Assisted Reproductive Technology
According to the CDC, assisted reproductive technology (ART) is defined as all fertility treatments that handle both a woman's egg and a man's sperm. ART typically involves 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.
These are the most common fertility treatment options for individuals or couples who need assistance to build their family.
Common Fertility Treatments and Procedures
This entails timing intercourse for the most optimal “fertility” time. The process often requires hormone-stimulating medication for 13 to 17 days before attempting conception. During this time, physicians monitor follicle growth and prescribe a trigger shot, which induces ovulation.
Once ovulation has been triggered, couples are instructed to have intercourse every other day for three days. Two weeks later, a pregnancy test will be taken to determine if the process was successful. Normally, the success rate of timed intercourse is between 9% and 33%. These rates decline as females age and can also be impacted by other factors.
Intrauterine Insemination (IUI)
Also called artificial insemination, this is a process in which sperm is inserted directly into the uterus through the use of a catheter. This is done either with or without a course of medication and after monitoring,
IUI success rates vary from 5-15% with a rate of multiples ranging from 8-30%. Success rates vary based on patient age and medication. The CDC and the Society for Assisted Reproductive Technology (SART) do not require fertility clinics to report IUI success.
In Vitro Fertilization (IVF)
This is a technique where an egg and sperm are combined in a special laboratory in order to create an embryo. Depending on the diagnosis and age of the woman, an embryo or embryos are transferred to the woman’s uterus through her cervix to enhance the chances of pregnancy. The national average for the IVF pregnancy rate is 52.4%. Success rates vary based on age, medical history, infertility diagnosis, history of previous births, miscarriages, and previous cycles.
- Preimplantation Genetic Testing for Aneuploidy (PGT-A): This test may be performed in conjunction with IVF treatment and involves testing embryos for chromosomal abnormalities. PGT-A testing supports single embryo transfer, reduces the risk of miscarriage and increases the probability of a successful pregnancy.
- Preimplantation Genetic Testing for Monogenic/Single Gene Diseases (PGT-M): This is a test used prior to embryo transfer to help identify genetic defects within embryos. This serves to prevent specific genetic diseases or disorders from being passed on to the child. Coverage of PGT-M is especially important for certain ethnic groups at a high risk of passing on genetic diseases such as sickle cell, Tay-Sachs and cystic fibrosis.
Single Embryo Transfer (SET)
During this procedure, one embryo selected from a larger number of available embryos is placed in the uterus. SET helps avoid several health risks that are associated with carrying multiples. It also helps families achieve success while preventing some risks known to be associated with giving birth to twins or what is called “high order multiple births” (three or more children born at the same time).
In Vitro Fertilization (IVF) - Fresh
An IVF fresh cycle starts by stimulating the ovaries with a course of medications. Following stimulation, the doctor will retrieve the eggs, which are then taken to the lab and fertilized. After three to five days, an embryo will be transferred into the uterus in the hopes of achieving pregnancy. Any remaining embryos, or embryos that are not transferred, may be biopsied for preimplantation genetic testing for aneuploidy (PGT-A) before being frozen using vitrification (“flash freezing”). The biopsy tissue is sent to a genetic lab for testing. PGT-A screens the embryo(s) for genetic abnormalities, to ensure that only chromosomally normal embryos are eligible for transfer. Any additional, genetically normal embryos will remain cryopreserved until needed. IVF fresh can also be used with donor egg and/or sperm.
In Vitro Fertilization (IVF) – Frozen
The IVF freeze-all process differs from an IVF fresh cycle and may increase the chances of success. An IVF freeze-all starts by stimulating the ovaries with a course of medication. Following this the doctor will retrieve the eggs, which are then taken to the lab and fertilized. The resultant embryos continue to develop until day five when they may be biopsied before being frozen using vitrification. The biopsy of the embryo tissue is sent to a genetic lab for preimplantation genetic testing for aneuploidy (PGT-A). PGT-A screens each sample for genetic abnormalities, allowing the fertility specialist to ensure that the most viable embryo is chosen for transfer. The embryos remain frozen in storage while the PGT-A testing takes place. During this time, the body has an opportunity to return to its pre-treatment state before a frozen embryo transfer is performed at a later date. IVF freeze-all can also be used with donor egg and/or sperm.
Frozen Embryo Transfer
Embryos that have been frozen during an IVF freeze-all, fertility preservation (egg freezing), or previous fresh IVF cycle can be thawed and transferred into the uterus. A frozen embryo transfer is commonly performed following an IVF freeze-all cycle to allow for preimplantation genetic testing for aneuploidy (PGT-A) on the resultant embryos. PGT-A testing ensures that only a genetically or chromosomally normal embryo is chosen for transfer.
Fertility Preservation (egg/sperm/embryo freezing)
Fertility preservation, also known as tissue cryopreservation or egg/sperm/embryo freezing, allows an individual or couple to preserve their fertility for the future. This treatment may be appropriate for women with health issues such as endometriosis, fibroids, diminished ovarian reserve/low egg supply, a family history of early menopause and cancer, or those who choose to delay childbearing . Men may be advised to consider sperm freezing due to low sperm count or related to other medical conditions. Fertility preservation is also an important treatment option for trans individuals to preserve their ability to have children before transitioning.