Assisted Reproductive Technology

Understanding Assisted Reproductive Technology

Assisted reproductive technology (ART) encompasses medical techniques, such as artificial insemination and in-vitro fertilization, that enable assisted human reproduction. It addresses infertility, advanced maternal age, same-sex couples, single parenthood, and family planning to reduce the risk of genetic diseases.

ART includes any reproductive process assisted by medicine involving the in-vitro or laboratory manipulation of eggs, sperm, and embryos to establish a pregnancy.

It can be performed through in-vitro fertilization or artificial insemination, increasing pregnancy chances for infertile couples and totaling over 5 million births worldwide.

ART: Various Techniques of Varying Invasiveness

Assisted reproductive techniques are indicated for couples experiencing difficulties conceiving (due to female or male infertility, or both), as well as for single women or men, same-sex couples wishing to have children, and families with pre-existing conditions, in addition to gamete cryopreservation (egg freezing).

ART procedures can be divided into two categories: low complexity and high complexity. Complexity is low when fertilization occurs in the female reproductive tract, as in artificial insemination or intrauterine insemination techniques. These are also minimally invasive techniques. High complexity refers to fertilization occurring in a laboratory, with the resulting embryos placed in the mother's uterus, as in in-vitro fertilization techniques. This ART technique is indeed much more invasive than those mentioned above.

IVF-ICSI (In-Vitro Fertilization with Intracytoplasmic Sperm Injection)

The most complex assisted reproduction technique that promotes the union of the egg and sperm in a laboratory environment. The formed embryos are cultured and selected before being transferred to the woman's uterus.

Sperm is placed in contact with the eggs for 24 hours to allow for "natural" fertilization. After 24 hours, the embryologist cleans the eggs and checks whether fertilization has occurred. The formed embryos are cultured until the fifth or sixth day of development before being frozen or transferred to the woman's uterus.

Before transfer, a biopsy can be performed, involving the removal of certain cells from the embryo for genetic viability study.

ICSI is a modification of in-vitro fertilization (IVF) that involves injecting a single living sperm into the oocyte cytoplasm (inside the egg). Thus, the technique can resolve infertility problems for many couples with significantly reduced sperm quantity or motility, in addition to cases of premature ovarian insufficiency and advanced maternal age.

Embryo Transfer

In the ART process, embryos are formed in a laboratory. Therefore, it is necessary to choose the embryo to be implanted in the mother. Embryos can be selected based on their development and morphology. Furthermore, embryo biopsy is possible, i.e., tests capable of evaluating the genetics of embryos, screening for syndromes and genetic conditions. In this way, the implantation of an embryo free from the identified conditions is prioritized, reducing the risk of miscarriage.

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A Progressive Protocol and Variable Success Rates

The success rate varies depending on the technique used and factors such as the mother's age, ovarian quality, sperm quality, etc.:

• Natural Pregnancy (without intervention): between 15 and 17%;
• Artificial Insemination: 20%;
• In-Vitro Fertilization: average of 45% (depending on age and embryo selection);

Studies show that when biopsy is performed on embryos from women over 38, the success rate can increase from 11% to 40%, and the miscarriage rate can decrease from 22% to 4%. In cases of artificial insemination, doctors can use certain medications to try to reduce the risk of miscarriage.

For in-vitro fertilization, there is a greater evaluation of the sperm (because there is already a possibility that there is a problem related to it), sperm DNA fragmentation testing, and genetic evaluation of embryos on the fifth or sixth day of development. Sperm evaluation is simple, from a sperm sample.

Embryo analysis is done from a biopsy, where the embryo's cells are analyzed to determine if there is a genetic syndrome, which can reduce the miscarriage rate from 22% to 4%. Thus, it is possible to prioritize the implantation of embryos free from syndromes, increasing the chances of pregnancy success.

Key tests include:

• PGT-A: PGT-A (Preimplantation Genetic Testing for Aneuploidies) is a test that analyzes the amount of genetic material in embryos generated by in-vitro fertilization;
• PGT-SR: PGT-SR (Preimplantation Genetic Testing for Structural Rearrangements) is a test that analyzes the structure of the genetic material of embryos generated by in-vitro fertilization. The aim of this examination is to find embryos free from structural alterations (such as translocations), as they have the lowest risk of miscarriage;

Research Challenges

Infertility has become increasingly common, being associated with health factors (such as hormonal changes) and social factors (such as delayed childbearing). In addition, families with pre-existing conditions contribute to the growing demand for assisted reproduction procedures for family planning.

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