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The Facts About Assisted Reproductive Technology

Find out how ART affects your sexual health.

A woman sits behind a man on a bed showing him a pregnancy test and smiling.

Infertility is on the rise in the United States. Since 1981, however, assisted reproductive technology (ART) has been around to help women become pregnant. The first "test-tube" baby, conceived by in vitro fertilization (IVF), was born July 28, 1978, at the Oldham and District General Hospital in Manchester, England.

A little more than 40 years later, 2.1 percent of American infants were conceived with the help of ART in 2019.

What is assisted reproductive technology?

ART is any treatment for infertility that handles eggs or embryos. A couple can use ART to help with conception if they have fertility problems. The Centers for Disease Control and Prevention (CDC) summarized ART procedures as:

  • Removing eggs from a woman's ovaries
  • Combining eggs with sperm in a laboratory
  • Returning eggs to a woman's body or donating them to another woman

This definition of ART does not cover treatments that only handle sperm or stimulate egg production without retrieving eggs. However, we'll cover all common infertility treatments that may sit outside of this definition.

Most common types of ART

Depending on the type of fertility problem and your family unit, several types of ART are available to assist with conception. Here are six of the most common procedures available:

1. In vitro fertilization (IVF)

During IVF, a woman's eggs and a man's sperm are combined in a laboratory to create an embryo. In straightforward terms, a simple outline of the process is as follows:

  • For ovulation induction, medication is given to stimulate the ovaries to produce one or more eggs.
  • The eggs are retrieved via a very thin needle and transferred to an incubator.
  • The male partner provides a sperm sample, which may be analyzed before use.
  • The sperm is combined with the eggs to create one or more embryos.
  • Successful embryo(s) are transferred into the woman's uterus.
  • Wait two weeks, then take a pregnancy test.

A cycle of IVF can take three to six weeks. It is invasive and expensive but can be successful for many people, depending on their circumstances.

2. Surrogacy

Surrogacy is when a woman carries and gives birth to a child for another person, couple or family.

You can use the eggs of the intended mother or a donor, so there is no genetic attachment to the surrogate. This is known as fall, host or gestational surrogacy.

Alternatively, the surrogate's egg is fertilized with the sperm of the intended father. This is known as partial, straight or traditional surrogacy.

Surrogacy is a popular option with male same-sex couples looking to start a family.

Women who cannot get pregnant or give birth due to a medical condition, or who experience repeated failed IVF cycles, might also choose surrogacy.

3. Gamete intrafallopian transfer (GIFT)

Gamete intrafallopian transfer (GIFT) involves removing the egg and sperm and mixing them into the fallopian tube immediately. Unlike IVF, the fertilization process takes place in the fallopian tube rather than in a laboratory.

At least one fallopian tube must be healthy, so the procedure may not be suitable if they are blocked or damaged. If a couple has religious or ethical factors preventing them from taking advantage of IVF, they may be able to undergo gamete intrafallopian transfer.

4. Intracytoplasmic sperm injection (ICSI)

Intracytoplasmic sperm injection (ICSI) is a more advanced and specific form of IVF. In regular IVF, sperm are added to an egg or eggs in a laboratory dish. Fertilization occurs when one of the sperm fertilizes the egg (there is no intervention from a technician). The embryo(s) is then implanted back into the woman's uterus.

In ICSI, a single sperm is injected directly into the egg's cytoplasm to accomplish fertilization. The embryo typically grows in the lab for three to six days and is then transferred to the uterus for the implantation phase.

ICSI is the most common and successful treatment for male factor infertility.

5. Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is a type of artificial insemination in which sperm is placed directly inside the womb. Technically, according to the CDC definition, it does not necessarily fit into the ART category. However, it is a common infertility treatment and is less invasive and expensive than IVF.

IUI aims to increase the number of sperm that reach the fallopian tubes, subsequently increasing the chance of fertilization. It can be a useful technique for LGBTQIA+ families or couples, or single women using a sperm donor, couples who cannot have sex due to a disability, and men who have HIV and need sperm washing to achieve safe pregnancy with their partner.

6. Egg donation

Egg donation is an option for women unable to get pregnant using their own eggs due to complications, such as premature ovarian failure (early menopause), extremely poor egg quality, a history of a genetic disease or hormonal imbalance.

