Introduction: 

Assisted Reproductive Technology (ART) is a blessing forcouples diagnosed with either suppressed fertility or infertility. It allstarted following a successful conception and delivery of Louise Brown in theyear 1978 at Bourne Hall fertility clinic in England by Patrick Steptoe and BobEdwards. Despite ART being developed less than four decades, it has grown inleaps and bounds thereby becoming one of the most rapidly developing facultiesin the field of medicine. There have been more than 5 million babies bornthrough IVF since then. ART encompasses various treatment methodologies such asovulation induction / controlled ovarian stimulation, intra uterineinsemination, in vitro fertilization/intra-cytoplasmic sperm injection,fertility preservation through gamete freezing and embryo freezing. ART alsoprovides the couple an opportunity to have an offspring through donor gametesand surrogacy. 

Intra-uterineinsemination (IUI): Intra uterine insemination is one of the commonly used procedures in assisted conception, where the sperms are placed within the uterus at thetime of ovulation. Some of the indications for this procedure include mild malefactor infertility, mild endometriosis, anovulation etc. Success rates of IUIrange between 10 -15 % per cycle. IUI can be done with or without controlledovarian stimulation depending on indication.  

In vitro fertilisation / Intracytoplasmic sperm injection (IVF/ICSI): IVF involves ovulation induction using gonadotropins, whichresults in multi-follicular development. Once this has been achieved, thedeveloped oocytes are picked up under ultrasound guidance. Following this,embryos are created with the sperms obtained from either the partner / donordepending on the clinical indication.The embryos are monitored for cell division and growth atour embryology lab and transferred back to the uterine cavity either on day 3or day 5 (Blastocyst). The success rates of IVF per cycle ranges between 35 –40 % based on the clinical presentation. ICSI is procedure where sperms are manually injected intothe oocyte with the view to enhance fertilization. This has its own indicationssuch as severe male factor infertility of a very thick zona of the oocyte,which might be difficult for the sperm to penetrate. 

Fertility Preservation 

Oocyte freezing:

Human oocyte cryopreservation(egg freezing) is a technique used to preserve a woman’s fertility, where hereggs/oocytes are retrieved, frozen and stored, following ovarianstimulation.  This provides her with theflexibility to delay her fertility, which could be by choice or due to variousmedical (chemo radiotherapy) conditions. When required, women may choose tohave her eggs thawed, fertilized, and transferred to the uterus as embryos to facilitate a pregnancy.The success rate of this procedure varies depending on the age of the woman atthe time of retrieval. This would range between 14.8 % (Women age <40 years)to 31.5 % (Women age >=25 years).  

Sperm banking: 

Sperm banking (cryopreservation) is a technique where sperms can be preserved indefinitely after cryopreservation. For human sperm,the longest reported successful storage is 22 years. Sperm freezing isrecommended in men prior to undergoing treatments that may compromise theirfertility, such as chemotherapy, radiation therapy or pelvic surgery. The technique of sperm banking is also adapted in some men who might not be able toproduce a masturbated sample on the day of treatment.

Embryo Freezing: 

Human embryo cryopreservation is a procedure to preserve embryos. Embryos are formed following IVF or ICSI atour embryology labs, following which one or two embryos may be transferred into the uterine cavity.  If there were excessamounts of embryos they are cryopreserved for future use. Embryo freezing iscommonly undertaken either on day 3 or day 5 (Blastocyst) following eggretrieval. Other indications for embryo freezing would also include ovarianhyper stimulation syndrome.Other modalities in Assisted conception 

Donor Gametes: 

The use of donor gametesi.e. eggs, sperms and embryos is designed to help recipients have a child whenone or both partners are unable to have their own biological child. Donordetails are kept highly confidential. All donors are screened for infectiousand sexually transmitted diseases such as HIV/Hep B/C, and VDRL. Externalcharacteristic matching is undertaken between the donor and recipient based onthe choice of the recipient prior to initiating management. 

Surrogacy :

Surrogacy is a method where a woman (Surrogate) agrees to carry a pregnancy for another person or a couple (commissioning couple). Surrogacy is divided into complete surrogacy and partial surrogacy. In complete surrogacy, embryos are created using the commissioning couple’s gametes and transferred to the surrogate’s uterus where as in partial surrogacy embryos are created using oocytes from the surrogate and sperms from the commissioning parent.

Surgical Sperm Retrieval :

Surgical sperm retrieval is used to collect sperms from men who are not ableto produce them. Methods employed include – Percutaneous epididymal spermaspiration (PESA), Testicular sperm aspiration (TESA) / extraction (TESE). Success rates using surgically retrieved sperms are comparable to an ejaculated sperm sample.