Assisted Reproduction: All the Treatments You Must Know
Explaining you in a simple way what assisted reproduction is and all the other low and high complexity techniques!
Assisted reproduction is a medical field made of a set of specialized procedures and treatments, such as in vitro fertilization, through which doctors help infertile or sterile heterosexual couples to finally become parents.
IVF combined with genetic testing, for example, can help couples without any sort of fertility issue, but who are carriers of one or more genetic diseases, to avoid passing on the inheritable illness achieving the birth of healthy children.
Even singles and homosexual couples can become parents through in vitro fertilization and other assisted reproduction techniques
because in order to have a child it is no longer strictly necessary to have sex or even have a partner at all!
Keep in mind, however, that every country in the world has its own laws regarding assisted reproduction.
(Here you can find the fertility treatment policies of European countries).
So, even if this is not very fair, not all treatments will be able to be performed everywhere on everyone.
The laws regarding in vitro fertilization and human reproduction in general are constantly changing and each country will have its pros and cons.
There are many different ways in which doctors can help patients achieve a pregnancy, but the treatments available can be divided into 2 major categories according to the level of invasiveness on the patient’s body. This said, all techniques are aimed at favoring the encounter between a woman’s egg cell and a man’s sperm cell.
Assisted Reproduction: Low Complexity Treatments
In this first category of procedures, the fertilization of the egg cell by the sperm occurs within the female reproductive system (what is called as “in vivo” fertilization).
Examples of this are:
Targeted sexual intercourse
In case of hormonal stimulation, your ovaries are mildly stimulated in order to promote the growth of one or two ovarian follicles and ovulation is then induced pharmacologically.
IUI or intrauterine insemination
This treatment involves inserting pretreated sperm into the uterus to increase the chances of getting pregnant.
The sperm used can be that of your male partner or alternatively donor sperm can be used.
Once again your cycle can be a “natural” cycle or mildly “stimulated” cycle.
Both of these techniques are effective only if your tubes are open, that is, if they are not blocked, because otherwise the sperm will never be able to meet the egg and fertilize it.
The woman’s fertility and the man’s sperm quality must both be sufficiently good, otherwise the advantage given by these 2 procedures is lost.
Assisted Reproduction: High Complexity Treatments
In this second category, the fertilization of the egg cell by the sperm occurs in a laboratory, therefore outside of the woman’s body (process known as “in vitro” fertilization). Examples of this are:
IVF
(In Vitro Fertilization)
ICSI
(Intra Cytoplasmatic Sperm Injection or microinsemination)
In both cases, a hormonal stimulation of the ovaries is performed to promote the growth and maturation of your oocytes (your egg cells).
The mature eggs are then taken from the ovaries through a procedure called “egg retrieval” or “pick-up“.
Once in the laboratory, in case of conventional IVF, the oocytes are put in contact with the sperm cells coming from a sperm sample.
This sample can be provided either by your male partner or a sperm donor and it will be the little sperm cells themselves that must penetrate and fertilize your mature egg cells.
On the other hand, if ICSI is performed, it will be an embryologist who will select and manually insert a sperm cell in each mature egg with the help of a very sophisticated microscope to allow fertilization to occur.
that can be transferred inside the uterus in an embryo transfer procedure (ET = Embryo Transfer).
Alternatively, the embryos can be “vitrified” (special freezing technique), in order to be transferred inside of the uterus at a later moment in time, possibly even years after its creation and freezing.
If the number of oocytes retrieved from your ovaries is low and/or the quality of the egg cells shows to be bad, it is possible to perform in vitro fertilization on donor eggs (Egg donation) with your male partner’s sperm or with donor sperm (Double donation).
Assisted Reproduction: Other Techniques
Other assisted reproduction techniques exist in which the fertilization of the egg cell by the sperm can take place either inside the female reproductive system or in a laboratory outside the woman’s body.
However, these techniques are only rarely used as they require very invasive procedures. Examples are:
- GIFT (Gamete Intra-Fallopian Transfer = transfer of oocytes and spermatozoa into the tubes),
- ZIFT (Zygote Intra-Fallopian Transfer = transfer of zygotes into the tubes),
- PROST (PROnuclear Stage Transfer = transfer of embryos at the stage of two pronuclei),
- TET (Tubal Embryo Transfer = embryo transfer into the tubes).
Assisted Reproduction: Important Factors
Not all in vivo and in vitro fertilization techniques are useful and effective for everyone in the same way. For this reason it is important to refer to a reproductive specialist gynecologist and let the fertility doctor advise you on which technique to start with and which tests to perform before performing any treatment.
IVF and other medical assisted reproduction strategies are very useful, but do not always lead to the desired result and can be overwhelming both on a physical and on an emotional level.
Unfortunately, the number of couples and singles who face problems trying to conceive is constantly increasing.
This is due to many factors including pollution, a wide diffusion of stressful and unhealthy lifestyles, but also to the unnatural rhythms imposed by society that lead to postponing more and more the age at which we decide to start trying to have a child.
The causes that lead to requiring an in vitro fertilization treatment are many and can be due exclusively to female fertility problems, exclusively to male fertility problems, or to a mixed fertility issue (when both the woman and the man of the couple suffer from conditions that make them less fertile or sterile).
The single factor that by itself has the most influence on the success rate of having a child, both in case of spontaneous conception and in case of in vitro fertilization, is the age of the egg cells, therefore the age of the woman!
Us women are in fact all born with all the eggs we will ever have. Unlike men, who constantly produce new sperm, we do not have the ability to “produce new eggs”.
For this reason, our reproductive potential decreases with the passing of the years. On top of this, female fertility starts decreasing more rapidly from about age 35 hitting zero at menopause.
Just like chicken eggs, our egg cells are also affected by aging in their “quality” not only in their quantity, so as the years go by, not only will we have fewer oocytes , but also a greater proportion of these oocytes will not be of “good quality”.
All this translates into an increasing difficulty in getting pregnant, even with in vitro fertilization techniques, as our age increases.
The beauty of an IVF treatment is that it can also allow you to “play ahead” by preserving your fertility potential.
In fact, performing one or more ovarian stimulation cycles before the age of 35 could prove useful in the future
allowing you to have a sufficient number of good quality eggs stored away on which to perform in vitro fertilization, years after having taken them from the ovaries in case a spontaneous conception were not to occur when trying to conceive later on in life.
Fertility preservation techniques are especially important in case of pathologies that directly or indirectly, due to the procedures necessary to treat them, risk causing a decrease in patient’s fertility.
An example is cancer especially in girls and young women who have not yet had children.
Regardless of the method through which you are trying to become pregnant, whether it is sexual intercourse or IVF, a healthy lifestyle can really improve your chances of having a baby.
Remember to:
- keep active,
- try to maintain an adequate weight for your height,
- take 400mcg of folic acid per day,
- avoid alcohol and smoking,
- limit your caffeine consumption to a maximum of 200mg per day (about 2 coffees).
Now you know that the primary goal of in vitro fertilization and the other fertility techniques is to favor the encounter between the oocyte (your egg cell) and the sperm to trigger fertilization…the first step to having your baby!
