Assisted (Advanced) Reproductive Technology (ART)

Assisted Reproductive Technology (ART) is the application of laboratory or clinical technology to sperm, eggs or embryos to assist a couple achieve pregnancy. The acronym "ART" is often interchangeable as "Assisted Reproductive Technology" and "Advanced Reproductive Technology" because there is no firm definition for either.

What is ART?

Assisted Reproductive Technology started as an experimental procedure called in vitro fertilization (IVF) in the mid-1970's, when doctors attempted to join a man's sperm and a woman's egg in a glass dish in a laboratory. In 1977, for the first time, conception occurred outside a woman's body and went to term. Nine months later, on July 25, 1978, Louise Brown was born. At the time, she was called the first "test tube" baby.

Now, more than two decades later, ART includes not only in vitro fertilization (IVF), but other state-of-the-art treatment options tailored to a patients' specific needs. The various technologies can be mixed and matched to increase the likelihood of success. Today, almost one out of every three ART cycles results in the birth of a baby. Younger couples who use IVF frequently achieve 50-70 percent success rates at experienced clinical centers.

Unlike the standard first-line treatments, ART procedures are more invasive and costly. To date, research does not find an increased risk of health problems or birth defects in children born from ART procedures, but due to the invasive nature and cost, most physicians recommend ART be reserved as a last resort to achieve pregnancy. Some wealthy couples are using ART, however, to allow more swift conception and more dependable family planning.

What Procedures Are Included In ART?

In vitro fertilization (IVF)

IVF is the most common of all ART procedures. In vitro fertilization is a highly sophisticated, meticulously timed procedure, which involves removing mature eggs from your ovaries, fertilizing them with prepared sperm, incubating the dividing embryos in a laboratory dish, and then transferring the developing embryo in your uterus at the appropriate time. The embryo transfer usually occurs three to five days after the egg retrieval.

The success and availability of IVF has enabled many previously untreatable infertile couples to conceive with very high success rates. In the not-too-distant past, women with blocked or absent fallopian tubes, severe male factor infertility and many other causes of infertility would have to consider adoption.

Intracytoplasmic sperm injection (ICSI)

ICSI is a procedure offered as part of IVF when male factor infertility impairs the sperms' ability to fertilize the eggs. In traditional IVF, sperm and eggs are placed together to allow for the sperm to fertilize the egg in the "natural" way. ICSI involves selecting one sperm and injecting it inside the egg using a microscopic needle. This results in very efficient fertilization. Once embryos are created they are allowed to develop in the same manner as traditional IVF. They are then transferred back into you, inside your uterus, when appropriate.

Gamete intrafallopian transfer (GIFT)

GIFT combines your eggs and sperm in the same way as with IVF, in a laboratory, but does not wait for fertilization and development before transferring them back inside your body. With GIFT, the eggs and sperm are placed into your fallopian tubes via laparoscopic surgery (the placement of thin tubes through your abdomenal wall under general anesthesia) so they can fertilizae inside your body. The resulting embryos travel to your uterus naturally and implant. This procedure was once common, but is rarely used anymore because success rates are not as high as with IVF. Some couples find this procedure more morally acceptable since embryos are not created in the lab: eggs and sperm are given a boost in efficiency since they have been put together, in the right place, at the right time. Before modern improvements in IVF lab techniques, GIFT was the most successful ART procedure.

Zygote intrafallopian transfer (ZIFT)

ZIFT is very much like GIFT - but your eggs are combined with your partner's sperm and embryos are allowed to grow in a dish in a lab. The embryo(s) is (are) then surgically placed in your fallopian tubes. Like GIFT, this procedure is not very common anymore since it has a lower success rate than IVF and involves more cost and risk due to the need for additional laparoscopic surgery.

Donation

Donor eggs may be utilized in ART in combination with your partner's sperm for fertilization, embryo development and then transfer into your body. This option is often used by women who are older, respond poorly to ovulation medication, or cannot ovulate for any reason. Success rates for IVF using young donor eggs is generally very high.

Donor sperm may also be utilized in ART to combine your eggs. This option is available when the man is unable to produce sperm or ICSI cannot overcome the male factor infertility problems.

Donor embryos may also be utilized in ART for couples that can produce neither egg nor sperm. Frozen embryos are currently available for "snowflake adoption" through various agencies. Virtually all of these embryos are donated by women who have gone through IVF, and for one reason or another, have left-over frozen embryos that they do not want to destroy. These services are not free, however, and most intermediate agencies charge many thousands of dollars for their assistance. Also, there is no guarantee with regard to the quality of the embryos in storage. Most couples choose the best embryos for themselves to be transferred fresh, when they are created. It is usually the poorer quality embryos that are frozen for backup...and become the "snowflakes." Because snowflake embryos generally have lower pregnancy success rates than fresh, unfrozen embryos, there are generally no cost savings when chosing to go the snowflake route.

Surrogacy

Surrogacy is sometimes called "gestational carrier." This is when another woman carries your embryos, created from your eggs and your partner's sperm, donor embryos or your eggs fertilized with donor sperm. A surrogate carries the resulting pregnancy to term and gives the baby to you after birth. This practice is not protected in all states and the use of an established agency that has experience with this legal minefield is highly recommended. California and Arkansas are states that are particularly amenable to these arrangements.