Assisted Fertilization: What is it? Procedures, Risks, Use, Ethics and Costs

It is a reproductive technology used mainly for infertility treatments; it is also known as fertility treatment.

Assisted reproduction technology (ART) is used to achieve pregnancy through fertility medication, in vitro fertilization, and surrogacy.

It mainly belongs to reproductive endocrinology and infertility, including intracytoplasmic sperm injection (ICSI) and cryopreservation.

Some forms of assisted reproduction technology are also used concerning fertile couples for genetic reasons (genetic diagnosis before implantation).

Assisted reproduction technology is also used for couples who are discordant for certain contagious diseases, for example, HIV, to reduce the risk of infection when a pregnancy is desired.



With assisted reproduction technology, sexual intercourse is overlooked, and fertilization of the oocytes occurs in the laboratory environment (i.e., in vitro fertilization).

In the USA UU., the Centers for Disease Control and Prevention (CDC), which is required due to the 1992 Fertility Clinic Success and Certification Rate Act, to publish annual success rates of Assisted Reproduction Technology in the U.S. Fertility Clinics U.U.


According to the Centers for Disease Control and Prevention, “they do not include treatments in which only sperm are handled (i.e., artificial or intrauterine insemination) or procedures in which a woman takes medication only to stimulate egg production without the intention to have recovered ovules. “

In Europe, assisted reproduction technology also excludes artificial insemination and includes only procedures where oocytes are manipulated.

The World Health Organization also defines assisted reproduction technology in this way.

Fertility medication

Most fertility medications are agents that stimulate the development of follicles in the ovary. Some examples are gonadotropins and gonadotropin-releasing hormones.

In vitro fertilization

In vitro fertilization is the technique that allows the fertilization of male and female gametes (spermatozoa and ovules) outside the female body. The methods generally used in in vitro fertilization include:

Transvaginal egg retrieval (OVR) is when a small needle is inserted through the back of the vagina and guided by ultrasound to the ovarian follicles to collect the fluid contained in the ovary. ovules

Embryo transfer is the step in the process whereby one or more embryos are placed in a woman’s uterus to establish a pregnancy. The less used techniques for in vitro fertilization are:

Assisted hatching of the area (AZH) is done shortly before the embryo is transferred to the uterus. A small opening is made in the outer layer that surrounds the egg to help the source out and help implant the growing embryo.

Intracytoplasmic sperm injection (ICSI) is beneficial in the case of male factor infertility, in which sperm counts are very low or failed fertilization occurred with previous attempts at in vitro fertilization.

The intracytoplasmic sperm injection procedure involves administering sperm carefully injected into the center of an egg with a microneedle.

With intracytoplasmic sperm injection, only one sperm per egg is needed. Without intracytoplasmic sperm injection, you need between 50,000 and 100,000. This method is also sometimes used when using donor sperm.

Autologous endometrial coculture is a possible treatment for patients who have failed previous attempts at in vitro fertilization or who have poor embryo quality.

The patient’s fertilized eggs are placed on a layer of cells from the uterine lining, creating a more natural environment for the embryo’s development.

In the zygote intrafallopian transfer (ZIFT), the ovules are extracted from the woman’s ovaries and fertilized in the laboratory; The resulting zygote is then placed in the fallopian tube.

Cytoplasmic transfer is the technique in which the contents of a fertile egg from a donor are injected into the patient’s infertile ovule and the sperm.

Egg donors are resources for women without ovules due to surgery, chemotherapy, genetic causes, poor egg quality, in vitro fertilization cycles, or advanced maternal age previously failed.

In egg donation, the ovules are recovered from a donor’s ovaries, fertilized in the laboratory with the sperm of the recipient’s partner, and the resulting healthy embryos are returned to the recipient’s uterus.

Sperm donation can provide the source of sperm used in in vitro fertilization procedures. The partner does not produce sperm or has a hereditary disease, or when the woman being treated does not have a male partner.

Preimplantation genetic diagnosis (PGD) involves the use of gene detection mechanisms such as fluorescent in situ hybridization (FISH) or comparative genomic hybridization (CGH) to help identify embryos genetically abnormal and improve beneficial results.

Embryo division can be used for twinning to increase the number of available embryos.


Other techniques of assisted reproduction include:

In the intrafallopian transfer of gametes (GIFT), a mixture of sperm and eggs is placed directly into a woman’s fallopian tubes by laparoscopy after the extraction of a transvaginal ovum.

The selection of sex is the attempt to control the sex of the offspring to achieve a desired sex. It can be completed in several ways, both before and after the implantation of an embryo and at the time of birth.

Preimplantation techniques include genetic diagnosis before implantation but also sperm classification.

