Assisted Reproductive Technology (ART)
ART are medical procedures used primarily to address infertility.
What is infertility? According to WHO, Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12months or more of regular unprotected sexual intercourse. A key phrase to note “regular unprotected sexual intercourse” i.e. about 3 to 4 times a week without any form of contraception.
Causes of infertility
Infertility is caused by male and/or female factors:
- Male factors – 35%
- Female factors – 35%
- Both – 20%
- Unknown – 10%
Male factors include:
- Sperm production/ sperm count disorders: low sperm count, azoospermia(no sperm cells in the semen),
- Erectile or ejaculatory deficiency
- Structural abnormalities: abnormal in the shape and motility of the sperm preventing the sperm from either swimming to or binding with the egg. etc
Female factors include:
- Ovulation disorders: polycystic ovarian syndrome
- Fallopian tube blockage
- Advanced age
- Hormone dysfunctions
- Abnormalities of the uterus etc
The different methods of ART include
- Artificial insemination
- In vitro fertilization(IVF)
This is the deliberate introduction of sperm into the female’s uterus or cervix for the purpose of achieving pregnancy through invivo fertilization by means other than sexual intercourse
invivo: inside the body
This is usually done when the cause of infertility is a male factor
The sperm used could be from the male partner or from a sperm donor. For example in azoospermia where a man can produce semen but the semen is devoid of sperm cell
It can also be used in a case where the female produces antibody to the semen. In this case, the semen is washed(in a lab) and the sperm is introduced to the uterus.
In the case of immotile sperm, the sperm is introduced directly into the fallopian tube where fertilization occurs.
This is the process of fertilization by extracting eggs, retrieving a sperm sample and then manually combining them in a lab(in vitro ie outside the body)
This involves the following steps:
- Ovary stimulation: medications(hormones) are given to the woman at targeted days of the menstrual cycle. The objective is to produce several fertilizable oocytes i.e. good quality eggs
- Oocyte retrieval ie Egg retrieval: this is the removal of the oocyte from the ovary of the female enabling fertilization outside the body. The eggs are obtained by transvaginal needle aspiration under ultrasound guidance. Surgery is not required
- Sperm retrieval – wash sperm: sperm sample is obtained from the male donor. The sperm is then washed and prepared for loading in the Laboratory glass dish for fertilization.
- Fertilization: the eggs and sperm are brought together in a laboratory glass dish to allow the sperm to fertilize the egg. This is called standard insemination
- In the case of abnormal sperm eg immotile sperm, a single sperm is injected into an egg under a microscope. This process is known as Intracytoplasmic sperm injection.
- Embryo Transfer: healthy fertilized embryos are transferred to the uterus
Pregnancy Test is done 14 days after Embryo Transfer
Other methods include:
- Gamete Intrafallopian Transfer (GIFT)
- Zygote Intrafallopian Transfer (ZIFT)
- Tubal Embryo Stage Transfer (TEST)
This is a process by which a woman carries and gives birth to a baby for the couple who wants to have a child
- Traditional or Complete Surrogacy: Sperm from the partner of the infertile woman is used to inseminate the surrogate mother, who will carry the pregnancy and give the resulting child over to the couple who then adopt the child.
- Gestation or Partial Surrogacy: The woman has intact ovaries but is unable to conceive due to an absent or severely malformed uterus. The couple create an embryo in vitro, then have it transferred to the uterus of the surrogate
NEGATIVE ASPECT OF ART
- Ovarian hyperstimulation syndrome(OHSS): dues to the administration of hormones
- Multiple pregnancy with its complications which include premature labor, hypertension in pregnancy etc
- Ectopic pregnancy
ART has been the answer for many childless couples, resulting in successful pregnancies and childbirth. Today there is a range of infertile treatment that aims to ensure a healthy sustainable pregnancy but there are still risks, stress and high cost associated with ART.
With the advent of new technologies, it is hoped that these shortcomings would be overcome in the near future and every infertile couple would have the privilege of parenthood.