Assisted reproductive technology (ART) is a general term referring to a variety of medical methods used to achieve pregnancy by artificial or partially artificial means.
If the couple experiences difficulties becoming pregnant, then artificial fertilisation – or assisted reproduction – can help.
If the man’s semen does not contain enough sperm cells or there are too many abnormal sperm cells, the sperm of a donor could be used.
This process is carefully regulated in many countries.
You will learn
1. The four main types of artificial fertilisation and associated risks for each
2. Why artificial fertilisation is sometimes criticised by doctors and women
3. Some thoughts on how to pay for artificial fertilisation
The Four Methods of Artificial Fertilisation
There are four different medical methods of artificial fertilisation:
- Intracytoplasmic Sperm Injection (ICSI)
- In-Vitro Fertilisation (IVF)
- Gamete Intra-Fallopian Transfer (GIFT)
Insemination is usually recommended when the sperm quality of the male partner is low. Before insemination is considered, you should try a high dose of L-Arginine for around six weeks (such as amitamin M forte or Arginmax). This is a natural way of increasing the quality and number of sperm by up to four times the amount, as healthy sperm requires a particularly large amount of this amino acid.
However, if the post-coital test (a test to see if there are sperm in the cervical mucus after sex) returns a negative result – for example because of a limited production of cervical mucus or because the body has developed antibodies against the sperm cells – then insemination can help you and your partner to conceive.
This is because insemination inserts the prepared sperm straight into the uterus through a thin tube, bypassing the vagina (intrauterine insemination, IUI). The process is generally quite safe and rarely causes complications, and pain during the procedure is unusual.
If your cycles are regular, then insemination can result in pregnancy without any additional medication. However, as the insertion of the sperm should occur at the point of highest fertility to ensure the highest chance of success, then many doctors recommend a dose of the peptide hormone HCG (Human chorionic gonadotropin) to trigger the release of an egg.
It can also sometimes make sense to gently stimulate the female cycle with hormones, so that two or three egg cells are released, increasing the chances of a pregnancy. In order to prevent a dangerous hyper-stimulation of the ovaries, you should visit your doctor regularly.
Sometimes couples decide to use donated sperm for insemination (heterologous insemination). This is often the case when the male produces absolutely no sperm cells, or when he suffers from an inherited condition which you would like to spare your child from.
Risks of Insemination
Hormonal stimulation in particular can have complex side effects. Especially dreaded is the development of Ovarian Hyper-stimulation Syndrome (OHSS), which is why regular visits to your doctor are necessary. This hyper-stimulation can also result in multiple pregnancies, which leads to an increased risk during pregnancy for both the mother and the children.
Heterologous insemination can moreover lead to psychosocial and ethical problems, as the male partner is not the biological father of the child. Despite careful controls, the danger of inherited conditions has not been completely eliminated.
ICSI – Intracytoplasmic Injection of Sperm into the Ovum
The difference between insemination and ICSI lies in the fact that in the latter process the fertilisation of the male and female cells takes place in the laboratory. Under a microscope, a single sperm cell will be injected into the egg cell.
Once the cell division has been completed, the doctor will transplant the embryo into the uterus.
When intracytoplasmic injections of sperm are used, the treatment of the woman is almost exactly the same as after in vitro fertilisation (IVF). This method is however usually used when the male partner only produces few and poorly developed sperm cells.
For ICSI, the male sperm cells are usually removed directly from the testes or epididymis under anaesthetic. One of these male sperm cells is then directly inserted into the egg cell in the laboratory.
Risks of Intracytoplasmic Sperm Injections (ICSI)
In addition to the risks which also arise when IVF is used, it has been demonstrated that ICSI can lead to deformities in the offspring 1. This probably results from the fact that this treatment inserts sperm cells that may never otherwise, under natural conditions, have made it to the egg cell.
Egg donation is illegal just in Germany. It is however the only method of conceiving a child for women whose ovaries do not produce any egg cells. This method involves transferring the embryo created using the egg cell of another woman and (usually) the sperm of your own partner into your uterus. Therefore, although the woman carries the foetus, she is not the genetic mother of the child. The removal and fertilisation of the egg cells is achieved through IVF or ICSI.
In Vitro Fertilisation (IVF)
In vitro fertilisation is a method of artificial fertilisation, where an egg cell is removed from the ovary of the woman and brought into contact with a sperm cell in a laboratory. If fertilisation occurs, then the embryo is transferred into the uterus of the woman, where it should hopefully implant itself into the uterus and develop as normal.
