INTRODUCTION

Assisted reproductive technology ART) are medical

procedures used primarily to address infertility. It includes
procedures such as in vitro fertilization. It may
include intracytoplasmic sperm injection (ICSI).When used
to address infertility, itmay also be referred to as fertility
treatment. ART mainly belongs to the field of reproductive
endocrinology and infertility. Some forms of ART are also
used with regard to fertile couples for genetic reason.

General:
With ART, the process of sexual intercourse is bypassed
and fertilization of the oocytes occurs in the laboratory
environment (i.e., in vitro fertilization).
In general, ART procedures involve surgically removing
eggs from a woman's ovaries, combining them with
sperm in the laboratory, and returning them to the
woman's body or donating them to another woman."
According to CDC, "they do not include treatments in
which only sperm are handled (i.e., intrauterine—or
artificial—insemination) or procedures in which a woman
takes medicine only to stimulate egg production without
the intention of having eggs retrieved."
In Europe, ART also excludes artificial insemination and
includes only procedures where oocytes are handled.

MODES:

Fertility medication:
Most fertility medications are agents that stimulate the
development of follicles in the ovary. Examples are
gonadotropins and gonadotropin releasing hormone.
In vitro fertilization:
In vitro fertilization is the technique of
letting fertilization of the male and
female gametes (sperm and egg) occur outside the
female body.
Techniques usually used in in vitro fertilization include:
 Transvaginal ovum retrieval (OVR) is the process
whereby a small needle is inserted through the back
of the vagina and guided via ultrasound into the
ovarian follicles to collect the fluid that contains the
eggs.
 Embryo transfer is the step in the process whereby

one or several embryos are placed into the uterus of

the female with the intent to establish a pregnancy.
Less commonly used techniques in in vitro fertilization
are:
 Assisted zona hatching (AZH) is performed shortly
before the embryo is transferred to the uterus. A small
opening is made in the outer layer surrounding the
 egg in order to help the embryo hatch out and aid in
the implantation process of the growing embryo.

Intracytoplasmic sperm injection (ICSI) is

beneficial in the case of male factor infertility where
sperm counts are very low or failed fertilization
occurred with previous IVF attempt(s). The ICSI
procedure involves a single sperm carefully injected
into the center of an egg using a microneedle. With
ICSI, only one sperm per egg is needed. Without
ICSI, you need between 50,000 and 100,000. This
method is also sometimes employed when donor
sperm is used.
 Autologous endometrial coculture is a possible
treatment for patients who have failed previous IVF
attempts or who have poor embryo quality. The
patient's fertilized eggs are placed on top of a layer of
cells from the patient's own uterine lining, creating a
more natural environment for embryo development.

 In zygote intrafallopian transfer (ZIFT), egg cells

are removed from the woman's ovaries and fertilized
in the laboratory; the resulting zygote is then placed
into the fallopian tube.
 Cytoplasmic transfer is the technique in which the
contents of a fertile egg from a donor are injected into
the infertile egg of the patient along with the sperm.
 Egg donors are resources for women with no eggs
due to surgery, chemotherapy, or genetic causes; or
with poor egg quality, previously unsuccessful IVF
cycles or advanced maternal age. In the egg donor
process, eggs are retrieved from a donor's ovaries,
fertilized in the laboratory with the sperm from the
recipient's partner, and the resulting healthy embryos
are returned to the recipient's uterus.
 Sperm donation may provide the source for the
sperm used in IVF procedures where the male partner
produces no sperm or has an inheritable disease, or
where the woman being treated has no male partner.
 Embryo splitting can be used for twinning to increase
the number of available embryos.

Other assisted reproduction techniques include:

 In gamete intrafallopian transfer (GIFT) a mixture of
sperm and eggs is placed directly into a woman's
fallopian tubes using laparoscopy following a
transvaginal ovum retrieval.
 Reproductive surgery, treating e.g. fallopian tube
obstruction and vas deferens obstruction, or reversing
a vasectomy by a reverse vasectomy. In surgical
sperm retrieval (SSR) the reproductive urologist
obtains sperm from the vas deferens, epididymis or
directly from the testis in a short outpatient procedure.
 By cryopreservation, eggs, sperm and reproductive
tissue can be preserved for later IVF.
Risks:

The majority of IVF-conceived infants do not have birth

defects.However, some studies have suggested that
assisted reproductive technology is associated with an
increased risk of birth defects. Artificial reproductive
technology is becoming more available. Early studies
suggest that there could be an increased risk for medical
complications with both the mother and baby. Some of
these include low birth weight, placental insufficiency,
chromosomal disorders, preterm deliveries and
gestational diabetes.
In the largest U.S. study, which used data from a
statewide registry of birth defects,6.2% of IVF-conceived
children had major defects, as compared with 4.4% of
naturally conceived children matched for maternal
age and other factors (odds ratio, 1.3; 95% confidence
interval, 1.00 to 1.67). ART carries with it a risk
for heterotopic pregnancy (simultaneous intrauterine and
extrauterine pregnancy).The main risks are:
 Genetic disorders
 Low birth weight In IVF and ICSI, a risk factor is the

decreased expression of proteins in energy

metabolism; Ferritin light chain and ATP5A1.
 Preterm birth. Low birth weight and preterm birth are

