Assisted reproductive technology: Definition, types, and ethics

Assisted reproductive technology (ART) refers to fertility treatments and procedures that can help with difficulties or an inability to conceive children. ART techniques involve the manipulation of eggs, sperm, or embryos to increase the likelihood of a successful pregnancy.

Infertility is when people cannot conceive after a period of regular sexual intercourse without the use of birth control. Evidence suggests that roughly 10% of women aged 15–44 in the United States have difficulty conceiving or staying pregnant. Research also indicates that worldwide, 8–12% of couples experience fertility problems, and 40–50% of cases may stem from factors that affect males.

According to the CDC, approximately 1.9% of all U.S. infants are born using ART. While the technology can be successful, it can also be expensive. Individuals wishing to conceive a child using ART in the U.S. can check their infertility coverage by state.

In this article, we will discuss some of the different types of ART, including their success rates, benefits, risks, costs, and the ethics of the technology.

ART refers to medical procedures that aim to achieve pregnancy. These complex treatments involve influencing gametes, or eggs and sperm, to increase the chances of fertilization. ART is typically an option for people for whom other infertility treatments may not work or those who have already tried treatment but have not become pregnant.

People considering ART will often discuss options with a healthcare professional and may require a consultation from a fertility specialist.

While people primarily use ART to address infertility, others may use it for genetic purposes or avoid pregnancy complications. Some people may also refer to ART as fertility treatment or medically assisted reproduction.

It may be difficult for many people to access fertility services such as ART due to its high cost and limited coverage by private insurance and Medicaid.

There are several types of ART procedures that involve different techniques and reproductive cells. A doctor can advise which ART will be most suitable depending on the circumstances. The most common type is in vitro fertilization (IVF).

IVF

IVF involves a doctor extracting eggs and fertilizing them in a special lab. Specialists can combine this with an embryo transfer (IVF-ET) and transfer the resulting embryos into a person’s uterus. The Society for Assisted Reproductive Technology states that IVF-ET accounts for 99% of ART procedures.

The Centers for Disease Control and Prevention (CDC) lists the 2018 success rates of IVF treatments for one oocyte retrieval from people using their own eggs as:

  • 52% for people aged 35 or younger
  • 38.1% for people aged 35–37
  • 23.5% for people aged 38–40
  • 7.6% for those over the age of 40

A person may also use a tool called an IVF success estimator to estimate their chance of having a baby using IVF.

It may take more than one IVF cycle to result in pregnancy, and some people may not conceive with IVF at all. The benefits of IVF are an increased chance of fertilization and pregnancy. Potential complications may include:

The National Conference of State Legislatures lists the average cost of a single IVF cycle as $12,000–17,000.

Click here to learn more about IVF.

Intrafallopian transfer

Some methods of ART are similar to IVF but use laparoscopic surgery to deliver the gametes directly into the fallopian tube. Some people may choose this method for religious reasons, or their insurance may only cover this type of ART.

Similar to other forms of ART, there is an increased chance of multiple pregnancy. Additionally, due to the laparoscopy, there is a risk of complications from the surgery, such as infection, organ puncture, or side effects from anesthesia. Intrafallopian transfers are typically more expensive than IVF.

Due to the higher costs and risks of this type of ART, specialists rarely use these procedures. As such, there is not much data available on their success rates.

Types include:

  • Gamete intrafallopian transfer (GIFT): GIFT involves collecting eggs and sperm in a tube before a doctor places the gametes directly into the fallopian tubes using laparoscopic surgery. As there is no IVF procedure, a person does not have to choose which embryo to transfer.
  • Zygote Intrafallopian Transfer (ZIFT): ZIFT is a combination of IVF and GIFT. Specialists stimulate and collect the eggs using IVF methods and mix the eggs with sperm in the lab before returning fertilized eggs or zygotes to the fallopian tubes. A benefit of ZIFT is that it may help those with damaged fallopian tubes or severe infertility issues become pregnant.
  • Pronuclear stage tubal transfer (PROST): PROST is similar to ZIFT but involves the transfer of a fertilized egg to the fallopian tube before cell division occurs.

Frozen embryo transfer

Frozen embryo transfer (FET) has become increasingly common in the U.S. It involves thawing previously IVF frozen embryos and inserting them into a person’s uterus. A 2017 study found that 52% of people who had FET had ongoing pregnancies.

According to the United Kingdom’s Human Fertilisation and Embryology Authority, FET is as safe as using fresh embryos in treatment. However, some evidence suggests an increased risk of preterm birth with FET. Another possible risk of FET is that not all frozen embryos survive the thawing out process.

The estimated cost of FET varies but can be up to $6,000.

Intracytoplasmic sperm injection

Intracytoplasmic sperm injection (ICSI) is a procedure that specialists can perform alongside IVF to help fertilize an egg. An embryologist, or embryo specialist, uses a tiny needle to inject a single sperm directly into the center of an egg.

ICSI fertilizes between 50–80% of eggs. The success rate of ICSI is similar to those of IVF, and it may be an effective method of ART for people with sperm-related infertility. ICSI is typically an add-on procedure to IVF, so it will be more costly than IVF alone.

Things to consider about ICSI include the following:

  • The procedure may damage some or all of the eggs.
  • The egg might not grow into an embryo even after being injected with sperm.
  • If a person becomes pregnant naturally, there is a 1.5 to 3% chance that the baby will have a major birth defect. However, the underlying infertility, rather than the treatment, may be the cause of the birth defect.

Third-party ART

Third-party ART is when another individual donates eggs, sperm, or embryos to an individual or couple. It can also include surrogate and gestational carriers. These refer to when another person is either inseminated with sperm from the couple using ART or implanted with an embryo from those using ART.

Evidence suggests that 50% of transfers with donated frozen embryos result in pregnancy, and 40% result in a live birth. Other benefits of third-party ART include the following:

  • It may work when IVF has repeatedly failed.
  • It may help to avoid passing on specific conditions.
  • It can help a person who produces healthy eggs but has had difficulty carrying a pregnancy to term.
  • It can help those who have difficulty producing an egg or sperm.

Depending on which type people choose, third-party ART can be very costly. Sperm donation is typically the cheapest option, costing around $1,000 per vial.

The other options can vary in cost for a single vial, and many cycles will require multiple vials. Estimated costs are:

Preparation for an ART treatment includes practicing behaviors that may help improve the chances of ART success. This can involve dietary changes, such as taking supplements that a healthcare professional recommends and reducing alcohol and caffeine intake.

It could also involve regular exercise and quitting smoking. Once ART is successful, prenatal care and tests can keep the pregnant person and baby healthy during pregnancy.

Many aspects of ART raise ethical issues, such as:

  • Does an individual or couple need ART?
  • Who has ownership of stored gametes and embryos?
  • Is it ethical for people to donate eggs to a clinic for free or discounted treatment?
  • How do a person’s religious beliefs align with different ART procedures?
  • Should there be age limits on ART?
  • Do children born through gamete donation have the right to know about their conception and their genetic parents?
  • Are all requests for ART treated equally without regard to relationship status or sexual orientation?
  • Is it ethical to use a deceased individual’s frozen embryos or sperm?

There are no simple answers on the ethical issues of ART. The American Society for Reproductive Medicine has a collection of ethics documents available here.

Persons considering ART can review their state laws or call the Office on Women’s Health Helpline at 1-800-994-9662.

Many types of ART are available to treat infertility. The success rates of ART vary according to the type of ART people choose, and factors such as the individual’s age and health.

A specialist will suggest ART based on an individual or couple’s preferences and type of infertility while also weighing the risks, benefits, and costs.