Infertility: Assisted Reproductive Technology

Edited By Irshad Anwar | Updated on Jul 02, 2025 07:17 PM IST

Definition Of Infertility

Infertility is the inability to conceive after a year of unprotected intercourse six months for women over 35, or the inability to carry pregnancy to term.

Definition Of Assisted Reproductive Technology

Assisted Reproductive Technology is a specific form of medical intervention used against infertility. This set of medical procedures helps people with infertility problems reproduce through more advanced and complex techniques like in vitro fertilization, zygote intrafallopian transfer, and gamete intrafallopian transfer.

Factors That Cause Infertility

Infertility can be caused by factors in both men and women and sometimes in both partners.

Male Factors

Defective spermatogenesis: Low count, poor motility, abnormal morphology
Genetic and hormonal imbalances
Blockages and ejaculatory problems
Lifestyle factors: Smoking, alcohol, drug use, obesity

Female Factors

Ovulation disorders: PCOS, hypothalamic dysfunction, premature ovarian insufficiency
Fallopian tube damage or blockage: Infections, surgery
Endometriosis: Tissue growth outside the uterus
Uterine or cervical issues: Polyps, fibroids, structural abnormalities
Age-related factors
Lifestyle factors: Smoking, alcohol, obesity, stress

Combined Factors

The cause of infertility may be the contributing issue from both partners.

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Unexplained Infertility

Those cases where no clear cause is identified despite proper evaluation.

Diagnostic Methods

Various diagnostic tests help ascertain the causes of infertility in males and females.

Male Infertility Tests

Semen analysis
Hormonal testing
Genetic testing
Testicular biopsy

Female Infertility Tests

Ovulation testing
Hysterosalpingography – HSG
Ovarian reserve testing
Hormonal testing
Imaging tests: Ultrasound, laparoscopy

Types Of Assisted Reproductive Technologies -ART

ART consists of medical procedures that increase the chances of becoming pregnant.
Used when natural conception is not possible due to various infertility issues.

In Vitro Fertilization (IVF)

IVF is a common ART method where eggs are fertilized outside the body.

Procedure Of IVF

Ovarian stimulation and egg retrieval
Sperm collection and fertilization in the lab
Embryo culture and transfer

Success Rates And Factors Affecting Success

Age, health conditions, quality of sperm/eggs

Advantages and Disadvantages

Benefits: Higher success rates, used in various infertility issues
Downsides: Cost, emotional and physical demands, multiple pregnancies

Zygote Intrafallopian Transfer (ZIFT)

ZIFT is a cross between IVF and natural conception in that it places a zygote in the fallopian tube.

Procedure Of ZIFT

The first steps similar to IVF
Transfer of zygote into the fallopian tube

Success Rates And Factors Affecting Success

Generally lower than IVF

Advantages And Disadvantages

Advantages: Natural implantation process
Disadvantages: Surgical procedure, lower success rates

Gamete Intrafallopian Transfer (GIFT)

GIFT is placing the eggs and sperm directly into the fallopian tube.

Procedure Of GIFT

Collection of eggs and sperm
Direct insemination into the fallopian tube

Success Rates And Factors Affecting Success

About the same as the success rates of natural conception

Advantages And Disadvantages

Pros: More natural conception
Cons: Needs patent Fallopian tubes, surgical risks

Table: IVF vs. ZIFT vs. GIFT

	IVF	ZIFT	GIFT
Procedure	Fertilization in the lab, embryo transfer to the uterus	Zygote transfer to fallopian tube	Gametes transfer to the fallopian tube
Success Rates	Generally higher, especially in younger women	Generally lower than IVF	Similar to natural conception rates
Advantages	Higher success rates, various infertility issues	Natural implantation process	More natural fertilization
Disadvantages	Cost, emotional and physical demands, multiple pregnancies	Surgical procedure, lower success rates	Requires healthy fallopian tubes, surgical risks

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Frequently Asked Questions (FAQs)

1. What are the most common causes of infertility both in males and females?

Low sperm count, poor sperm motility, and genetic and other influences on their lifestyle lead to infertility among men. In women, the main causes are ovulation disorders, damage to the fallopian tubes, endometriosis, and advanced age.

2. How does IVF work, and what are its success rates?

IVF is a process of inducing the ovaries to produce eggs, retrieving them, fertilizing them with sperm in the laboratory, and then transferring the embryo into the uterus. The success rates vary and are generally higher for younger women.

3. What's the difference between IVF, ZIFT, and GIFT?

IVF fertilizes the eggs in a laboratory and then does an embryo transfer to the uterus. ZIFT transfers a zygote into the fallopian tube. GIFT puts the eggs and sperm directly into the fallopian tube so that fertilization can occur naturally.

4. Do infertility treatments have any risks?

Multiple pregnancies, ovarian hyperstimulation syndrome, surgical complications.

