From Wikipedia, the free encyclopedia
Assisted reproductive technology
(ART) is a general term referring to methods used
to achieve pregnancy by
artificial or partially artificial means. It is reproductive technology used
primarily in infertility treatments. Some forms of
ART are also used in fertile couples for genetic reasons.
ART is also used in couples who are discordant for certain
communicable diseases, i.e. Aids, to reduce the risk of infection when
a pregnancy is desired. The term also includes any reproductive
technique involving a third party e.g. a sperm donor. There is yet
no strict definition of the term.
While there is no consensus on the definition, generally the
process of intercourse is bypassed either by insemination (example
fertilization of the oocytes
in the laboratory environment (i.e. in IVF).
- The Centers for
Disease Control and Prevention(CDC) -- which is required as a
result of the 1992 Fertility Clinic Success Rate and Certification
Act to publish the annual ART success rates at U.S. fertility
clinics—defines ART to include "all fertility treatments in which
both eggs and sperm are handled. In general, ART procedures involve
surgically removing eggs from a woman’s ovaries, combining them
with sperm in the laboratory, and returning them to the woman’s
body or donating them to another woman." According to CDC, "they do
not include treatments in which only sperm are handled (i.e.,
intrauterine—or artificial—insemination) or procedures in which a
woman takes medicine only to stimulate egg production without the
intention of having eggs retrieved."
Procedures are mainly fertility medication, as well as
ART techniques that use more substantial and forceful
interventions, of which in vitro fertilisation (IVF) and
expansions of it (e.g. OCR, AZH, ICSI, ZIFT) are the most
prevalent. However, there are also other manual ART, not
necessarily dependent on IVF (e.g. PGD, GIFT, SSR).
Most fertility medication are agents that stimulate the
development of follicles in the ovary. Examples are gonadotropins
and gonadotropin releasing hormone.
In vitro fertilisation (IVF) is the technique of letting fertilisation of
the male and female gametes (sperm and egg) occur outside the
transfer is the step in the process whereby one or several
embryos are placed into the uterus of the female with the intent to
establish a pregnancy.
The following are techniques involved in, or requiring, in vitro
fertilisation. In vitro fertilization does not necessarily involve
- Transvaginal ovum retrieval (OCR) is the
process whereby a small needle is inserted through the back of the
vagina and guided via ultrasound into the ovarian follicles to
collect the fluid that contains the eggs.
- Assisted zona hatching (AZH) is
performed shortly before the embryo is transferred to the uterus. A
small opening is made in the outer layer surrounding the egg in
order to help the embryo hatch out and aid in the implantation
process of the growing embryo.
injection (ICSI) is beneficial in the case of male factor
infertility where sperm counts are very low or failed fertilization
occurred with previous IVF attempt(s). The ICSI procedure involves
a single sperm carefully injected into the center of an egg using a
microneedle. This method is also sometimes employed when donor
sperm is used.
Intracytoplasmic Sperm Injection (ICSI)
- Autologous endometrial
coculture is a possible treatment for patients who have failed
previous IVF attempts or who have poor embryo quality. The
patient’s fertilized eggs are placed on top of a layer of cells
from the patient’s own uterine lining, creating a more natural
environment for embryo development.
- In zygote intrafallopian
transfer (ZIFT), egg cells are removed from the woman's ovaries
and fertilized in the laboratory; the resulting zygote is then
placed into the fallopian tube.
- Cytoplasmic transfer is the
technique in which the contents of a fertile egg from a donor are
injected into the infertile egg of the patient along with the
donors are resources for women with no eggs due to surgery,
chemotherapy, or genetic causes; or with poor egg quality,
previously unsuccessful IVF cycles or advanced maternal age. In the
egg donor process, eggs are retrieved from a donor’s ovaries,
fertilized in the laboratory with the sperm from the recipient’s
partner, and the resulting healthy embryos are returned to the
- A gestational carrier is an option when a
patient’s medical condition prevents a safe pregnancy, when a
patient has ovaries but no uterus due to congenital absence or
previous surgical removal, and where a patient has no ovaries and
is also unable to carry a pregnancy to full term.
- Preimplantation genetic
diagnosis (PGD) involves the use of genetic screening
mechanisms such as Fluorescent In Situ Hybridization (FISH) or
Comparative Genomic Hybridization (CGH) to help identify
genetically abnormal embryos and improve healthy outcomes.
The following Assisted Reproduction techniques don't necessarily
- In gamete intrafallopian
transfer (GIFT) a mixture of sperm and eggs is placed directly
into a woman’s fallopian tubes using laparoscopy following a
transvaginal ovum retrieval.
selection is the attempt to control the sex of offspring to
achieve a desired sex. It can be accomplished in several ways, both
pre- and post-implantation of an embryo, as well as at birth.
Pre-implantation techniques include PGD, but also sperm sorting.
