Assisted reproductive technology (ART) is a group of procedures that involve the in vitro (outside of body) handling of human oocytes (eggs) and sperm or embryos for the purposes of establishing a pregnancy. Each ART treatment involves a number of stages and is generally referred to as an ART treatment cycle. The embryos transferred to a woman can either originate from the cycle in which they were created (fresh cycle) or be frozen (cryopreserved) and thawed before transfer (thaw cycle). There were 84,064 ART treatment cycles reported from Australian and New Zealand fertility clinics in 2018 (76,341 and 7,723 respectively), representing an increase of 1.9% in Australia and 6.2% in New Zealand from 2017. This equates to 14.8 cycles per 1,000 women of reproductive age (15–44 years) in Australia, compared with 7.9 cycles per 1,000 women of reproductive age in New Zealand. Women used their own oocytes or embryos (autologous cycles) in 94.1% of treatments. Embryos and oocytes that had been frozen and thawed were used in 36.9% of autologous cycles. There were 41,927 women who undertook 79,072 autologous fresh and/or thaw cycles in Australia and New Zealand in 2018. On average, 1.9 autologous fresh and/or thaw cycles per woman were undertaken in 2018, with more cycles per woman in Australia (1.9 cycles per woman) than in New Zealand (1.7 cycles per woman). The number of cycles where embryos were selected using preimplantation genetic testing (PGT) marginally decreased from 9,169 in 2017 to 9,124 in 2018. Over the last five years the proportion of cycles where all oocytes or embryos were cryopreserved for potential future use (freeze-all cycles) has doubled from 13% of initiated fresh cycles in 2014 to 26.7% in 2018. This practice is used for a variety of reasons, including reducing the risk of ovarian hyperstimulation syndrome (OHSS), improving endometrial - embryo synchronicity, as part of a PGT cycle or for fertility preservation. Patient's age The average age of women undergoing autologous cycles in 2018 was 35.8 years, which is similar to previous years. The average age of women undergoing ART treatment using donor oocytes or embryos was around five years older at 40.3 years. Approximately one in four (23.7%) women who underwent an autologous cycle in 2018 were aged 40 years or older. The average age of male partners of women undergoing autologous and recipient cycles was 38.1 years, with approximately one-third (31.5%) aged 40 years or older. Treatment outcomes and number of babies Of the 84,064 initiated ART cycles, 70,196 (83.5%) resulted in either an embryo transfer or all oocytes/embryos being cryopreserved. Of the initiated cycles, 23.2% (19,514) resulted in a clinical pregnancy and 18.4% (15,475) in a live birth. The overall clinical pregnancy rate for cycles reaching embryo transfer was 34.4%. In 2018, there were 4 GIFT cycles resulting in 2 live births. The live birth rate per initiated autologous fresh cycle was 16.8% after freeze-all cycles were excluded, and 24.5% for fresh cycles reaching embryo transfer. The live birth rate per initiated autologous thaw cycle was 28.5% and for thaw cycles reaching embryo transfer cycle was 29.4%. There was a higher live birth rate in younger women. For women aged younger than 30 years, the live birth rate per embryo transfer was 40.4% for autologous fresh cycles and 34.9% for autologous thaw cycles. For women older than 44 years, the live birth rate per embryo transfer was 0.8% for autologous fresh cycles and 7.8% for thaw cycles. Cycle-specific success roles ANZARD includes data items that make it possible to follow a woman’s consecutive ART treatment cycles. A cohort of 15,404 women were followed from the start of their first autologous non-freeze-all fresh cycle during 2016, through subsequent fresh and thaw cycles until December 2018 or until they achieved a live birth. The cycle-specific live birth rate per initiated cycle for all women was 23.1% in their first cycle, and 11.6% in their eighth cycle. Approximately one in four women who did not achieve a live birth in a specific cycle discontinued ART treatment during the period. Trends in ART procedures Treatment trends in the last five years have included a continued shift from cleavage stage transfers to blastocyst transfers (from 67.5% in 2014 to 86.6% in 2018); an increase in vitrification as a cryopreservation method (from 85.6% of thaw blastocyst transfer cycles in 2014 to 94.1% in 2018); and a small decrease in the use of intracytoplasmic sperm injection (ICSI) (from 63.8% of embryo transfer cycles in 2014 to 60.3% in 2018). The proportion of embryo transfer cycles transferring a cryopreserved embryo increased from 47.1% in 2014 to 57.2% in 2018. Of the 15,475 live births resulting from ART treatment in 2018, 61.5% resulted from thaw cycles, compared to 48.4% in 2014. In the last five years the live birth rate per fresh embryo transfer cycle increased from 23.7% to 24.6%, and the live birth rate per thaw embryo transfer cycle increased from 24.9% to 29.3%. This could be explained by the increase in freeze-all cycles over the years. Overall, live birth rates per embryo transfer have risen from 24.3% in 2014 to 27.3% in 2018, a 12.3% improvement. Multiple birth trends A continuing trend in ART treatment in Australia and New Zealand has been the reduction in the rate of multiple births, from 4.9% in 2014 to 3.2% in 2018. This has been achieved by clinicians and patients shifting to single embryo transfer, with the proportion increasing from 79.2% in 2014 to 90.6% in 2018. Importantly, this decrease in the multiple birth rate has been achieved while overall live birth rates per embryo transfer increased from 24.3% in 2014 to 27.3% in 2018. Assisted reproductive technology (ART) refers to fertility treatments and procedures that can help with difficulties or an inability to conceive children. ART techniques involve the manipulation of eggs, sperm, or embryos to increase the likelihood of a successful pregnancy. Infertility is when people cannot conceive after a period of regular sexual intercourse without the use of birth control. Evidence suggests that roughly 10% of women aged 15–44 in the United States have difficulty conceiving or staying pregnant. Research also indicates that worldwide, 8–12% of couples experience fertility problems, and 40–50% of cases may stem from factors that affect males. According to the CDC, approximately 1.9% of all U.S. infants are born using ART. While the technology can be successful, it can also be expensive. Individuals wishing to conceive a child using ART in the U.S. can check their infertility coverage by state. In this article, we will discuss some of the different types of ART, including their success rates, benefits, risks, costs, and the ethics of the technology.