Reproductive surgery treats, for example, the obstruction of the fallopian tube and the obstruction of the vas deferens or reverses a vasectomy through a reverse vasectomy.

In the recovery of surgical sperm (SSR), the reproductive urologist obtains the sperm from the vas deferens, the epididymis, or directly from the testicle in a brief outpatient procedure.

The ovules, sperm, and reproductive tissue can be preserved by cryopreservation for subsequent in vitro fertilization.

Risks of assisted fertilization

Most babies conceived for in vitro fertilization do not have congenital disabilities. However, some studies have suggested that assisted reproductive technology is associated with an increased risk of congenital disabilities.

Artificial reproductive technology is increasingly available. Early studies suggest that there may be an increased risk of medical complications between the mother and the baby.

These include low birth weight, placental insufficiency, chromosomal disorders, premature births, gestational diabetes, and preeclampsia (Aiken and Brockelsby). The most extensive study in the U.S. U.U. Used data from a state registry of congenital disabilities.

6.2% of children conceived with in vitro fertilization had significant defects, compared to 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).

Assisted reproduction technology risks heterotopic pregnancy (simultaneous intrauterine and extrauterine pregnancy). The main chances are:

In genetic disorders, in vitro fertilization, and intracytoplasmic sperm injection, a risk factor is decreased protein expression in energy metabolism, Light chain of ferritin, and the enzyme ATP5A1.

Preterm birth, low birth weight, and premature births are strongly associated with many health problems, such as visual impairment and cerebral palsy. Children born after in vitro fertilization are approximately twice as likely to suffer from cerebral palsy.

Other risk factors are:

Damage to the membrane can be reflected by an increased expression of the membrane fusion proteins of the NAPA and Annexin A3 gene.

Sperm donation is an exception, with a congenital disability rate of almost one-fifth compared to the general population. It can be explained that sperm banks only accept people with a high sperm count.

Current data indicate little or no risk of postpartum depression among women using assisted reproductive technology.

The use of assisted reproductive technology, including ovarian stimulation and in vitro fertilization, has been associated with an increased overall risk of childhood cancer in the offspring, which may be caused by the same disease or original condition that caused infertility or subfertility. In the mother or the father.

In a historical document by Jacques Balayla et al., it was determined that babies born after assisted reproductive technology have a neurological development similar to babies born after natural conception.


Assisted reproduction technology procedures performed in the USA UU have more than doubled in the last ten years, with 140,000 systems in 2006, which has resulted in 55,000 births.

In Australia, 3.1% of births result from assisted reproductive technology.

In case of interruption of fertility treatment, the most common reasons have been estimated:

  • Postponement of treatment (39%).
  • Physical and psychological burden (19%, psychological burden of 14%, physical burden of 6.32%).
  • Relational and personal problems (17%, personal reasons 9%, relational issues 9%).
  • Refusal of treatment (13%).
  • Organizational matters (12%)
  • Clinical cases (8%).


Despite a poor prognosis, some couples find it difficult to stop treatment, resulting in useless therapies. This can give assisted reproductive technology providers the difficult decision to continue or refuse treatment.

Some assisted reproduction technologies can be harmful to both the mother and the child.

They are presenting a psychological and physical health risk, which may affect the continued use of these treatments. Adverse effects can cause alarm and should be strictly regulated to ensure that candidates are not only prepared mentally but physically.

Fictitious representation

Films and other works of fiction that represent the emotional struggles of assisted reproductive technology have seen an upturn in the latter part of the 2000s. However, techniques have been available for decades.

However, the amount of people who can relate to her from personal experience in one way or another is growing, and the variety of trials and struggles is huge.

For specific examples, see fiction sections in individual sub-items, for instance, subrogation, sperm donation, and fertility clinic.

In addition, reproduction and pregnancy in speculative fiction have been present for many decades.


The U.S.

Many Americans do not have insurance coverage for research and fertility treatments. Many states are beginning to demand coverage, and the usage rate is 278% higher in states with a full range.

Some health insurance companies cover the diagnosis of infertility, but often once diagnosed, they will not cover the costs of treatment.

2005: approximate costs of treatment / diagnosis (United States, costs in US $):

  • Initial treatment, hysteroscopy, hysterosalpingogram, blood analysis ~ $ 2,000.
  • Sonohisterograma (SHG) ~ $ 600 – $ 1,000.
  • Clomiphene citrate cycle ~ $ 200 – $ 500.
  • Fertilization cycle in vitro ~ $ 10,000 – $ 30,000.

The use of a surrogate mother to take the child depends on the arrangements.

Another way to see the costs is to determine the expected cost of establishing a pregnancy; therefore, if treatment with clomiphene has the possibility of establishing pregnancy in 8% of the cycles and costs $ 500.

