Assisted reproductive technology (ART) has been used in the United States since 1981, after the much publicized “test tube” baby, Louise Joy Brown, was born using these techniques in England in 1978. The most common ART procedure is in vitro fertilization (IVF), the transfer of fertilized eggs into a woman’s uterus.
Treatments in which there is handling of eggs and/or embryos outside of the body are considered ART. Typically, ART procedures involve removing an egg(s) from your ovary, combining it with sperm in a laboratory and returning it to your body. Sometimes ART procedures include the use of donor eggs and embryos, as well as cryopreserved (frozen) eggs and embryos.
ART does not include treatments in which only sperm are handled (such as intrauterine insemination), or treatments that only involve taking fertility medication.
How prevalent is ART?
The use of ART has doubled over the past 10 years, yet the use of of these procedures are still considered rare, especially in contrast to the possible demand. Though approximately 6 million couples in the U.S. experience infertility every year, just over 1 percent of all infants born are conceived using ART. In vitro fertilization (IVF) accounts for the vast majority of these procedures.
According to the Centers for Disease Control's (CDC) 2012 preliminary ART Fertility Clinic Success Rates Report (the latest report as of 2014), in 2012 over 175,000 ART cycles were performed at over 450 reporting clinics in the U.S. Over 50,000 babies were born through the use of ART.
Common forms of ART
- In Vitro Fertilization (IVF) - IVF is a procedure through which a woman’s eggs and a man’s sperm are combined outside of the body in a laboratory dish. One or more of these fertilized eggs (embryos) are transferred into the woman’s uterus so that they may implant in the uterine lining and develop. In vitro fertilization accounts for 99% of all ART procedures in the U.S.
- Gamete Intrafallopian Transfer (GIFT) - This procedure is similar to IVF, but in GIFT, the gamete (eggs and sperm) is put into to a woman’s fallopian tubes rather than her uterus. It is hoped that fertilization will occur in the tubes and that the embryo will move down the tube and attach to the uterine wall. This procedure can only be used in women who have normal fallopian tubes. Some couples may consider GIFT for religious reasons because eggs are not fertilized outside the body.
- Zygote Intrafallopian Transfer (ZIFT) and Tubal Embryo Transfer (TET) In these procedures, an egg is retrieved form the woman one day, fertilized in the lab, and on the next day the zygote (the fertilized egg before cell division begins) is transferred to the fallopian tube.
- Intracytoplasmic Sperm Injection (ICSI) In this procedure, used with in vitro fertilization (IVF), a single sperm is injected directly into a mature egg, making it easier for the sperm to fertilize the egg.
Success rates for ART
In terms of percentages, success rates vary significantly according to the procedure. According to the latest statistics from Society for Assisted Reproductive Technology (SART), overall success rates (percentage of cycles resulting in live births) for IVF range from 3.9 percent to 40.7 percent depending on age.
For all ART procedures using fresh embryos from non-donor oocytes, the success rate for women were:
- under 35 years old is approximately 40.7 percent
- between 35 and 37 years, the success rate is about 31.3 percent
- between 38-40, the success rate is around 22.2 percent
- between 41-42, the success rate is approximately 11.8 percent
- above the age of 42, the success rate is 3.9 percent
The downsides of ART
ART can take up a great deal of time and can be expensive. However, many couples have been able to conceive babies using these techniques that otherwise would not have been able to. The most common complication of ART is multiple births. Babies born from IVF, for example, can be smaller than those born when natural conception took place, though they are typically still in the normal range. The majority of studies have not found an increased risk of birth defects in babies conceived with IVF.
Other risks associated with ART include:
- Ovarian hyperstimulation syndrome (OHSS) - A condition characterized by swollen and painful ovaries. Fluid may also gather in the abdomen and chest, and the woman may experience bloat, nausea, vomiting and suppressed appetite.
- Ovarian cancer - While studies have not supported the conclusion that fertility drugs are linked to ovarian cancer, there is still uncertainty regarding risk. Therefore, an annual gynecologic exam is recommended.
- Bleeding, infection and organ damage - These are all known risks associated with any surgery.
- Miscarriage or ectopic pregnancy - Would likely occur in the first trimester, or 13 weeks after conception.
- Psychological stress - Mental and emotional stress can occur as a result of the physical, financial and emotional commitment.
Updated August 2014