Assisted reproductive technology (ART)

She is 38, two years trying, patent tubes, a normal semen analysis and a day-3 FSH that is fine — and she wants to know her real chance. Assisted reproduction is where subfertility care lands when lower-intensity options are exhausted or bypassed, and the fellowship registrar who can walk the pathway, name the protocol choice, defend the embryo-transfer number and counsel honestly on age will carry this station.^[3][4]

Overview and definition

Start with definitions the examiners will check. The International Glossary on Infertility and Fertility Care (2017) defines infertility as a disease of the male or female reproductive system — a consensus-driven set of 283 terminologies built to harmonise how the field reports and communicates.^[2] Clinically, infertility is the failure to achieve a pregnancy after 12 months or more of regular unprotected intercourse, and ART is the umbrella for every intervention that handles human oocytes, sperm or embryos in vitro to establish a pregnancy.^[2][9]

The cardinal distinction is IVF versus ICSI: in IVF, oocytes and sperm are mixed in vitro to allow fertilisation; in ICSI, a single spermatozoon is injected into each mature oocyte — first reported as successful pregnancies by Palermo and colleagues in the Lancet in 1992.^[1] IUI and ovulation induction are fertility treatments, but they are not ART, because no gamete is handled in vitro.^[4]

References15ShowHide

1. [1]Palermo G, Joris H, Devroey P, Van Steirteghem AC Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte Lancet, 1992.PMID 1351601
2. [2]Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R, Rienzi L, Sunde A, Schmidt L, Cooke ID, Simpson JL, van der Poel S The International Glossary on Infertility and Fertility Care, 2017 Hum Reprod, 2017.PMID 29117321
3. [3]Malizia BA, Hacker MR, Penzias AS Cumulative live-birth rates after in vitro fertilization N Engl J Med, 2009.PMID 19144939
4. [4]Pandian Z, Gibreel A, Bhattacharya S In vitro fertilisation for unexplained subfertility Cochrane Database Syst Rev, 2015.PMID 26583517
5. [5]van der Linden M, Buckingham K, Farquhar C, Kremer JA, Metwally M Luteal phase support for assisted reproduction cycles Cochrane Database Syst Rev, 2011.PMID 21975790
6. [6]Glujovsky D, Quinteiro Retamar AM, Alvarez Sedo CR, et al. Cleavage-stage versus blastocyst-stage embryo transfer in assisted reproductive technology Cochrane Database Syst Rev, 2022.PMID 35588094
7. [7]Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technologies Guidance on the limits to the number of embryos to transfer: a committee opinion Fertil Steril, 2021.PMID 34330423
8. [8]Youssef MM, et al. Culture media for human pre-implantation embryos in assisted reproductive technology cycles Cochrane Database Syst Rev, 2015.PMID 26585317
9. [9]Ovarian Stimulation TEGGO; ESHRE Guideline Group on Ovarian Stimulation ESHRE guideline: ovarian stimulation for IVF/ICSI Hum Reprod Open, 2020.PMID 32395637
10. [10]Al-Inany HG, Youssef MA, Ayeleke RO, Brown J, Lam WS, Broekmans FJ Gonadotrophin-releasing hormone antagonists for assisted reproductive technology Cochrane Database Syst Rev, 2016.PMID 27126581
11. [11]Brown J, Buckett W, Buckett W Ultrasound versus 'clinical touch' for catheter guidance during embryo transfer in women Cochrane Database Syst Rev, 2016.PMID 26984325
12. [12]Abou-Setta AM, et al. Post-embryo transfer interventions for assisted reproduction technology cycles Cochrane Database Syst Rev, 2014.PMID 25157849
13. [13]Chambers GM, Lee E, Hoang VP, Hansen M, Bower C, Sullivan EA Hospital utilization, costs and mortality rates during the first 5 years of life: a population study of ART and non-ART singletons Hum Reprod, 2014.PMID 24310618
14. [14]Yang J, Zhang X, Ding X, Wang Y, Huang G, Ye H Cumulative live birth rates between GnRH-agonist long and GnRH-antagonist protocol in one ART cycle when all embryos transferred: real-word data of 18,853 women from China Reprod Biol Endocrinol, 2021.PMID 34384445
15. [15]Youssef MA, Van der Veen F, Al-Inany HG, Mochtar MH, Griesinger G, Nagi Mohesen M, Aboulfoutouh I, van Wely M Gonadotropin-releasing hormone agonist versus HCG for oocyte triggering in antagonist-assisted reproductive technology Cochrane Database Syst Rev, 2014.PMID 25358904