What ART Options Are Available?
Infertility affects millions of people, making assisted reproductive technology (ART) an important part of modern family building. When hearing the term ART, many people may think of in vitro fertilization (IVF), but numerous other fertility treatments fall under this header. From sperm injection to genetic testing, advanced ART procedures can help further improve the chances of pregnancy. Understanding the full spectrum of assisted reproductive technologies available can help patients make informed decisions when undergoing fertility treatment.
Treatment starts with testing
Before starting any fertility treatment, patients should undergo a comprehensive evaluation. Blood work, ultrasound imaging, a semen analysis (SA), and other diagnostic tests help identify potential causes of infertility. Results from this evaluation allow fertility specialists to recommend the most appropriate treatment based on individual barriers to conception. While some patients can benefit from standard IVF, other couples may require more advanced procedures to achieve pregnancy. This is especially true if the female patient is older, both the man and woman have underlying fertility issues, or if previous IVF attempts have been unsuccessful.
ICSI may improve success
Intracytoplasmic sperm injection (ICSI) is an advanced fertility procedure that involves injecting a single sperm into a mature egg during the IVF process. ICSI can be particularly beneficial for couples with severe male-factor infertility since only 1 healthy sperm is required. Approximately 70-80% of eggs injected with ICSI are expected to fertilize in patients with male-factor infertility, rates that are similar to standard IVF success in patients without male-factor infertility. For many couples who have not been able to achieve success with standard IVF, ICSI may be the solution.
PGT reduces risk
In some cases, an IVF cycle can go completely to plan, only to result in an earlier miscarriage. In many cases, these difficult early losses are attributable to an underlying genetic problem. Preimplantation genetic testing (PGT) screens all embryos before transfer, helping to reduce risk. There are different types of PGT available. PGT-A screens for abnormal chromosome numbers, while PGT-M and PGT-SR assess embryos for specific inherited conditions or structural chromosome abnormalities. A discussion with the fertility team and a genetic counselor can help patients make an informed decision about which version of PGT to pursue.
Assisted hatching can help
Another advanced procedure that some couples may want to consider is assisted hatching (AH), a lab procedure done during IVF. During AH, the embryologist makes a small hole in the outer layer of the embryo. This procedure may increase the likelihood of the embryo being able to break out of the shell and attach to the uterus. AH cannot substantially improve success rates, but for some select patients, this approach may marginally increase pregnancy chances.
Additional options to consider
Despite advances in ART, some couples will still require help beyond IVF, ICSI, PGT, and AH. Women with diminished ovarian reserve (DOR), premature ovarian insufficiency (POI), or advanced maternal age (AMA) can consider the use of donor eggs to achieve a pregnancy. Donor sperm can be beneficial for couples dealing with male-factor infertility, especially if previous ICSI attempts have been unsuccessful. Egg and sperm donors are also essential for individuals pursuing single parenthood and same-sex couples. If a medical condition prevents a woman from carrying a pregnancy, a gestational carrier may be an appropriate option.
Looking toward the future
Nowadays, there are many different ways to build a family. Beyond standard IVF, the use of ICSI, PGT, and AH may help couples faced with infertility. Donors and gestational surrogates may also be appropriate in select cases. Considering all the available options allows patients to make an informed decision. With the right approach, pregnancy is possible.