It's not as simple as taking an egg from one woman and placing it in another. The recipient's cycle needs to be aligned with that of the donor. Therefore, they need to take hormone therapy before an egg is implanted, especially if uterine preparation is required due to ovarian failure.

Recipients commonly take estrogen for two weeks and then daily progesterone starting the day before or the day of the donor's egg retrieval. To fertilize the egg, the male partner provides a semen sample, and the semen and eggs are fertilized using IVF. The embryo is then implanted into the recipient's uterus.

Why consider ART?

The primary purpose of assisted reproductive technology is to address infertility problems, such as:

  • Female factor infertility, such as endometriosis, fibroids, tubal ligation, polycystic ovary syndrome (PCOS), failure to ovulate and so on.
  • Male factor infertility, such as sperm disorders, testicular problems, hypogonadism (low testosterone) or ejaculation problems, etc.
  • Conditions where pregnancy is contraindicated.
  • Difficulty with conception due to disability.
  • In situations where preimplantation genetic testing is required.
  • Unexplained infertility.
  • When fertility preservation is needed, for example, due to cancer treatment or aging.
  • When sperm washing is required, for example, due to HIV.

Additionally, people can turn to ART to assist same-sex couples or single people interested in building a family.

Risks of assisted reproductive technology

As with any medical procedure, there are risks worth consideration. Research published in 2013 indicated perinatal (the time from pregnancy until a year after birth) outcomes are poorer in IVF babies than in those conceived spontaneously.

According to the American College of Obstetricians and Gynecologists (ACOG), perinatal risks associated with ART include:

  • Placental abruption, or partial or complete separation of the placenta
  • Cesarean (C-section) delivery
  • Congenital disabilities
  • Low birth weight/small for gestational age
  • Multiple pregnancies
  • Perinatal mortality
  • Placenta previa, or when the placenta covers the opening in the mother's cervix
  • Preeclampsia, which is characterized by high blood pressure
  • Premature birth

There is also a slight increase in maternal risk when using ART compared to traditional pregnancy. There is an increased risk of developing serious medical conditions, such as preeclampsia, gestational diabetes and other severe maternal complications.

Although ART risks are noted, most research states these risks are relatively small.

The average cost of ART types

The cost of ART varies considerably depending on the treatment needed or chosen. On average, an IVF cycle costs approximately $12,000, with an additional fee of $1,500 for ICSI. IUI is cheaper, ranging from $1,500 to $4,000 per cycle. Gamete intrafallopian transfer costs about $15,000 to $20,000 per cycle.

Depending on where you live, experts estimate that surrogacy costs $100,000 to $200,000 to cover agency fees, surrogate expenses, legal fees and medical costs. Using an egg donor can also be costly. It may reach up to $100,000 when you consider donor compensation, agency fees, legal fees and medical costs.

Some insurance companies, including Cigna, Blue Cross Blue Shield and Aetna, cover IVF but usually have limitations in place.

Ethics of assisted reproductive technology

Although forms of ART have progressed and help people with family-building, there are ethical issues to be considered as part of the process:

  • Questions of "interference" in the reproduction process: Is it morally acceptable?
  • The production of "savior siblings," that is, a child conceived to provide a stem cell transplant to a sibling affected with a fatal disease.
  • The production of surplus embryos and the destruction of unused embryos in IVF.
  • The right to privacy of donors and the right of children to know their parents when using sperm/egg donation.
  • The use of ART for sex selection, that is, choosing embryos for other traits.
  • The use of preimplantation genetic testing to select an embryo.


What's the difference between ART and IVF?

ART (assisted reproductive technology) is the overarching term for all types of infertility treatments that assist people unable to conceive naturally. IVF (in vitro fertilization) is one specific type of ART that combines a woman's egg and a man's sperm in a laboratory to make an embryo.

What are the types of ART?

The most common types of ART are:

  • In vitro fertilization (IVF)
  • Intracytoplasmic sperm injection (ICSI)
  • Intrauterine insemination (IUI)
  • Gamete intrafallopian transfer (GIFT)
  • Surrogacy
  • Egg donation
  • Surgical sperm extraction