Background

Assisted Reproductive Technology (ART) includes all clinical techniques directed toward the treatment of fertility and involves the handling of ova, sperm, or embryos outside the body. 

ART essentially means a technique that is employed to achieve conception. They are commonly applied when couples experience problems with fertility or other issues linked to reproduction. The most frequently used and widely recognized type of ART is In Vitro Fertilization or IVF. 

Indications

• Tubal Factor Infertility: Tubal obstructions or injuries may keep the sperm away from the egg or hinder the embryo from implanting in the uterus. 
• Male Factor Infertility: These include low sperm concentration, slow and weak moving sperm, or sperm with strange shapes and sizes that can hamper the rate at which the sperm can fertilize the egg. 
• Ovulatory Disorders: Such disorders like polycystic ovary syndrome or other diseases that lead to irregular menstruation or non-ovulation. 
• Unexplained Infertility: When there are failed recommendations found on diagnostic investigation without detection of general cause of infertility. 
• Endometriosis: A disease that develops from the endometrium, thus causing some obstruction to the normal functioning of the ovaries, uterus, and fallopian tubes. 
• Uterine Factor Infertility: Pathological or non-pathological anatomical disorders of the uterus, e.g., fibroids, polyps, congenital malformations of the uterus. 
• Age-related Infertility:
  Reduced fertility due to the high age of mothers. 
• Previous Tubal Sterilization: Women who have had tubal ligation and who
  would like to get pregnant again. 
• Failed Prior Fertility Treatments: If the medications or intrauterine insemination (IUI) have not worked out for the couple. 

Contraindications

• Untreated Reproductive Tract Infections: Conditions such as PID must be treated before a couple can be enrolled for ART. 
• Severe Male Factor Infertility: Even so, ART can improve many male factors of infertility, but extremely low sperm density or motility may decline the chances of techniques such as IVF. 
• Uncontrolled Medical Conditions: Several diseases like diabetes, hypertension, and thyroid may influence the results of pregnancy and might require regulation before turning to ART. 

Outcomes

Equipment

Incubators 

Microscopes 

Micro-manipulation Tools 

Centrifuges 

Sperm Analyzers 

Oocyte Retrieval Needles 

Cryopreservation Equipment 

Ultrasound Machine 

Embryo Transfer Catheters 

Air Quality Control Systems 

Laminar flow hood 

Patient Preparation

Medical Evaluation and Testing 

Patient interaction with IVF specialist 

Initial Consultation: Attend a consultative meeting with the fertility specialist to provide information on medical history including past treatment for infertility, and health. 

Blood Tests: These may include Hormone levels, Ovarian reserve and screening for infections. 

Ultrasound: To evaluate the condition of the uterus and ovaries. 

Semen Analysis: For male partners, to check the sperm concentration, viability, and shape of the sperm. 

Hysterosalpingography (HSG): To rule out tubal causes of infertility or congenital anomalies of the uterus. 

Genetic Testing: To check for any hereditary diseases or disorders. 

Lifestyle Modifications 

Diet and Nutrition: Eat a proper diet and include a healthy number of fruits, vegetables, whole grains, lean protein, and other nutritional sources.  

Advise patients to reduce their chances of drinking so much caffeine and alcohol. 

Exercise: Get moderate exercise often to avoid putting on a lot of weight. 

Quit Smoking: These modifiable factors include smoking that affects fertility in male and female. 

Stress Management: Involve in yoga, meditation, or counselling if needed. 

Medications and Supplements 

Prenatal Vitamins: It is also recommended that women should begin to take prenatal vitamins with folic acid. 

Medications: Take the recommended medicines for irregular periods and other menstrual disorders. 

Technique

In vitro fertilization 

Step 1-Ovarian Stimulation: The woman takes hormones in a process known as ovulation induction to cause her ovaries to release more than one mature egg instead of the one produced every month. 

Step 2-Monitoring: During the stimulation process blood tests and ultrasound exams are performed to check the level of hormones, as well as the development of the eggs in the woman’s body. 

Step 3-Egg Retrieval: This process happens until the eggs are ready and a procedure follicular aspiration or egg retrieval is done. To remove the eggs, a very fine needle is passed through the skin into each ovary. This procedure is often performed by use of an anesthesia. 

Step 4-Sperm Collection: Before the process of egg retrieval, the male partner ejaculates, resulting in a sperm sample that is used to prepare for fertilization of the eggs. 

Step 5-Fertilization: Then in the laboratory the sperm and the eggs are placed in a petri dish and put in a special chamber. Fertilization normally takes a few hours and then the embryos are observed for further development. 

Step 6-Embryo Culture: The fertilized eggs (embryos) are then cultured in the laboratory for several days only. At this stage, they are observed to ensure they are dividing and developing as required. 

