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Assisted Reproductive Technology: Clinical Aspects

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Clinical Reproductive Medicine and Surgery

Abstract

Assisted reproductive technologies (ARTs) are all fertility treatments that include the handling of oocytes and sperm and/or embryos. Historically, ART has included procedures such as gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT), although these procedures are rarely performed today. In vitro fertilization (IVF), which involves harvesting oocytes and combining them with sperm in a laboratory setting, growing the embryos and transferring them directly into the uterus under ultrasound guidance, is the mainstay of current ART treatments. Far-reaching advances in clinical and laboratory techniques have been made since 1978, when the first IVF baby was born in England. Today, ART procedures are responsible for over 1% of all children born in the USA each year. The process of IVF is a highly coordinated, time-intensive process that involves weeks of preparation. The existing IVF protocols take advantage of preventing ovulation in the face of controlled ovarian hyperstimulation. Special considerations include how to fertilize the oocytes (intracytoplasmic sperm injection or conventional insemination) and whether to perform preimplantation genetic testing on the embryos. Many controversies exist, as technological advances push the boundaries of current practice. IVF, which was originally designed to treat infertility, now offers the possibility to screen embryos for specific genetic mutations, hence allowing a family to have a child without a heritable genetic condition. In addition, screening for aneuploidy is becoming increasingly more common. In this way, IVF is raising new questions about human genetics, and it will continue to challenge our ethical frameworks.

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Abbreviations

Assisted reproductive technology (ART):

The Centers for Disease Control and Prevention (CDC) defines ART as the following: “all fertility treatments in which both [oocytes] and sperm are handled. In general, ART procedures involve surgically removing [oocytes] 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 [oocyte] production without the intention of having [oocytes] retrieved.”

In vitro fertilization (IVF):

A method of assisted reproductive technology that involves combining an oocyte with sperm in the laboratory

Preimplantation genetic screening (PGS):

The process of removing one or more cells from an embryo to test for a normal number of chromosomes

Preimplantation genetic diagnosis (PGD):

The process of removing one or more cells from an embryo to test for an allele that is associated with a particular disease

Gonadotropins:

Endogenously, these are the hormones that come from the pituitary in response to gonadotropin releasing hormone and act on the ovaries to cause follicular growth and maturation; exogenously, these are fertility medications given by injection that contain follicle stimulating hormone (FSH) alone or combined with luteinizing hormone (LH)

Saline infusion sonogram (SIS): A procedure using ultrasound and sterile saline to evaluate the uterus and the shape of the uterine cavity

Controlled ovarian hyperstimulation (COH):

The administration of hormone medications that stimulate the ovaries to produce multiple oocytes. It is sometimes called enhanced follicular recruitment or superovulation

Intracytoplasmic sperm injection (ICSI):

A micromanipulation procedure in which a single sperm is injected directly into an oocyte to attempt fertilization

Third party reproduction:

The use of oocytes, sperm, or embryos that have been donated by a third person (donor) to enable an infertile individual or couple (intended recipient) to become a parent (or parents). This also refers to the use of a gestational carrier

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Acknowledgments

The authors wish to acknowledge Michael P. Steinkampf, Beth A. Malizia, Damon Davis, Cristine Silva, and Melissa Hiner, who were contributors to the first edition of this chapter, as well as Beth Plante, Gary D. Smith, and Sandra Ann Carson, who were contributors to the second edition of this chapter.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Michigan, L3001 Univ Hospital South, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA

    Erica B. Mahany MD & Yolanda R. Smith MD

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Correspondence to Erica B. Mahany MD .

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  1. Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio, USA

    Tommaso Falcone

  2. Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA

    William W. Hurd

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Mahany, E.B., Smith, Y.R. (2017). Assisted Reproductive Technology: Clinical Aspects. In: Falcone, T., Hurd, W. (eds) Clinical Reproductive Medicine and Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-52210-4_17

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