PREGNANCY WITH ASSISTED REPRODUCTIVE TECHNOLOGY

Pregnancy With Assisted Reproductive Technology

Assisted reproductive technology (ART) is the use of reproductive technology to treat infertility. This is today the only application of reproductive technology to increase reproduction that is used routinely.

Assisted Reproductive Technology (ART) procedures are used to overcome infertility. It includes infertility treatments in which eggs and sperm are handled in the laboratory to establish a pregnancy. Women who undergo those procedures are more likely to deliver multiple-birth infants than those who conceive naturally. This report presents the most recent national data and state-specific results. [MMWR 2009;58(SS05):1–25]

Some of the reproductive technologies available to infertile women include :

1. In vitro fertilisation (IVF)

In vitro fertilisation (IVF) is conception within a test tube (or similar). The woman undergoes ovulation induction and a number of eggs are removed. This is done through the vagina under ultrasound control. The collected eggs are then mixed with previously collected sperm from the woman's partner and placed in a special incubator. The fertilised eggs are then implanted into the woman's uterus via a thin tube inserted through the cervix.

Since 1983, when the first infant was conceived from in vitro fertilization (IVF) in the United States, the use of IVF and related procedures (assisted reproductive technology) has increased substantially. [MMWR 2002;51(05):97–101]

Variations on IVF include:

1. Use of donor eggs and/or sperm in IVF. This happens when a couple's eggs and/or sperm are unusable, or to avoid passing on a genetic disease.
2. Intracytoplasmic sperm injection (ICSI)in which a single sperm is injected directly into an egg; the fertilized egg is then placed in the woman's uterus as in IVF.
3. Zygote intrafallopian transfer (ZIFT) in which eggs are removed from the woman, fertilized and then placed in the woman's fallopian tubes rather than the uterus.
4. Gamete intrafallopian transfer (GIFT) in which eggs are removed from the woman, and placed in one of the fallopian tubes, along with the man's sperm. This allows fertilization to take place inside the woman's body.

2. Surgery

Usually, an egg released during ovulation is ushered down the fallopian tube. If it meets with a sperm on its journey, conception may occur. Female infertility can be caused by obstructions within reproductive organs. Some of the problems that can be addressed by surgery include:

1. Fibroids - non-malignant tumours growing inside the uterus.
2. Polyps - overgrowths of the uterine lining (endometrium), which can be caused by fibroids.
3. Endometriosis - the growth of endometrial tissue outside of the uterus. This misplaced tissue can block the fallopian tubes.
4. Salpingitis - the fallopian tube becomes inflamed and scarred by bacterial infection.

3. Ovulation induction

Irregular or absent periods may indicate that ovulation is irregular or absent too. However, even women with regular periods may skip ovulation every now and then. Ovulation can be induced with a range of drugs in a tablet or injection form. The drug schedule includes synthesised versions of gonadotrophins, the hormones released by the pituitary gland in the brain that prompt the ovaries to release an egg every menstrual cycle. However, the drugs tend to trigger the release of a number of eggs per cycle, which means the risk of having a multiple pregnancy is about 20 per cent. Sometimes, the response to synthesised gonadotrophins may be excessive, leading to a condition known as ovarian hyperstimulation syndrome. The symptoms include oedema (fluid retention), abdominal pain and bloating. Regular blood tests are used to help fine-tune the dosage and minimise the risk of ovarian hyperstimulation syndrome from occurring.

4. Other assisted reproductive technology:

a. Assisted hatching
b. Fertility preservation
c. Freezing (cryopreservation) of sperm, eggs, & reproductive tissue
d. Frozen embryo transfer (FET)

Pregnancy isn't always possible

Despite the sophistication of assisted reproductive technologies, pregnancy doesn't always happen. It depends on a range of factors, including the reasons for the woman's infertility, her age and the type of technology used.

Potential health risks

Some of the problems associated with the use of assisted reproductive technologies include:
1. Ovarian hyperstimulation syndrome
2. Associated risks of multiple pregnancies
3. Increased risk of premature labour and low birth weight
4. Increased risk of caesarean delivery.

Ethics

Many issues of reproductive technology have given rise to bioethical issues, since technology often alters the assumptions that lie behind existing systems of sexual and reproductive morality. Also, ethical issues of human enhancement arise when reproductive technology has evolved to be a potential technology for not only reproductively inhibited people but even for otherwise reproductively healthy people.