IVF and Assisted Reproductive Technology: Understanding the Latest Advancements

Do you know about IVF and Assisted Reproductive Technology? ART covers a wide spectrum of technologies. Simple techniques are often attempted initially, as they are less invasive than more advanced options. These techniques include:

•  • ovulation induction
•  • artificial insemination, also known as intrauterine insemination
• • donor insemination. Advanced techniques are:
•  • in-vitro fertilisation (IVF)
•  • intracytoplasmic sperm injection (ICSI)
•  • preimplantation genetic diagnosis (PGD).

What is IVF?

Technically, IVF is the name given to any process used to conceive a child outside the body. IVF is used in a range of circumstances to assist with conception but is often the sole means of achieving pregnancy for women whose fallopian tubes are damaged or blocked due to disease.

As a result of the damage or blockage, there is an obstruction between the egg and sperm, and IVF is required to allow this fertilization to occur. In IVF, the woman’s eggs are collected, along with sperm from the male partner or donor. The egg and sperm are left in a culture dish in a laboratory to allow the egg to be fertilized by the sperm. This creates an embryo, which is then placed back into the woman’s uterus in a procedure called embryo transfer.

Sometimes, more than one embryo develops in the laboratory, and it is possible to freeze these embryos for use in later transfer procedures.

Preimplantation Genetic Testing (PGT)

PGD is largely used as a means for reducing the risk of an individual or couple passing on a specific genetic or chromosomal disease or abnormality to their child. PGD may also be appropriate for women older than 38 or for individuals or couples who have experienced repeated miscarriages or repeated IVF failure. In PGD, embryos are generated through the process of IVF. Then, one or two cells from the embryo are screened for a genetic condition prior to the transfer of the embryo into a woman’s uterus.

The screening gives information regarding the genetic status of the embryo, enabling the selection of unaffected embryos prior to implantation and before pregnancy is established. This allows the individual or couple to choose not to be impregnated with an affected embryo rather than face a difficult choice of whether or not to terminate a pregnancy.

Intracytoplasmic sperm injection (ICSI)

ICSI is used for the same reasons as IVF, but especially when a man has sperm-related problems such as low sperm count. Essentially, ICSI follows the same process as IVF, except ICSI involves the direct injection of a single sperm into each egg to achieve fertilization. After this, the process is the same as described for IVF.

Artificial Intelligence (AI) in IVF

Artificial intelligence has begun to play an increasing role in IVF by improving the efficiency and accuracy of the process. AI and machine learning algorithms are being used to optimize various aspects of IVF, from selecting the best embryos for transfer to monitoring the development of embryos in the lab.

One key application of AI is in embryo selection. Traditional methods of selecting embryos for transfer rely on visual assessment by embryologists, which can be subjective. AI algorithms, however, can analyze large datasets of embryo images and predict which embryos have the highest potential for implantation, increasing the chances of success.

Additionally, AI-powered tools are being used to predict the likelihood of success in IVF, helping patients make more informed decisions about their treatment.

Third-party ART

Third-party ART Trusted Source is when another individual donates eggs, sperm, or embryos to an individual or couple. It can also include surrogate and gestational carriers. These refer to when another person is either inseminated with sperm from the couple using ART or implanted with an embryo from those using ART.

Evidence suggests that 50% of Trusted sources of transfers with donated frozen embryos result in pregnancy and 40% result in a live birth. Other benefits of third-party ART include the following:

• It may work when IVF has repeatedly failed.
• It may help to avoid passing on specific conditions.
• It can help a person who produces healthy eggs but has had difficulty carrying a pregnancy to term.
• It can help those who have difficulty producing an egg or sperm.

Depending on which type people choose, third-party ART can be very costly

At its inception, oocyte retrieval was initially performed via laparotomy, then by laparoscopy. It is standardly performed today vaginally using ultrasound guidance under general anesthesia or conscious sedation. A needle is inserted trans-vaginally and guided with ultrasound into each follicle to aspirate the follicular fluid, usually containing an oocyte.  

Greater numbers of oocytes retrieved (up to 15) are associated with improved live birth outcomes.

Before the ultrasound-guided transvaginal approach, laparoscopic or abdominal retrievals of oocytes were performed. While largely fallen out of practice, laparoscopic and abdominal egg retrievals are occasionally used to obtain oocytes, such as in cases of vaginal agenesis or when the ovaries are not in the pelvis (such as in the case of ovarian transposition in advance of radiation therapy or with patients who have a huge fibroid uterus). 

Cryopreservation 

Embryos not used in the current cycle can be cryopreserved. Cryopreservation is typically achieved with vitrification, a rapid freezing process. Vitrification is thought to prevent cryoinjury by decreasing the development of intracellular crystals. All embryos can also be frozen in patients at risk for ovarian hyperstimulation syndrome (discussed further in “Complications”).

 The embryos from these “freeze-all” cycles can then be used in a future cycle not associated with the controlled ovarian stimulation. Freeze-all cycles are also utilized in some clinics routinely, as frozen-thawed embryos have been associated with improved pregnancy rates and obstetric outcomes, such as a decreased risk of perinatal mortality and preterm birth.

Gamete intrafallopian transfer (GIFT)

 GIFT was launched as a more ‘natural’ version of IVF. Instead of fertilization occurring in a culture dish in a laboratory, the woman’s eggs are retrieved from her ovaries and inserted between two layers of sperm in fine tubing. This tubing is then fed into one of the woman’s fallopian tubes, where the egg and sperm are left to fertilize naturally. These days, GIFT is very rarely used. However, it may be used as an option for couples who don’t want to use IVF for religious reasons, providing that the woman’s fallopian tubes are functioning.

Enhancing Healthcare Team Outcomes

As highlighted throughout this review, IVF and Assisted Reproductive Technology require a cohesive interdisciplinary team that ranges from reproductive endocrinology and infertility physicians and nurses to the andrology/embryology team to psychiatric/mental health support. Communication between these teams is vital to the success of ART and enhancing outcomes.