5. What are some of the ways to boost infertility?

A good diet, regular exercise, stress reduction, and staying away from smoking, excessive alcohol, and drugs would improve fertility.

6. What is Assisted Reproductive Technology (ART)?

Assisted Reproductive Technology (ART) refers to a group of medical procedures used to help individuals or couples conceive a child when they are experiencing infertility. These techniques involve manipulating eggs, sperm, or embryos outside the body to increase the chances of successful pregnancy.

7. How does In Vitro Fertilization (IVF) work?

In Vitro Fertilization (IVF) involves retrieving eggs from a woman's ovaries, fertilizing them with sperm in a laboratory dish, and then transferring the resulting embryos into the woman's uterus. This process bypasses certain fertility issues and allows for direct fertilization outside the body.

8. What is ovarian stimulation, and why is it used in ART?

Ovarian stimulation is the process of using hormones to encourage the ovaries to produce multiple eggs in one cycle. This is done to increase the number of eggs available for fertilization, improving the chances of successful pregnancy in ART procedures like IVF.

9. What is the role of hormones in ART procedures?

Hormones play a crucial role in ART by controlling and manipulating the reproductive cycle. They are used to stimulate egg production, trigger ovulation, prepare the uterus for embryo implantation, and support early pregnancy. Common hormones used include FSH, LH, and progesterone.

10. What is gamete intrafallopian transfer (GIFT)?

Gamete intrafallopian transfer (GIFT) is an ART procedure where eggs and sperm are collected and immediately placed into a woman's fallopian tubes, allowing fertilization to occur naturally inside the body. This technique is less commonly used now due to the higher success rates of IVF.

11. What is ovarian reserve, and how does it impact ART?

Ovarian reserve refers to the quantity and quality of a woman's remaining eggs. It naturally declines with age and can be assessed through hormonal tests and ultrasound. A diminished ovarian reserve can reduce the success rates of ART procedures, often requiring more aggressive stimulation protocols or consideration of donor eggs.

12. What is the impact of thyroid disorders on ART outcomes?

Thyroid disorders can significantly affect fertility and ART outcomes. Both hypothyroidism and hyperthyroidism can interfere with ovulation, implantation, and early pregnancy development. Proper diagnosis and management of thyroid conditions before and during ART treatment can improve success rates and reduce the risk of complications.

13. How does caffeine consumption affect fertility and ART outcomes?

Moderate caffeine consumption (200-300 mg per day) is generally considered safe during fertility treatment and pregnancy. However, high caffeine intake may negatively impact fertility and increase the risk of miscarriage. Some studies suggest that reducing caffeine intake might improve ART outcomes, but more research is needed for definitive conclusions.

14. What is the impact of environmental toxins on fertility and ART outcomes?

Environmental toxins, such as certain pesticides, plastics, and heavy metals, can negatively impact fertility and ART outcomes. These toxins may disrupt hormonal balance, affect gamete quality, and interfere with embryo development. Minimizing exposure to these toxins before and during ART treatment may improve outcomes, though more research is needed in this area.

15. How does the quality of the sperm sample affect ICSI success rates?

While ICSI can overcome many male factor infertility issues, the quality of the sperm sample still impacts success rates. Factors such as DNA fragmentation, morphology, and motility can affect the ability of the sperm to fertilize the egg and support early embryo development. Advanced sperm selection techniques may be used to improve outcomes in cases of poor sperm quality.

16. Can lifestyle factors affect the success of ART?

Yes, lifestyle factors can significantly impact ART success. Factors such as smoking, excessive alcohol consumption, poor diet, obesity, and high stress levels can reduce fertility and the effectiveness of ART procedures. Maintaining a healthy lifestyle can improve outcomes.

17. How does male factor infertility affect ART choices?

Male factor infertility can influence the choice of ART technique. For mild cases, standard IVF might be sufficient. For more severe cases, such as very low sperm count or poor motility, ICSI might be recommended. In some cases, surgical sperm retrieval techniques may be necessary.

18. How does endometriosis affect ART outcomes?

Endometriosis can negatively impact ART outcomes by reducing egg quality, altering the uterine environment, and potentially interfering with implantation. However, ART, particularly IVF, often remains an effective treatment option for women with endometriosis-related infertility, though multiple cycles may be needed.

19. How does polycystic ovary syndrome (PCOS) impact ART treatment?

PCOS can complicate ART treatment due to hormonal imbalances and irregular ovulation. Women with PCOS may be at higher risk of ovarian hyperstimulation syndrome during ovarian stimulation. However, with careful monitoring and medication adjustment, many women with PCOS achieve successful pregnancies through ART.

20. What is the success rate of ART procedures?

Success rates for ART procedures vary widely depending on factors such as age, cause of infertility, and specific technique used. On average, IVF success rates range from 20-35% per cycle for women under 35, decreasing with age. It's important to discuss individual chances with a fertility specialist.

