Assisted Reproductive Technologies (ART)

Assisted Reproductive Technology (ART) are methods used to achieve pregnancy by artificial or partially artificial means. It is reproductive technology used primarily for infertility treatments, and is also known as fertility treatment. Some forms of ART are also used with regard to fertile couples for genetic reasons (preimplantation genetic diagnosis). ART is also used for couples who are discordant for certain communicable diseases; for example, AIDS to reduce the risk of infection when a pregnancy is desired. ART include In Vitro Fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI), Cryopreservation and Intrauterine Insemination (IUI). There is yet no strict definition of the term ART; its usage mainly belongs to the field of reproductive endocrinology and infertility.


While there is no consensus on the definition, generally the process of sexual intercourse is bypassed either by artificial Insemination or fertilization of the oocytes in the laboratory environment (i.e., in vitro fertilization).


ART means 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, 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 Fertilization (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).


Fertility Medication

Most fertility medications are agents that stimulate the development of follicles in the ovary. Examples are gonadotropins and gonadotropin releasing hormone.


Artificial insemination involves sperm being placed into a female's uterus (intrauterine) or cervix (intracervical) using artificial means rather than by sexual intercourse.


Sperm donors may be used where the woman does not have a male partner with functional sperm.


In Vitro Fertilization (IVF)

In Vitro Fertilization (IVF) is the technique of letting fertilization of the male and female gametes (sperm and egg) occur outside the female body under aseptic conditions.


Transvaginal Ovum Retrieval (OCR) is the process whereby a small needle is inserted through the vagina and guided via ultrasound into the ovarian follicles to collect the fluid that contains the eggs.


Embryo 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.


Less commonly used techniques in in vitro fertilization are:
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.


Intracytoplasmic Sperm Injection (ICSI)

Intracytoplasmic sperm 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.


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.


s 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 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 recipient's uterus.


Sperm donation may provide the source for the sperm used in IVF procedures where the male partner produces no sperm or has an inheritable disease, or where the woman being treated has no male partner.


Surrogacy

Surrogacy, where a woman agrees to become pregnant and deliver a child for a contracted party. It may be her own genetic child, or a child conceived through natural insemination, In Vitro Fertilization (IVF) or Embryo Transfer using another woman's ova. Surrogacy via 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.


Other assisted reproduction techniques include:

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.


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 outpatient procedure.


By cryopreservation, eggs, sperm and reproductive tissue can be preserved for later IVF.

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