2019-20

Assisted Reproductive Techniques

(ART)

Jerusha Anna Philipose

XII - B
Roll No : 7
 Introduction
Assisted Reproductive Techniques are medical procedures used primarily to address infertility. It
includes procedures such as In Vitro Fertilization (IVF). It may include Intracytoplasmic Sperm
Injection (ICSI, Cryopreservation of gametes or embryos, and/or may involve the use of fertility
medication. When used to address infertility, it may also be referred to as fertility treatment. ART
mainly belongs to the field of reproductive endocrinology and infertility. Some forms of ART are
also used concerning fertile couples for genetic reasons (preimplantation genetic diagnosis). ART
may also be used in surrogacy arrangements, although not all surrogacy arrangements involve
ART. It is treatments or procedures that include handling of human eggs and sperm or embryos
to establish a pregnancy.

It involves surgically removing eggs from

women and combining them with sperm in the
laboratory. ART also helps in solving
abnormalities due to genetic issues infertile
couples. Couples also choose ART if they are
incongruous to particular communicable
diseases. ART techniques help to reduce the infection risks at the time of pregnancy parturition
and lactation.

These ART data are a rich source of information that can give potential ART users an idea of their
average chances of success per ART cycle or ART transfer. Average chances, however, do not
necessarily apply to a particular individual or couple. ART success rates vary in the context of
patient and treatment characteristics, such as age, infertility diagnosis, number of embryos
transferred, type of ART procedure, use of techniques such as ICSI, and history of previous births,
miscarriages, and ART cycles. People considering ART should consult a physician to discuss their
treatment options.
 INFERTILITY
Infertility is the inability of a
person to reproduce by natural means.
It is usually not the natural state of a
healthy adult. It is the inability to
become pregnant after one year of
intercourse without contraception
involving a male and female partner. It
may be that one partner cannot
contribute to conception, or that a woman is unable to carry a pregnancy to full term.
There are many causes of infertility, including some that medical intervention can treat.
Estimates from 1997 suggest that worldwide about five percent of all heterosexual
couples have an unresolved problem with infertility. Many more couples, however,
experience involuntary childlessness for at least one year: estimates range from 12% to
28%. Infertility in 25–40% cases are due to combined problems in both parts (both the
female and male).

Factors affecting Conception:

 production of healthy sperm.

 healthy eggs by the woman.
 Unblocked fallopian tubes.
 The ability of the sperm to fertilize the egg.
 The ability of the embryo to implant in the uterus.

Fertility declines with age in both men and women,

but the effects of age are much greater in women. In
their 30s, women are about half as fertile as they are in
their early 20s, and women's chance of conception
declines significantly after age 35.6 Male fertility also declines with age, but more
gradually.

There actually can be several different causes of infertility. Some of the causes can be
fixed with certain lifestyle changes while other causes would involve more invasive
procedures. In spite of the different causes of infertility, the great news is that there are
alternative methods you can take to get pregnant.
Female Infertility
Female infertility refers to infertility in women. It affects an estimated 48 million women,
with the highest prevalence of infertility affecting people in South Asia, Sub-Saharan Africa,
North Africa/Middle East, and Central/Eastern Europe and Central Asia. Infertility is caused by
many sources, including nutrition, diseases, and other malformations of the uterus. Infertility
affects women from around the world, and the cultural and social stigma surrounding it varies.
Female Infertility is the cause for 20–35% of Infertility cases.

Causes:
 Age: The ability to conceive starts to fall around the age of 32 years.

 Smoking: Smoking significantly increases the risk of infertility in both men and women,
and it may undermine the effects of fertility treatment. Smoking during pregnancy
increases the chance of pregnancy loss.

 Alcohol: Any amount of alcohol consumption can affect the chances of conceiving.

 Being obese or overweight: This can increase the risk of infertility in women as well as
men.
 Eating disorders: If an eating disorder leads to serious weight loss, fertility problems may
arise.
 Sexually Transmitted Infections (STIs):
 Eg: Chlamydia can damage the fallopian tubes in a woman.
 Exposure to some chemicals: Some pesticides, herbicides, metals, such as lead, and
solvents have been linked to fertility problems in both men and women. A mouse study
has suggested that ingredients in some household detergents may reduce fertility.
 Ovulation Disorders
 Blocked fallopian tubes caused by a pelvic inflammatory disease or endometriosis ( a
condition that causes adhesions and cysts)
Male Infertility
Male infertility refers to a male's inability to cause pregnancy in a fertile female. In humans, it
accounts for 40–50% of infertility. It affects approximately 7% of all men. Male infertility is
commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure
of male fecundity. The main sign of male infertility is the inability to conceive a child. There may
be no other obvious signs or symptoms. In some cases, however, an underlying problem such as
an inherited disorder, a hormonal imbalance, dilated veins around the testicle or a condition that
blocks the passage of sperm causes signs and symptoms.
Causes:
Male infertility is due to low sperm production, abnormal sperm function or blockages that
prevent the delivery of sperm. Illnesses, injuries, chronic health problems, lifestyle choices, and
other factors can play a role in causing male infertility. Some common causes are
· Azoospermia - lack of sperm production.
· Inability to ejaculate normally.
· Varicocele - Veins in the scrotum are enlarged which can heat the inside of the scrotum and
can affect sperm production.
· Teratospermia – increased percentage of abnormal shapes of the sperm.
Statistics of Infertility :
 Infertility affects more than 15% of the couples in the United States.
 About one-third of infertility cases are caused by male factors.
 In about 20% of infertile couples, the cause is unknown.
 The remaining one-third of infertile cases is caused by a combination of factors in both
partners.
 The chances of becoming pregnant decreases 3–5 % per year after the age of 30.