strongly associated with many health problems, such

as visual impairment and cerebral palsy, and children
born after IVF are roughly twice as likely to have
cerebral palsy.
Sperm donation is an exception, with a birth defect rate
of almost a fifth compared to the general population. It
may be explained by that sperm banks accept only
people with high sperm count.
Current data indicate little or no increased risk
for postpartum depression among women who use ART.
Usage of assisted reproductive technology
including ovarian stimulation and in vitro
fertilization have been associated with an increased
overall risk of childhood cancer in the offspring, which
may be caused by the same original disease or
condition that caused the infertility or subfertility in the
mother or father.
Usage:
Assisted reproductive technology procedures performed in the U.S. has more than
doubled over the last 10 years, with 140,000 procedures in 2006,resulting in 55,000
births.
In Australia, 3.1% of births are a result of ART.
In case of discontinuation of fertility treatment, the most common reasons have been
estimated to be: postponement of treatment (39%), physical and psychological burden
(19%, psychological burden 14%, physical burden 6.32%), relational and personal
problems (17%, personal reasons 9%, relational problems 9%), treatment rejection
(13%) and organizational (12%) and clinic (8%) problems.

Society and culture:

Ethics:
Some couples find it difficult to stop treatment despite very bad prognosis, resulting in
futile therapies. This may give ART providers a difficult decision of whether to continue
or refuse treatment.
For treatment-specific ethical considerations, see entries in individual subarticles, e.g. In
vitro fertilisation, Surrogacy and Sperm donation
Some assisted reproductive technologies can in fact be harmful to both the mother and
child. Posing a psychological and a physical health risk, which may impact the ongoing
use of these treatments. The adverse effects may cause for alarm, and they should be
tightly regulated to ensure candidates are not only mentally, but physically prepared.

Fictional representation
Films and other fiction depicting emotional struggles of assisted reproductive technology
have had an upswing in the latter part of the 2000s decade, although the techniques
have been available for decades. Yet, the number of people that can relate to it by
personal experience in one way or another is ever growing, and the variety of trials and
struggles are huge.
In addition, reproduction and pregnancy in speculative fiction has been present for many
decades.

Research and speculative uses:

The idea of using future ART techniques, including direct human germline engineering
technologies, to select and genetically modify embryos for the purpose of human
enhancement has been referred to as designer babies, reprogenetics, and liberal
eugenics and has been discussed since the introduction of biotechnology in the late
1970s.
The term "liberal eugenics" was coined by bioethicist Nicholas Agar. Liberal eugenics is
aimed at "improving" the genotypes of future generations through screening and genetic
modification to eliminate "undesirable" traits. The term "reprogenetics" was coined
by Lee M. Silver, a professor of molecular biology at Princeton University, in his 1997
book Remaking Eden.
The philosophical movement associated with these speculative uses
is transhumanism. When eugenics is discussed in this context it usually in context of
allowing parents to select desirable traits in an unborn child and not in the use of
genetics to destroy embryos or to prevent the formation of undesirable embryos.
Safety is a major concern when it comes to the gene editing and mitochondrial transfer,
as problems may not arise in the first children for many years, and their offspring may be
affected, and problems may only appear in those subsequent generations. New
diseases may be introduced accidentally.
Neither the first generation nor their offspring will have given consent to have been
treated. On a larger scale, germline modification has the potential to impact the gene
pool of the entire human race in a negative or positive way.
Another concern, especially for people who believe that life begins at conception, is the
fate of flawed or unchosen embryos created during the work of reaching an embryo with
the desired qualities.[50] The embryo cannot give consent and some of the treatments
have long-lasting and harmful implications.[50]
In many countries, editing embryos and germline modification is illegal. As of 2015, 15 of
22 Western European nations had outlawed human germline engineering. Human
germline modification has for many years has been heavily off limits. As of 2016 there
was no legislation in the United States that explicitly prohibited germline engineering,
however, the Consolidated Appropriation Act of 2016 banned the use of U.S. Food and
Drug Administration (FDA) funds to engage in research regarding human germline
modifications.
Germline modification is considered a more ethically and morally acceptable treatment
when one or both of the parents is a carrier for a harmful trait and is treated to improve
the genotype and safety of the future generations.[50] When the treatment is used for this
purpose, it can fill the gaps that other technologies may not be able to accomplish. The
American National Academy of Sciences and National Academy of Medicine gave
qualified support to human genome editing in 2017 once answers have been found to
safety and efficiency problems "but only for serious conditions under stringent
oversight. Germline modification would be more practical if sampling methods were less
destructive and used the polar bodies rather than embryos. In 2018, the Nuffield Council
on Bioethics issued a report which concluded that under certain circumstances, editing
of the DNA of human embryos could be acceptable. The Nuffield Council is a British
independent organisation that evaluates ethical questions in medicine and biology.
Lee Silver has projected a dystopia in which a race of superior humans look down on
those without genetic enhancements, though others have counseled against accepting
this vision of the future. It has also been suggested that if designer babies were created
through genetic engineering, that this could have deleterious effects on the human gene
pool. Some futurists claim that it would put the human species on a path to participant
evolution. It has also been argued that designer babies may have an important role as
counter-acting an argued dysgenictrend.
In November 2018, Jiankui He announced that he had edited the genomes of two
human embryos, to attempt to disable the gene for CCR5, which codes for a receptor
that HIV uses to enter cells. He said that twin girls, Lulu and Nana, had been born a few
weeks earlier. He said that the girls still carried functional copies of CCR5 along with
disabled CCR5 (mosaicism) and were still vulnerable to HIV. The work was widely
condemned as unethical, dangerous, and premature. Carl Zimmer compared the
reaction to He's human gene editing experiment to the initial reactions and subsequent
debate over mitochondrial replacement therapy (MRT) and the eventual regulatory
approval of MRT in the United Kingdom.[64]
arrangements involve ART.