21. What is the difference between IVF and ICSI?

While both are ART techniques, IVF allows sperm to fertilize the egg naturally in a lab dish, whereas Intracytoplasmic Sperm Injection (ICSI) involves directly injecting a single sperm into an egg. ICSI is often used when there are severe male factor infertility issues.

22. Can same-sex couples use ART to have biological children?

Yes, same-sex couples can use ART to have biological children. For example, lesbian couples might use donor sperm and IVF, while gay couples might use a surrogate mother and one partner's sperm. Some techniques allow for both partners to be genetically related to the child.

23. How does age affect the success of ART?

Age significantly impacts ART success rates, particularly for women. As women age, both the quantity and quality of their eggs decrease, reducing the chances of successful fertilization and healthy embryo development. Success rates tend to decline sharply after age 35.

24. What is preimplantation genetic testing (PGT)?

Preimplantation genetic testing (PGT) is a technique used in ART to screen embryos for genetic abnormalities before they are implanted in the uterus. This can help identify embryos with the best chance of developing into healthy pregnancies and reduce the risk of certain genetic disorders.

25. How does freezing eggs or embryos work in ART?

Egg and embryo freezing (cryopreservation) involves cooling the cells to very low temperatures, typically using liquid nitrogen. This process allows for long-term storage without damage. When needed, the eggs or embryos can be thawed and used in ART procedures, preserving fertility options for the future.

26. How does surrogacy work in the context of ART?

Surrogacy involves a woman (the surrogate) carrying and giving birth to a child for another person or couple. In gestational surrogacy, the most common form used with ART, an embryo created through IVF (using the intended parents' or donors' gametes) is transferred to the surrogate's uterus.

27. What are the potential risks associated with multiple pregnancies in ART?

Multiple pregnancies, which are more common in ART, carry increased risks such as premature birth, low birth weight, developmental issues, and complications for the mother like gestational diabetes and preeclampsia. To mitigate these risks, many clinics now advocate for single embryo transfer.

28. How does the cost of ART procedures compare to adoption?

The cost of ART procedures can vary widely but is often comparable to or higher than adoption costs. A single IVF cycle can cost $10,000-$15,000, with multiple cycles often needed. Adoption costs also vary but typically range from $20,000-$45,000. Both options may have additional expenses and financial considerations.

29. What ethical concerns are associated with ART?

Ethical concerns surrounding ART include issues related to embryo status and disposal, selective reduction in multiple pregnancies, genetic screening and selection, commercialization of reproduction, and access inequality due to high costs. These issues continue to be debated in medical, legal, and ethical forums.

30. What is the difference between fresh and frozen embryo transfer in IVF?

In fresh embryo transfer, embryos are transferred to the uterus within days of egg retrieval and fertilization. Frozen embryo transfer involves thawing previously frozen embryos and transferring them in a later cycle. Frozen transfers allow for better timing with the woman's natural cycle and may improve success rates in some cases.

31. What is mini-IVF, and how does it differ from standard IVF?

Mini-IVF, or minimal stimulation IVF, uses lower doses of fertility medications to stimulate egg production. This results in fewer eggs but can reduce side effects and costs. It may be suitable for women who respond poorly to standard stimulation or those wishing to avoid high doses of hormones.

32. How do ART clinics measure and report success rates?

ART clinics typically report success rates as the percentage of cycles resulting in live births. However, it's important to consider factors like patient age, infertility diagnosis, and number of embryos transferred. Some clinics also report pregnancy rates or implantation rates. Standardized reporting helps patients compare clinics accurately.

33. What is the role of acupuncture in ART?

Some studies suggest acupuncture may improve ART outcomes by increasing blood flow to the uterus, reducing stress, and balancing hormones. While not a standard part of ART, many patients use acupuncture as a complementary therapy. However, more research is needed to definitively prove its effectiveness in improving ART success rates.

34. How does obesity affect ART outcomes?

Obesity can negatively impact ART outcomes by affecting hormone levels, egg quality, and implantation rates. It may also increase the risk of pregnancy complications. Weight loss before starting ART can improve success rates, but the benefits must be balanced against the potential delay in treatment, especially for older patients.

35. What is preimplantation genetic diagnosis (PGD) and how does it differ from PGS?

Preimplantation genetic diagnosis (PGD) tests embryos for specific genetic disorders known to run in a family. Preimplantation genetic screening (PGS), now often called PGT-A, screens for overall chromosomal abnormalities. PGD is used when there's a known genetic risk, while PGS is often used to improve IVF success rates, especially in older patients.

36. How does the microbiome affect fertility and ART outcomes?

Emerging research suggests that the microbiome - the community of microorganisms in the body - may play a role in fertility and ART outcomes. A balanced vaginal and uterine microbiome may improve implantation rates and reduce the risk of miscarriage. This area is still being studied, but it may lead to new approaches in ART.