- Artificial insemination (AI) is
when sperm is placed into a female's uterus (intrauterine) or
cervix (intracervical) using artificial means rather than by
- Conception devices, such as a conception cap are used to aid conception
by enhancing the natural process. Conception caps are used by
placing semen into a small
conception cap, then placing the cap onto the cervix. This holds the semen at the cervical os, protecting the semen from the
acidic vaginal secretions and keeping it in contact with the
- Artificial insemination by
donor is used in situations where the woman doesn't have a
partner with functional sperm. Instead, a sperm donor supplies
- Surrogacy, where a
woman agrees to become pregnant and deliver a child for a
contracted party. It may be her own biological child, or a child
conceived through in vitro
fertilization or embryo transfer using another woman's
- Reproductive surgery, treating
e.g. fallopian tube obstruction
and vas deferens
obstruction, or reversing a vasectomy by a reverse vasectomy.
- In surgical sperm
retrieval (SSR) the reproductive urologist obtains sperm from
the vas deferens, epididymis or directly from the testis in a short
- By cryopreservation, eggs, sperm and
reproductive tissue can be preserved for later IVF.
The majority of IVF-conceived infants do not have birth
However, some studies have suggested that assisted reproductive
technology is associated with an increased risk of birth
In the largest U.S. study, which used data from a statewide
registry of birth defects,
6.2% of IVF-conceived children had major defects, as compared with
4.4% of naturally conceived children matched for maternal
age and other factors (odds ratio, 1.3; 95% confidence
interval, 1.00 to 1.67).
The main risks are:
Other risk factors are:
donation is an exception, with a birth defect rate of almost a
fifth compared to the general population. It may
be explained by that sperm banks accept only people with high sperm
Assisted reproductive technology procedures performed in the
U.S. has more than doubled since 10 years ago, with 140.000
procedures in 2006,
resulting in 55.000 infants born.
In Australia, 3.1
percent of babies now born are a result of ART.
States of America
Not everyone in the U.S. has insurance coverage for fertility
investigations and treatments. Many states are starting to mandate
coverage, and the rate of utilization is 277% higher in states with
There are some health insurance companies that cover diagnosis
of infertility but frequently once diagnosed will not cover any
2005 approximate treatment/diagnosis costs (United States, costs
- Initial workup: hysteroscopy, hysterosalpingogram, blood tests ~$2,000
- Intrauterine Insemination (IUI) fka Artificial insemination ~
$200– 900 per. trial
- Sonohysterogram (SHG) ~ $600 – 1,000
- Clomiphene citrate cycle ~ $ 200 - 500
- IVF cycle ~ $10,000 -30,000
- Use of a surrogate mother to carry the child -
dependent on arrangements
Another way to look at costs is to determine the cost of
establishing a pregnancy. Thus if a clomiphene treatment has a
chance to establish a pregnancy in 8% of cycles and costs $500, it
will cost ~ $6,000 to establish a pregnancy, compared to an IVF
cycle (cycle fecundity 40%) with a corresponding cost of
For the community as a whole, the cost of IVF on average pays
back by 700% by tax from future employment by the conceived human
In the UK all patients have the right to preliminary testing,
provided free of charge by the National Health Service.
However, treatment is not widely available on the NHS and there can
be long waiting lists. Many patients therefore pay for immediate
treatment within the NHS or seek help from private clinics.
In Sweden, official fertility clinics provide most necessary
treatments and initial workup, but there are long waiting lists,
especially for egg donations, since the donor gets just as low
reward as the receiving couple are charged. However, there are
private fertility clinics.
Some treatments are covered by OHIP (public health insurance) in
Ontario and others are not. If you are undergoing artificial
insemination or if you have bilaterally blocked fallopian tubes and
are under 40, the treatment is covered but you are still required
to pay lab fees which are around $3,000-4,000. Coverage would vary
in other provinces. Most other patients are required to pay for
Israel's National Health Insurance, which is mandatory for all
Israeli citizens, covers nearly all fertility treatments.
In-Vitro-Fertilization costs are fully subsidized up to the birth
of two children for all Israeli women, including single women and
lesbian couples. Embryo transfers for purposes of gestational
surrogacy are also covered.
Some couples find it difficult to stop treatment despite very
bad prognosis, resulting in futile therapies, and may put ART
providers a hard choice whether to continue or refuse
For treatment-specific ethical considerations, see entries
individual articles, e.g. In vitro fertilisation#Ethics,
Films and other fiction depicting emotional struggles of
assisted reproductive technology have had an upswing first in the
latter part of the 2000s decade, although the techniques
have been available for decades.
Yet, the amount of people that can relate to it by personal
experience in one way or another is ever growing, and the variety
of trials and struggles are huge.
Any individual examples are referred to individual
subarticles, e.g. surrogacy and sperm
In addition, reproduction
and pregnancy in speculative fiction has been present for many
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Infertility by the numbers Colleen Mastony. June 21, 2009
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Heartache of infertility shared on stage, screen By Colleen
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