What is Assisted Reproductive Technology – ART ?

Author Name: Dr. Ritu Punhani || Mentor Name: Dr. Nitasha Gupta on April 24, 2020

Parenthood has the power to redefine life. It brings immense joy and is the most exhilarating and daunting experience for a couple. Every couple wants to have a child at some point of time in their life, however many are deprived mostly due to some medical reasons. In the past, there was no treatment for most of them, but the advent of assisted reproductive technology has helped most of such couples to turn their dreams into a reality.

Assisted Reproductive technology (ART) is the umbrella term given to describe a number of different treatments that can help a couple to achieve pregnancy. It has no single definition and it is usually illustrated in contrast to sexual intercourse as the method of reproduction. It refers to the handling of egg ,sperm or embryos outside of the body. Thanks to this technology which has helped people to overcome several kinds of fertility issues. Although there are a wide range of procedures under the cover of this umbrella, but the best option for a couple will
depend on their cause of infertility and also on their personal situation. At times only one of the partner might need the treatment and other times both partners can use a combination of treatments together.

Doctors have been trying since long to help the infertile couples to start their family by using this technology .The various treatments included in this are Intrauterine insemination( IUI), In-vitro fertilization (IVF), Intra-cytoplasmic sperm injection(ICSI), Oocyte in-vitro maturation (IVM), and Vitrification. The first artificial insemination was documented by famous Scottish surgeon, John Hunter in the 1770s. Since then, there has been no looking back, infact many new techniques have been introduced and have brought better chances of success.

IUI was one of the first and simplest forms of ART. It involves semen collection , followed by preparation and finally insertion of the washed semen into the uterus (womb) of the woman around the time the ovary releases one or more eggs to be fertilized. Patent tubes is the most important prerequisite for performing IUI.

A cycle of IUI can be undertaken in a normal cycle or with fertility drugs, depending on the reasons for infertility. It is usually suitable only for selected couples like the ones with mild male factor infertility, cervical factor of infertility , and those couples without any fertility problems, like unexplained infertility,
single women and same-sex couples. Donor sperms are also used by some women to get pregnant.

IVF is probably one of the best known forms of this technology. The upsurge from artificial insemination to IVF was real massive. The history of early attempts of IVF dates back to 1890 and around 80 years later , Robert Edwards and Patrick Steptoe performed their first successful IVF in humans on 25th July 1978, which lead to the birth of the first test tube baby of the world, Louise Brown. In essence, here the eggs and sperms are combined outside in a petri dish in the laboratory to form the embryos, which are later placed in the uterus. Ever since the first born IVF baby, more than eight million babies have been born world -wide so far through its use.

IVF has helped many couples who otherwise would have been unable to conceive, especially the ones with blocked and damaged tubes , females with advanced age & low ovarian reserve, males with impaired sperm production , retrograde ejaculation and erectile dysfunction . There are few other conditions like endometriosis, polycystic ovarian disease , ovulatory disturbances , premature ovarian insufficiency and unexplained infertility which can also be benefited with IVF. In most of the above mentioned conditions, patient can directly opt for IVF with success rates being quite good in present times. Contrary to the popular conception, there are several different ways of doing IVF, like natural cycle IVF, conventional IVF and mild stimulation IVF and all these differ depending on the
amount of stimulation which is given during an IVF cycle.

The introduction of ICSI in 1992 by Palermo , revolutionized the treatment of infertile couples and has been heralded as a ground-breaking technique since then. Here the zona pellucid is bypassed and a single selected sperm is injected into the cytoplasm of oocyte which increases the chances of fertilization and subsequent embryo development. In ICSI the sperm selection is reliant on human choice, unlike in conventional IVF where the best sperm is chosen by natural selection. Today, worldwide ICSI is being utilized in almost 66% of all assisted reproductive treatment cycles especially so in patients with severe male factor infertility and in those with previous fertilization failure.

Oocyte in vitro maturation emerged as a promising, attractive and exciting form of ART in 1994. In this technique the immature eggs are collected from a woman’s ovaries during a natural unstimulated cycle, which are then artificially matured in the laboratory and once they have reached sufficient maturity, ICSI is performed to
achieve fertilization. Hence, by using this technique multiple embryos can be created without giving any fertility drugs. This technology has the potential to replace the standard IVF techniques and has few advantages over it such as cost reduction, simplicity, and elimination of ovarian hyperstimulation syndrome. Worldwide, over 5000 babies have been born so far using this technology.

Vitrification is the most recent and advanced assisted reproductive technology. Since last two decades it has been commonly used to freeze eggs, sperm and embryos. The first live birth derived from a frozen embryo was reported in 1984 and since then the freeing techniques have undergone a major evolution. The previous techniques used for freezing were risky, however ,with the advent of vitrification scenario has changed for good ,as thawing success rate for embryos has increased drastically. This treatment option is being widely used in clinical practice and has progressively eliminated fresh embryo transfers, integrated preimplantation genetic testing with IVF/ICSI and also contemplated the use of cryopreserved oocytes as a viable resource.

Over the last few decades, assisted reproductive technologies have proven to be a blessing to numerous childless couples and has helped them in various ways by providing a chance of experiencing parenthood. The rapid evolution in the treatment of infertile couple has been an extraordinary restorative accomplishments throughout the world. The extensive refinement of techniques in this field has opened up opportunities in finding solutions to fertility problems which in the ancient times were considered impossible.