37. How do ART procedures differ for same-sex male couples compared to same-sex female couples?

For same-sex male couples, ART typically involves using one partner's sperm to fertilize donor eggs, with the resulting embryos carried by a gestational surrogate. Same-sex female couples might use one partner's eggs fertilized with donor sperm, with the other partner carrying the pregnancy. The specific approach can vary based on individual circumstances and preferences.

38. How does the timing of embryo transfer affect ART success rates?

The timing of embryo transfer is crucial for ART success. Traditionally, embryos were transferred on day 3 after fertilization, but many clinics now prefer day 5 (blastocyst) transfers. Blastocyst transfers allow for better embryo selection and may improve implantation rates. However, the optimal timing can vary based on individual circumstances and embryo development.

39. What is the role of assisted hatching in ART?

Assisted hatching is a technique where a small opening is made in the outer layer (zona pellucida) of the embryo before transfer. This is thought to help the embryo "hatch" and implant in the uterus more easily. It may be recommended for older patients, those with previous IVF failures, or when the zona appears thicker than normal.

40. What is ovarian hyperstimulation syndrome (OHSS) and how is it managed in ART?

Ovarian hyperstimulation syndrome (OHSS) is a potential complication of ovarian stimulation in ART. It occurs when ovaries overreact to fertility medications, causing swelling and fluid accumulation. Mild cases are common and resolve on their own, but severe cases can be dangerous. Management includes careful monitoring, adjusting medication protocols, and in some cases, freezing all embryos to allow the ovaries to recover before transfer.

41. How does the use of donor eggs or sperm affect the legal aspects of parenthood in ART?

The use of donor eggs or sperm in ART can complicate the legal aspects of parenthood. Laws vary by country and state, but generally, the intended parents (not the donors) are considered the legal parents. However, it's crucial to work with a lawyer specializing in reproductive law to ensure proper contracts and legal protections are in place for all parties involved.

42. What is the role of preconception genetic carrier screening in ART?

Preconception genetic carrier screening tests potential parents for genetic mutations that could be passed on to their children. In ART, this information can guide treatment decisions, such as using PGD to select embryos without specific genetic disorders. It's particularly important for couples with a family history of genetic conditions or those from populations with higher rates of certain genetic disorders.

43. How does the culture medium used in IVF affect embryo development and ART outcomes?

The culture medium, the liquid in which embryos grow in the lab, plays a crucial role in embryo development. Different types of media can affect embryo metabolism, gene expression, and overall viability. Ongoing research aims to optimize culture conditions to improve embryo quality and ART success rates. Some clinics now use time-lapse imaging and AI to select the best-developing embryos.

44. What is the concept of "social egg freezing" and how does it relate to ART?

Social egg freezing, also known as elective egg freezing, involves women freezing their eggs for non-medical reasons, often to delay childbearing. This ART technique allows women to preserve younger, healthier eggs for future use, potentially increasing their chances of successful pregnancy at an older age. However, it's important to note that egg freezing doesn't guarantee future pregnancy success.

45. How do immunological factors affect ART outcomes?

Immunological factors can impact ART outcomes by affecting implantation and early pregnancy maintenance. Some theories suggest that certain immune system imbalances might cause the body to reject embryos. While controversial, some clinics offer immunological testing and treatments (such as intralipid infusions or steroids) to patients with recurrent implantation failure or miscarriage.

46. What is the role of genetics in male infertility and how does it impact ART treatment?

Genetic factors play a significant role in male infertility, including chromosomal abnormalities, Y chromosome microdeletions, and single gene mutations. These can affect sperm production and quality. Genetic testing may be recommended before ART, as some genetic causes of male infertility can be passed on to offspring. The results can guide treatment choices, such as using ICSI or considering donor sperm.

47. How does the uterine microbiome affect embryo implantation in ART?

The uterine microbiome, the community of microorganisms in the uterus, is emerging as a potential factor in embryo implantation success. A balanced microbiome may create a more favorable environment for implantation, while an imbalanced microbiome might hinder it. Some clinics are exploring treatments to optimize the uterine microbiome before embryo transfer, though more research is needed in this area.

48. What is the concept of "add-ons" in ART and how should patients evaluate their use?

"Add-ons" in ART refer to additional treatments or techniques offered alongside standard IVF to potentially improve success rates. These can include treatments like endometrial scratching, embryo glue, or various nutritional supplements. While some add-ons show promise, many lack strong scientific evidence. Patients should carefully evaluate the evidence, potential benefits, and costs with their doctor before deciding on any add-ons.

49. How does the timing of intercourse or insemination affect success rates in non-IVF fertility treatments?

In non-IVF treatments like timed intercourse or intrauterine insemination (IUI), timing is crucial