What is assisted reproduction and what does it consist of?
Assisted reproduction is a multidisciplinary specialty, bringing together professionals such as gynecologists, urologists, embryologists and immunologists, among others.
Assisted reproduction is used to treat infertility, with different techniques and technologies in terms of treatment protocols, procedures in the embryology laboratory and also performing a diagnosis of the patient.
Broadly speaking, assisted reproduction is the tool to treat fertility problems. Through it, we prepare the woman’s body to host a gestation and for this we have to obtain embryos of the best possible quality. These embryos can be obtained with eggs and sperm from the couple or with donated gametes, depending on the case.
What types of assisted reproduction are available?
Assisted reproduction and the protocols chosen for each patient can vary greatly depending on the case:
- We have simpler, low-complexity treatments, such as artificial insemination or directed intercourse, which are already used less and less due to the low chances of pregnancy they offer.
- Treatments such as In Vitro Fertilization (IVF), which consist of ovarian stimulation for the woman, ovarian puncture and fertilization of the oocytes in the laboratory. The embryos obtained are then transferred to the mother’s uterus.
- Treatments such as oocyte donation, which is aimed at women with early ovarian failure, pre-menopause or menopause, or with poor oocyte quality, and which consists of receiving eggs from another woman, anonymously, in order to obtain a pregnancy.
- We can also use more advanced technologies to accompany the treatments, such as Preimplantation Genetic Diagnosis (PGT-A), which allows us to analyze the embryos genetically before transferring them to the uterus. In addition, there are other additional laboratory techniques to assist in embryo selection or sperm selection.
- Finally, there is a preventive treatment that consists of preserving a woman’s fertility: egg freezing. It is recommended for women of childbearing age who want to postpone childbearing without losing oocyte quality.
What type of assisted reproduction is most common?
Undoubtedly, the most common treatment is In Vitro Fertilization, although with the general delay of motherhood in our country, we see more and more women who need an egg donation treatment.
The use of genetic techniques such as PGT-A is also spreading, as more and more patients want to rule out possible miscarriages or implantation failures due to the genetics of the embryo. It is a technique that allows us to achieve gestation in a safer and faster way, since fewer embryo transfers are necessary.
In what cases is assisted reproduction recommended?
When we are looking for a natural pregnancy and we do not achieve it, we should not take long to consult a specialist in assisted reproduction. It depends mainly on the woman’s age.
For a woman under 35 years of age, we recommend seeing a specialist after a year of unsuccessful attempts. For a woman between 35 and 40 years old, this period is shortened to 6 months. And for a woman over 40, we should not wait more than 3 months.
In this regard, it is important to know that age and time are decisive in establishing a diagnosis. After the age of 35, women lose both oocyte quantity and quality, and it can be more difficult to become pregnant spontaneously.
In any case, it is always a matter of personalizing the patient’s diagnosis as much as possible, and checking all the parameters of both the woman and the man.
What are the latest advances in assisted reproduction?
Assisted reproduction is still a young specialty, but it has made some very notable advances in just a few years, and it continues to evolve every year with new technologies and studies that make it possible to help couples in a situation of infertility better and better.
From my point of view, one of the greatest advances has been the ICSI technique for in vitro fertilization. It consists of microinjecting a sperm directly into the egg to “provoke” fertilization. This technique has been around for about 30 years, but it is part of the remarkable advances in assisted reproduction.
As for the latest advances, we can mention Preimplantational Genetic Diagnosis, which makes it possible to discard embryos with aneuploidy and thus avoid miscarriages and implantation failures for the patient. This technology will undoubtedly be, in the coming years, one of the most widely used in assisted reproduction. If we look at the United States, for example, it is already systematically performed on embryos before transferring them.
And we finally have very useful diagnostic techniques to try to explain implantation failures, such as the endometrial receptivity test or reproductive immunology tests.