ART refers to medical procedures that aim to achieve pregnancy. These complex treatments involve influencing gametes, or eggs and sperm, to increase the chances of fertilization. ART is typically an option for people for whom other infertility treatments may not work or those who have already tried treatment but have not become pregnant. People considering ART will often discuss options with a healthcare professional and may require a consultation from a fertility specialist. While people primarily use ART to address infertility, others may use it for genetic purposes or avoid pregnancy complications. Some people may also refer to ART as fertility treatment or medically assisted reproduction. It may be difficult for many people to access fertility services such as ART due to its high cost and limited coverage by private insurance and Medicaid. There are several types of ART procedures that involve different techniques and reproductive cells. A doctor can advise which ART will be most suitable depending on the circumstances. The most common type is in vitro fertilization (IVF). IVFIVF involves a doctor extracting eggs and fertilizing them in a special lab. Specialists can combine this with an embryo transfer (IVF-ET) and transfer the resulting embryos into a person’s uterus. The Society for Assisted Reproductive Technology states that IVF-ET accounts for 99% of ART procedures. The Centers for Disease Control and Prevention (CDC) lists the 2018 success rates of IVF treatments for one oocyte retrieval from people using their own eggs as:
A person may also use a tool called an IVF success estimator to estimate their chance of having a baby using IVF. It may take more than one IVF cycle to result in pregnancy, and some people may not conceive with IVF at all. The benefits of IVF are an increased chance of fertilization and pregnancy. Potential complications may include: The National Conference of State Legislatures lists the average cost of a single IVF cycle as $12,000–17,000. Click here to learn more about IVF. Intrafallopian transferSome methods of ART are similar to IVF but use laparoscopic surgery to deliver the gametes directly into the fallopian tube. Some people may choose this method for religious reasons, or their insurance may only cover this type of ART. Similar to other forms of ART, there is an increased chance of multiple pregnancy. Additionally, due to the laparoscopy, there is a risk of complications from the surgery, such as infection, organ puncture, or side effects from anesthesia. Intrafallopian transfers are typically more expensive than IVF. Due to the higher costs and risks of this type of ART, specialists rarely use these procedures. As such, there is not much data available on their success rates. Types include:
Frozen embryo transferFrozen embryo transfer (FET) has become increasingly common in the U.S. It involves thawing previously IVF frozen embryos and inserting them into a person’s uterus. A 2017 study found that 52% of people who had FET had ongoing pregnancies. According to the United Kingdom’s Human Fertilisation and Embryology Authority, FET is as safe as using fresh embryos in treatment. However, some evidence suggests an increased risk of preterm birth with FET. Another possible risk of FET is that not all frozen embryos survive the thawing out process. The estimated cost of FET varies but can be up to $6,000. Intracytoplasmic sperm injectionIntracytoplasmic sperm injection (ICSI) is a procedure that specialists can perform alongside IVF to help fertilize an egg. An embryologist, or embryo specialist, uses a tiny needle to inject a single sperm directly into the center of an egg. ICSI fertilizes between 50–80% of eggs. The success rate of ICSI is similar to those of IVF, and it may be an effective method of ART for people with sperm-related infertility. ICSI is typically an add-on procedure to IVF, so it will be more costly than IVF alone. Things to consider about ICSI include the following:
Third-party ARTThird-party ART is when another individual donates eggs, sperm, or embryos to an individual or couple. It can also include surrogate and gestational carriers. These refer to when another person is either inseminated with sperm from the couple using ART or implanted with an embryo from those using ART. Evidence suggests that 50% of transfers with donated frozen embryos result in pregnancy, and 40% result in a live birth. Other benefits of third-party ART include the following:
Depending on which type people choose, third-party ART can be very costly. Sperm donation is typically the cheapest option, costing around $1,000 per vial. The other options can vary in cost for a single vial, and many cycles will require multiple vials. Estimated costs are: Preparation for an ART treatment includes practicing behaviors that may help improve the chances of ART success. This can involve dietary changes, such as taking supplements that a healthcare professional recommends and reducing alcohol and caffeine intake. It could also involve regular exercise and quitting smoking. Once ART is successful, prenatal care and tests can keep the pregnant person and baby healthy during pregnancy. Many aspects of ART raise ethical issues, such as:
There are no simple answers on the ethical issues of ART. The American Society for Reproductive Medicine has a collection of ethics documents available here. Persons considering ART can review their state laws or call the Office on Women’s Health Helpline at 1-800-994-9662. Many types of ART are available to treat infertility. The success rates of ART vary according to the type of ART people choose, and factors such as the individual’s age and health. A specialist will suggest ART based on an individual or couple’s preferences and type of infertility while also weighing the risks, benefits, and costs. |
What are assisted reproductive technologies how infertility is treated by assisted reproductive technologies?
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