Before an egg cell can be extracted, the natural function of the ovaries must however be ‘turned off’ with the help of hormones. As soon as this has been successful, then the ovaries must be hyper-stimulated with further medication containing hormones.
Ideally, around 15 egg follicles need to mature which can be used later for in vitro fertilisation. Other medical treatment must accompany this treatment, as it can in extreme cases lead to a life-threatening hyper-stimulation of the ovaries.
After further hormones have been used to trigger the release of an egg, the egg cell is removed from the donor. A puncture is made using a tiny needle whilst the donor is under full anaesthetic. The male partner donates sperm at the same time, produced by masturbation.
Next, the egg cell and the prepared sperm are brought together in a nutrient solution. If the fertilisation is successful, then between one and three embryos are inserted through a tube through the vagina into the uterus. It is important in the following luteal phase of in vitro fertilisation to support the female body with further hormones.
In vitro fertilisation is used in cases of blocked or missing fallopian tubes or endometriosis. When other insemination methods or hormonal stimulations without artificial fertilisation have failed, IVF is often the method of choice.
When more egg cells are fertilised than necessary, these can be frozen as cryopreserved embryos for future treatments. This saves you and the donor from going through the expensive and arduous process of ovary stimulation and egg extraction.
Risks of In Vitro Fertilisation
The female body can get a bit mixed up by all the extra hormones. Ovarian hyper-stimulation is however rare. There are nevertheless many other side effects which can occur as a result of hormonal changes, including mood swings, problems sleeping, stomach pains, increases in weight and nausea.
The extraction of the egg can also in very rare cases lead to the injury of a surrounding organ or to an infection. The anaesthetic used during the procedure also obviously brings certain risks.
As two embryos are often transferred into the uterus, IVF treatment leads to multiple pregnancies more frequently than other methods of fertilisation, which means an increased risk for both the mother and the child. Ectopic pregnancies (pregnancy in the fallopian tube) occur more frequently after IVF treatment than in natural pregnancies.
The rate of miscarriage and still birth rate is also higher when IVF has been used. This is partly due to other factors, such as the fact that couples seeking IVF treatment are often older. Researchers have however also demonstrated in a large-scale study that the treatment itself involves certain risks 2.
Babies created as the result of IVF treatment are more likely to be born prematurely than children conceived naturally. It has not yet been clarified if artificial fertilisation also increases the occurrence of deformities or long-term damage in the child.
A study has shown that in cases where a cryopreserved embryo has been used, then premature births, occurring before the 34th week, occur more frequently than when conception has occurred naturally in the womb. The number of still births is also higher.
Children conceived using this method are significantly more likely to have a high birth weight, necessitating a caesarean. Interestingly, scientists have reached the conclusion that cryopreserved embryos actually develop better than ‘fresh’embryos, that is those used for IVF straight after their creation in the laboratory 3. On the other hand, the chances of a successful implantation are higher when fresh embryos are used.
Gamete Intra-Fallopian Transfer (GIFT)
The term gamete refers to the sperm and the egg cells which fuse during fertilisation. Intra-fallopian means the insertion of the male and female cells through the fallopian tubes.
Criticism of Artificial Fertilisation
Many doctors criticise assisted reproduction as unethical. If there are no problems with the woman’s reproductive system, four out of five women who receive treatment are pregnant within a couple of months.
Women who have had positive experiences with artificial fertilisation are convinced of the benefits of this treatment. It is important to them that they themselves are able to bear the child.
Assisted reproduction doesn’t always help childless couples. Sometimes it takes several attempts to result in a pregnancy. There are several approaches to artificial fertilisation. Which technique is suitable for which couple is decided by the doctor treating them.
If the initial treatment method remains unsuccessful, then other methods can be considered. It is therefore important that couples who wish to conceive in this manner receive counselling and do not panic if the first method does not immediately produce results.
Assisted reproduction can take up to a year before it is successful in fertilising an egg.
Meeting the Costs of Artificial Fertilisation
Health insurance companies will only take on the costs of artificial fertilisation in very rare cases. Even then, not all costs will be met by the insurance company. Firstly, it depends on which technique of assisted reproduction is used, and secondly, the individual conditions of the insurance of the couple undergoing treatment play a heavy role. For further information, please consult your own health insurance provider.