What is Assisted Reproductive Technology and its types
High Complexity ART
In my last post, we went through the Low Complexity ART types.
Let’s review the “star” treatment of the ART Technology.
The most important treatment in ART these days is called IVF. It stands for “in vitro Fertilization”.
This treatment is recommended primarily to women that have blocked uterine tubes (formerly named Fallopian tubes). When a woman, for many reasons, have them tied up or sutured (due a bilateral salpingloclasia or bilateral tubal ligation), the egg can’t meet the sperm for the natural fertilization to take place.
It is also recommended when there is a severe male factor. Meaning that the sperm of the partner has a low cell count, has low motility or simply can’t ejaculate because of a blockage on the testicular vas deferens tissue. When this happens, the sperm cells must be retrieved by biopsy. A technique called TESA (testicular sperm aspiration).
How does IVF work?
Mainly, the eggs from the woman are retrieved, analyzed and set into a Petri dish in the IVF lab. The man gives his sperm sample (through masturbation) to later be prepared (capacitated) and set alongside with the eggs for conventional fertilization to take place.
Lately, conventional IVF is not regularly used as there is a very effective technique used in the lab called ICSI (intracytoplasmatic sperm injection). With ICSI, the embryologists grab sperm cell by sperm cell and inject directly into the egg, guaranteeing the fertilization.
The ICSI’ed eggs are left in culture media inside an incubator to give place to their development.
The day after the IVF, the embryologists will evaluate egg by egg if the fertilization occurred. This will be the first time we have a report on the cell division and further development into an embryo.
After 5 days of embryo development the embryologists will let us know how many embryos we have to perform an embryo transfer. Usually, we transfer 2 embryos on Day5 (blastocysts) of their development in order to increase the chances of at least one embryo to attach to the uterine lining.
If there are embryos remaining, the embryologists will proceed to rapidly freeze them (vitrification method) and will be placed in a nitrogen tank under the name of their parents for future attempts.
IVF is used in a wide range of situations to assist in conception like IVF with egg donation or in case the couple needs a genetic diagnose on their embryos or simply want to do gender selection.
What other types of IVF exist?
There is one variation of the IVF which is recurring to an egg or embryo donor.
IVF egg donation is recommended when:
A woman cannot produce quality eggs or no eggs at all (consequence of age or genetic predisposition of low ovarian reserve)
A woman has experienced several miscarriages, or
There is a high risk of the woman to passing on a genetic disease or abnormality condition to her children.
If any of they are diagnosed on the couple, egg donors are available to help them out.
How does egg donation work?
Well, as it is a very difficult step to consider whilst undergoing fertility treatments, you will have a coordinator by your side (this case me), to guide you through the process.
These are the usual steps on an IVF egg donation case:
1. The fertility specialist Dr. will diagnose you and let you know that the only going way in order for you to conceive is egg donation.
2. You will go through a variety of options, like egg donor catalogues, for your selection of the profile that you are looking for. In this step, I will help you out to consider the best genetic options for you. This might be a little frustrating.
3. Once selected, the egg donor starts the ovarian stimulation treatment (as we want to retrieve several eggs to be cost-effective)
4. Then the eggs are retrieved and fertilized with the partner’s or donor sperm.
5. The embryos are transferred to the recipient mother and the remaining will be frozen and taken to the nitrogen tank for future attempts.
What is embryo donation?
This can be used when a person or couple needs both egg and sperm donor to become pregnant. Although is rare for a previous IVF couple to donate their own embryos, some clinics have access to them (with their previous consent and donation of course).
When created from scratch from an egg and sperm donor, these embryos are named “Century 21 embryos”, meaning that they were created with the top screening processes and some of them are already genetically screened and actually know if they are male or female.
How do I know if the IVF worked?
Well, 10 days after the embryos are transferred, the recipient mother (or IP-intended parent) will take a blood test for an evaluation of the beta subunit of hCG (human chorionic gonadotropin) which is a hormone that is produced by the placenta after the embryo implantation. This way, if there is a presence of the hormone, we can confirm that the pregnancy took place.
But IVF pregnancies are a little bit tricky. Up until this moment we can’t yet confirm victoriously the pregnancy. We usually confirm it until the 12th week of gestation or on when we confirm the embryo’s heart beat.
The last but not least (and my personal favorite) is PGD.
PGD stands for Preimplantation Genetic Diagnose. You can stumble upon PGS as well. Is actually the same but a little bit more specific on the genetic markers we’re looking for if there is pre-existing genetic condition from a person or the couple.
This is merely to avoid passing on a genetic disease or chromosomal abnormality to your future children.
How does PGD/PGS work?
Well, as we by now are already experts in IVF, on the Day5 or even Day6 of embryo development, the embryologists will perform a minimal invasive cell biopsy on each little embryo. Is like taking a chunk of cells for their further analysis. (the embryo has the faculty to regenerate these cells, don’t worry about it, they are very resilient).
These chunks are later sent to a molecular/genetic testing lab and they will process each genetic material so they can afterwards send a report on each “embabie”.
They will let us know by each embryo whether they are healthy or not and they will tell us which embryo is a girl or is a boy.
This is the reason why PGD-gender selection exists. Although is not legal or recommended in most countries (due to ethical or religious reasons), for instance, in Mexico it is permitted and have really good results on the pregnancy rates after the screening is performed.
It is also recommended for women that undergo IVF with their own eggs but are above 38 years old or have history of previous miscarriages.
With all these said, there is one ART treatment left to mention. Which involves a whole lot of people involved and is mostly a legal implication with IVF on its way.
It is called Surrogacy.
But what exactly is Surrogacy?
It is a form of ART in which a third party woman (the surrogate mother) carries a child/children for another person/couple with the further intention of giving the baby away at the moment of birth.
This is a very complex treatment and I will give a full post to explain how does it work, its history around its implications and how and where can you have access to it.
In Med&ART Consulting, we made the compromise of helping people get pregnant and when treating patients will be as if you were speaking with a friend, but a friend that is highly specialized in the ART field.If you want to know more about us, you can send us an email at: firstname.lastname@example.org
We don’t charge a first consultation but you can buy our Consultant Biologist Ale Motta a coffee, and talk about your case so she can guide you through your fertility journey at: http://ko-fi.com/amotta☕️