Infertility is not an easy condition and is certainly very difficult to deal and face. Fortunately, we live
in a time where there are many ART treatments available that help to deal with this situation and
solve it.

Assisted Reproductive Technology (ART)

Assisted Reproductive Technology is a number of different processes for the treatment of infertility.
It helps to own pregnancy in different methods like in vitro fertilization, surrogacy, and fertility
medications. ART falls into the category of field endocrinology and cryopreservation, reproductive
technology and infertility treatments, and intracytoplasmic sperm injection (ICSI).

ART also helps in solving abnormalities due to genetic issues in the fertile couples. Couples also
choose ART if they are incongruous to particular communicable diseases. ART techniques help to
reduce the infection risks at the time of pregnancy parturition and lactation.
 Infertility is not an easy condition and is certainly very difficult to deal and face. However, there are
many ART treatments available that help to deal with this situation and solve it. Various types of
ART to solve infertility complications are

 In Vitro Fertilization (IVF)

 GIFT
 ZIFT
 Intracytoplasmic sperm injection (ICSI)
 Intrauterine Insemination (IUI)
 Surrogacy
 Donor Eggs

In Vitro Fertilization (IVF)

In Vitro Fertilization or IVF is one of the most common types of ART techniques. Majority of the
patients opt for IVF over other ART methods. In this method, a woman’s egg and a man’s sperm
are undergoing combination in the laboratory. The next step is to transfer the embryo inside the
woman’s uterus immediately after the fertilization of the embryo.

The method starts with the keeping track of the woman’s ovulatory process and stimulating it in
order to remove an egg (ovum or ova) from the woman’s ovaries. The eggs are kept with sperm in
a liquid for fertilization in a laboratory. The fertilization of egg results in the formation of zygote.

Furthermore, the zygote undergoes embryo culture for the duration of 2-6 days. Finally, transfer of
the embryo culture in the same or another woman’s uterus takes place with the aim for the
establishment of a successful pregnancy.

Gamete Intrafallopian Transfer (GIFT)

Earlier before the advancement of technology, Gamete Intrafallopian Transfer (GIFT) was very
common for couples having infertility issues. In this method, eggs from woman and sperms from
man undergo combination by employing laboratory techniques in the lab.

Later, the eggs are implanted in the fallopian tube of the female. The fertilization occurs inside the
body of the women by applying GIFT treatments and not in the lab. Couples who want a natural
treatment so that the fertilization and implantation process occurs inside the woman’s body opt for
this form of assisted reproductive technology.
(Source: explorebiotech)

Zygote Intrafallopian Transfer (ZIFT)

This is another form of assisted reproductive technology. ZIFT is similar to IVF and embryo transfer.
However, the primary difference is that the embryo transfer after fertilization is done in the
fallopian tube in case of ZIFT whereas in case of IVF the embryo is transferred in the uterus. The
other name of this method is TET (tubal embryo transfer) due to the transfer of embryo directly
into the tubes. The next step in the process is to transfer the fertilized egg in the fallopian tube at
24 hours.

Intra Cytoplasmic Sperm Injection

It is a special form of in vitro fertilization technique that helps in the formation of an embryo in the
man by direct injection of the sperm into the egg/ovum. In this technique, it is possible to directly
inject a single sperm cell into the cytoplasm of the ova. This technique helps in the preparation of
gametes and formation of embryos which is finally transferred into the uterus of the woman.

Source: explorebiotech
Source: Wikipedia

Intrauterine Insemination (IUI)

Intrauterine Insemination is the process of transfer of a man’s sperm into a woman’s uterus with
the help of a long narrow tube. Moreover, it is possible to apply this method in combination with
stimulation of ovulation. Together the processes can sometimes increase the chances of pregnancy.

The success rate of this technique completely depends upon the reason of infertility. Additionally, it
is possible to increase the success rate of this method by nearly 20 percent if the inseminations
take place on a monthly basis with fresh or frozen sperms. However, the increase of success rate
depends upon woman’s age, fertility medications, infertility diagnosis and many other reasons.

(Source: Wikimedia)

Surrogacy

Surrogacy refers to the process where another woman bears a baby of the couple facing infertility
issues. The formation of the baby can take place either by fertilization of egg and sperm from the
couple or from donor egg and sperm. Thus, we can say a surrogate act as the carrier of the baby.

Donor Eggs

This ART method is applicable when it is not possible to see the woman’s eggs or there is some
defect in the formation of eggs. The eggs/ova of the donor is taken. Therefore, the donor eggs
further undergo fertilization with the man’s sperm. Moreover, the embryo remains in incubating
condition until the transfer of the embryo to the woman’s uterus. The same process is applicable
using sperm from a donor if the same problem lies in male member of the couple.

As we can see, there are many options available for the treatment of infertility. However, these
techniques require very high precision technique along with expensive instruments and
experienced and trained professionals. The numbers of centres are gradually increasing but still,
there are very few centres in the country. Moreover, many factors such as religious, social and
emotional play an important role and sometime deterrent in the adoption of this method.

The main aim of the method is to have children. However, one thing that majority of the couple
unable to have children overlook is that there are many orphan and destitute children in need of
proper a life. These children will not even survive till maturity if they do not get a good life.
Moreover, there are laws in India that help a couple to adopt these children.

The couples if opting for this option for parenthood, not only they will be able to have a child but
they will also be able to give a proper and healthy life for the children who are in dire need for this.