Step 7-Embryo Transfer: Multiple embryos are transferred in uterus of women.This is done with a thin catheter passed through the cervix into the uterus, thus reducing the risk of introducing microorganisms. 

Step 8-Implantation: Pregnancy occurs when the embryo implants itself into the lining of the uterus, which is the endometrium of the uterus. Pregnancy is confirmed by a blood test approximately two weeks after the embryo transfer. 

Step 9-Freezing (Cryopreservation): Those extra embryos left over may be frozen (cryopreserved), which is helpful if the couple wishes to use them in the future. 

Step 10-Follow-Up: When pregnancy occurs, the woman is followed up for several Weeks with a view of confirming whether pregnancy is on the normal progress. 

In-vitro fertilization 

Intracytoplasmic sperm injection technique

Step 1-Preparation and Ovulation Induction: 

The female partner usually takes fertility drugs to initiate the growth of more than one egg within the ovaries. 

Step 2-Egg Retrieval: 

Once the eggs are matured, they are harvested from the ovaries using a needle with the help of ultrasound. This procedure is often performed with the help of sedation or under general anesthesia. 

Step 3-Sperm Collection: 

Sperm is produced from the male partner through ejaculation on the same day as the procedure of egg retrieval. When the male fertility problems are most serious, sperm can be gathered straight from the testicles through surgery or TESA or TESE. 

Step 4-Sperm Preparation: 

The collected sperm is placed through preparation in the laboratory. This involves subjecting it to a process that involves washing and picking the most viable sperm to be used for the ICSI technique. Sperm concentration, percentage of progressively motile sperm, and sperm morphology are usually determined during a microscopical examination. 

Step 5-ICSI Procedure: 

Sperm is chosen with the help of using a microscope, after that the sperm is directed to the cytoplasm, which is the middle of the fully grown egg, with the help of a fine thin tube or a needle. This is accomplished using micromanipulation skills to have increased accuracy and minimal invasiveness to the egg. 

Step 6-Fertilization and Embryo Development: 

After injection, the eggs are then placed in the incubator which is specifically designed to culture eggs. Fertilization is evident when paternal pronuclei are detected in the egg, this occurs about 16-20 hours after injecting the needle. 

The fertilized eggs (embryos) are then incubated for additional development proceeds in the next few days. 

Step 7-Embryo Transfer: 

Normally, one or two embryos that appear normal are transferred into the woman’s uterus with the use of a catheter. This is carried out a few days after fertilization which is normally a day 3 or 5. 

Step 8-Post-Transfer Care: 

Some of the medications that may be administrated after the embryo transfer to the uterus are those that help to support the lining of the uterus to supply the embryos adequately and ensure further implantation. 

The pregnancy test is done after approximately 10-14 days after the embryo transfer to check for implantation. 

Laboratory tests

Ovarian Reserve Testing: Fertility tests help determine the number and quality of a woman’s eggs such as FSH, estradiol, AMH and AFC. 

Semen Analysis: Testing the sperm concentration and the total sperm number, movement, shape, structure, and other criteria. 

Sperm DNA Fragmentation Test: Examining the DNA fragmentation of sperm, thereby affecting the fertilization rate and embryonic development. 

Embryo Culture and Assessment: Tracking the development of embryos in the lab and often, in an incubator, for a specified number of days; this process can be done by time time-lapse imaging and appropriate culture media. 

Endometrial Receptivity Assay: Assessing endometrial receptivity to the embryos through the hormonal tests as well as in some instances molecular assays. 

Genetic Screening: For checking and diagnosing chromosomal disorders in embryos (Preimplantation Genetic Testing; PGT) or status of a particular genetic disorder in prospective parents (Preimplantation Genetic Diagnosis; PGD). 

Complications

Multiple Pregnancies: Some forms of ARTs raise the possibility of having twins, triplets, or multiple births, which is riskier to both the mother and the fetus. 

Ovarian Hyperstimulation Syndrome (OHSS): This often happens when the ovaries are hyper-stimulated because of fertility drugs that are used in assisted reproductive techniques. Severe cases can lead to fluid buildup in the abdomen and chest. 

Ectopic Pregnancy: There is also a risk of ectopic pregnancy in which pregnancy is developed outside the womb, usually the fallopian tubes and this tends to be slightly higher in cases of ART procedures. 

Miscarriage: It has been observed that depending upon the mother’s age and nature of fertility problem, chances of miscarriages may slightly raise only in some of ART procedures. 

References

Assisted Reproductive Technology (ART) Techniques – StatPearls – NCBI Bookshelf (nih.gov) 

References

Assisted Reproductive Technology (ART) Techniques – StatPearls – NCBI Bookshelf (nih.gov)