ART : everything you need to know
Assisted Reproductive Technologies (ART) represent all the procedures and treatments available with a view to having a child.
These include ovarian stimulation treatments, intrauterine sperm insemination and in vitro fertilization with or without sperm microinjection (IVF). These assisted reproduction techniques can be carried out using the future parents’ own gametes or donor gametes.
These treatments are aimed at infertile couples, single women and couples of women, as a donor is required for the sperm needed for procreation.
Who can benefit from ART ?
France is one of the few countries in the world to provide 100% reimbursement for assisted reproduction procedures up to the age of 43.
Single women and women’s couples have recently been able to benefit from ART as part of their life plans.
ART with third-party donor
For assisted reproduction to be possible for single women and female couples, semi-anonymous sperm straws have to be allocated to them. This process takes between 12 and 18 months.
The first step is to make an appointment at a human sperm conservation center (CECOS) with a letter from your gynecologist. A medical consultation will gather information on the request, confirm the need for sperm donation, assess the cumulative risk for the recipient woman and note the applicant’s physical characteristics (ethnicity, hair and eye color).
If the indication and the request are confirmed, a consultation with a psychologist or psychiatrist will be carried out, and the couple or single woman will have to take steps with a notary. At the same time, the gynecologist specializing in assisted reproduction will begin IVF preparations (hormone levels, serology, uterine condition). These steps culminate in the allocation of straws based on physical compatibility criteria, genetic risk factors and blood groups. The actual treatment can then begin.
When should you consult an ART center?
The WHO definition of infertility is now well known: infertility is a disorder of the male or female reproductive system defined by the impossibility of achieving pregnancy after 12 months or more of regular unprotected sexual intercourse.
It is therefore necessary to consult your doctor if there has been no pregnancy after one year, and more rapidly if you have a medical or surgical history that may have affected your fertility, or if you need to use donor straws (for single women or couples, for example).
Talk to your gynecologist, who will be able to guide you in finding the professionals in your area who can provide you with comprehensive support and quality care.
Female and male infertility
Female infertility may be due to ovarian failure, endometriosis, polycystic ovary syndrome or ovulatory disorders, tubal blockage, uterine pathology, recurrent miscarriage.
Male infertility can be linked to an absence of spermatozoa (azoospermia) or to a reduction in the number and/or mobility and/or normal forms of spermatozoa (oligo-astheno-teratospermia).
Steps in the ART process
The ART process begins with a diagnostic phase, with an infertility assessment.
Depending on the results of the first assessment and any additional tests carried out over the months, your ART team will provide you with the best possible support to ensure successful implantation.
The first appointment details your medical, surgical, obstetrical and family history for each member of the couple, the weight and height of each, exposure to pollutants (tobacco, other), your professions and the duration of the infertility. This initial discussion helps us to better understand your project and your family and medical environment. It’s an essential meeting to prepare for the full assessment, which will then lead to the support plan.
Once the assessment and additional tests have been carried out, the second consultation defines the strategy for achieving pregnancy, based on the results obtained.
In the event of difficulty in defining the best strategy, multidisciplinary meetings involving doctors, surgeons and biologists specialized in reproduction are often organized.
Supporting an ART program requires a great deal of medical expertise and the involvement of several specialists. This consultation meeting enables everyone to express their views on the basis of the assessment, in order to recommend a comprehensive strategy for overcoming infertility.
Each center has its own specific organization, but before you make an attempt, you need to have collected your identity papers, your certificates of social security coverage, your consents for the chosen ART procedure, and your up-to-date serologies and sperm cultures.
The ART file will then follow you throughout your procedure.
The main drug treatments used in ART are hormones administered by subcutaneous injection in the evening to stimulate ovulation. These are mainly follicle-stimulating hormone (FSH). Natural hormones such as estrogen and progesterone (in ova) are also used to synchronize cycles and support the luteal phase.
The composition of an ART team
An ART team is made up of doctors and biologists specialized in reproduction. The gynecologist prescribes the ovarian stimulation treatment, and monitors the prescribed treatment using ultrasound scans and blood tests. He/she also performs oocyte puncture, embryo transfer or intrauterine insemination, depending on the treatment prescribed.
The biologist prepares the sperm after collection, fertilizes the oocytes, micro-injects the sperm into the oocyte, and monitors and evaluates the embryos before transfer or freezing.
What to do after several failed IVF attempts?
After several IVF failures, it is necessary to analyze the reasons for the failure. The doctor will then review the entire file to understand :
How to improve the quality of the embryos produced
In women, we will try to improve ovarian stimulation (change of protocol or product) to obtain more good-quality oocytes. In men, we will explore all the factors that can improve sperm quality (treatment of increased sperm fragmentation, search for varicocele). We’ll review with biologists how to improve the stages of fertilization and embryo development in vitro (IMSI, individual incubator or time-lapse).
Finally, we’ll make sure that the hysteroscopy is recent (no polyps or fibroids), and that the thyroid is well balanced.
How to improve embryo implantation
Only 25 to 30% of embryos transferred result in birth.
To improve this implantation rate, it is essential to look for a dysregulation of the uterine immunological balance, in order to understand the reason for the non-implantation of transferred embryos and, above all, to correct the imbalance and thus encourage their implantation.
The aim is to improve the immune dialogue between the embryo and the uterus during implantation and placental development. The mission is not only to accept the embryo (which is always genetically different from its mother), but also to nourish it while protecting it from aggression.
By understanding the type of dysregulation, the doctor can personalize care, either by activating local mechanisms for the embryo’s adhesion to the uterus, or by controlling immune cells to prevent rejection.
It is estimated that after 4 embryos have been transferred without pregnancy, it is necessary to carry out this assessment. A study is currently underway to establish whether it would be appropriate to offer this assessment earlier. The results will be available in summer 2023.
The search for uterine imbalance will also be essential for spontaneously fertile women who have had more than 2 miscarriages unexplained by the standard work-up.
Psychological support during the ART process
The ART process is inevitably fragile for oneself, for one’s couple and, more broadly, for one’s relationships with others. It’s important to take this into account, and to build a strategy to avoid getting bogged down in the process. For some, this means psychological support; for others, it means planning trips or adventures together, or investing in creative activities. In all cases, you’ll need to build a project in which you’ll have to invest yourself, but in which PMA doesn’t have to take over everything. Whatever you think will be useful and good for you will be the right thing to do.
Conclusion :
ART is an option for couples experiencing difficulties in having children.
There are different types of ART with different success rates and risks.
It’s important to find out about costs, reimbursements and financing options before embarking on an ART program.