing such a procedure, the sperm will be retested for any genetic problems that may be preventing it from penetrating the egg without any assistance.
- After about a week, the fertilized egg will begin to form an embryo. The embryo will then be injected into the uterus to complete the IVF procedure.
Intrauterine Insemination (IUI) is less complex than IVF, in a sense that the egg will no longer be retrieved from the uterus prior to fertilization. In IUI, the male partner's sperm is injected directly into the uterus once the egg is mature.
Third party-assisted ART is similar to IUI with the main difference that a donor provides the egg or sperm.
Possible risks and complications
Some of the reasons why IVF and other ART techniques have a low success rate are the many risks involved in the procedure and possible complications.
Couples who have infertility problems may find themselves stressed due to their condition. ART and IVF may give them hope, but they can also cause additional stress, especially if the procedures fail. Therefore, it's imperative that couples know exactly what to expect.
Other risks include miscarriage, ectopic pregnancy, birth defects, multiple births, and premature delivery. The percentage of miscarriage of pregnancies through IVF compared to normal pregnancies is about the same. However, if IVF was performed using a frozen embryo, the possibility of a miscarriage happening increases slightly.
Risks are also present during the procedure itself. For instance, in an IVF, the mature egg has to be retrieved from the ovary. However, the procedure can result in abnormal bleeding, damage to the bowel or bladder, and adverse reactions to an anesthetic should one be used.
Another risk is the use of fertility drugs to induce ovulation. These drugs may cause a condition called ovarian hyperstimulation syndrome. Although the condition is not known to be life threatening, it can produce symptoms such as diarrhea, vomiting, abdominal pains, and bloating. Severe cases of the condition, which are very uncommon, result in weight gain and difficulty breathing.
Lobo RA. Infertility: etiology, diagnostic evaluation, management, prognosis. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, Pa: Elsevier Mosby; 2012: chap 41.
Goldberg JM. In vitro fertilization update. Cleve Clin J Med. May 2007; 74(5): 329-38. The Practice Committee of the Society for Assisted Reproductive Technology and the Practice Committee of the American Society for Reproductive Medicine. Criteria for number of embryos to transfer: a committee opinion. Fertil Steril. Jan 2013;99 (1):44-46.
Jackson RA, Gibson KA, Wu YW, et al. Perinatal Outcomes in Singletons following in vitro fertilization: a meta-analysis. Obstet Gynecol. 2004;103: 551-563.