The expected cost is $ 6,000 to establish a pregnancy, compared to an in vitro fertilization cycle (fertility cycle of 40%) with the corresponding expected cost of $ 30,000 ($ 12,000 / .4).

For the community, the cost of in vitro fertilization, on average, pays 700% for taxes on the future employment of the conceived human being.

United Kingdom

In the United Kingdom, all patients are entitled to preliminary tests, provided free of charge by the National Health Service. However, treatment is not widely available in the National Health Service, and there may be long waiting lists.

Therefore, many patients pay for immediate treatment within the National Health Service or seek help in private clinics.

In 2013, the National Institute of Excellence in Health and Care published new guidelines on who should access in vitro fertilization treatment at the National Health Service in England and Wales.

The guidelines also say that women between 40 and 42 should be offered an in vitro fertilization cycle at the National Health Service if all of the following criteria are met.

They have never before received in vitro fertilization treatment, have no evidence of low ovarian reserve (this is when eggs in the ovary are soft in number or of low quality), and have been informed of the additional implications of in vitro fertilization and pregnancy at this age.

However, if tests show that in vitro fertilization is the only treatment likely to help them become pregnant, women should immediately be referred for in vitro fertilization.

This policy is often modified by local clinical commissioning groups, in a relatively flagrant violation of the National Health Service for England Constitution.

That states that patients have the right to medications and treatments that have been recommended by the National Institute of Excellence in Health and Care for use in the National Health Service.

For example, the Clinical Commissioning Group of Cheshire, Merseyside, and West Lancashire insist on additional conditions:

The person who undergoes the treatment must have begun the treatment before turning 40 years old. The person undergoing treatment must have a body mass index between 19 and 29. None of the members must have living children, either from their current or previous relationship. This includes adopted and biological children.

Subfertility should not be the direct result of a sterilization procedure for any parties (this does not include conditions in which sterilization occurs due to another medical problem).

Couples who have reversed their sterilization procedure are not eligible for treatment.


In Sweden, official fertility clinics provide the most necessary and initial treatments. Still, there are long waiting lists, especially for egg donations, since the donor receives a reward as low as the couple.

However, there are private fertility clinics.


Some treatments are covered by OHIP (public health insurance) in Ontario, and others are not. Those with bilaterally blocked fallopian tubes and those under 40 have the covered treatment but are still required to pay the lab fees (about $ 3,000 – $ 4,000).

Coverage varies in other provinces. Most other patients must pay for the treatments themselves.


Israel’s national health insurance, mandatory for all Israeli citizens, covers almost all fertility treatments.

The costs of in vitro fertilization are fully subsidized until the birth of two children for all Israeli women, including single women and lesbian couples.

Embryo transfers for purposes of gestational surrogacy are also covered.

New Zealand

The National Public Health System of New Zealand covers in vitro fertilization treatment only in specific circumstances, based on an equation of “points for conception challenges.”

Publicly funded in vitro fertilization treatments are limited (between one and three treatments depending on the criteria) and are subject to substantial waiting lists, which rely on the local health financing region, which increases the potential inequity of health care support. Assisted reproductive technology throughout the country.

Infertility tests through blood tests can be covered with public funds; however, additional investigations may not be covered publicly in the absence of explicit gynecological complications.

Research such as a hysterosalpingogram may be covered, but the waiting list may exceed six weeks, while a private-source sonohysterogram may cost $ NZ900 but is available.

Many New Zealanders select self-funded in vitro fertilization cycles, at approximately $ NZ10,000 per cycle, and other forms of assisted reproductive technology.

Like intrauterine insemination, at approximately $ NZ1200, using the services of private fertility clinics, which in itself is a growing local industry.

People who use private services are generally not covered by personal health insurance policies in New Zealand.


On January 27, 2009, the Federal Constitutional Court ruled that it is unconstitutional that health insurance companies must pay only 50% of the cost of in vitro fertilization.

On March 2, 2012, the Federal Council approved a bill of some federal states, which states that the federal government grants a subsidy of 25% of the cost. Therefore, the proportion of the expenses generated by the pair would be reduced to only 25%.


In Jordan, not everyone has insurance coverage for research and treatment of fertility. The army forces cover the army members for all the investigations and treatments of infertility. It also covers three trials of in vitro fertilization in cases of primary infertility.

Some insurance companies cover the diagnosis and treatment of infertility for people with government health insurance but will not cover any of the assisted reproduction techniques.

Many centers offer private treatment for infertility in the private sector, including assisted reproduction techniques. Conventional cost of in vitro fertilization 1170JD = 1654 US $, ICSI costs 1270 JD = 1797 US $ Both prices include assisted hatching.

However, it does not include the medication cost, which averages between 500-700 JD, equivalent to between 700-1000 USD.