11 October 2019

Which assisted reproductive technology programmes should I choose?

By the Editorial Comitee IVI Blog

If you are experiencing fertility difficulties and thinking about seeking help, the array of assisted reproductive technology treatments can seem bewildering. In this article we aim to guide you through the decision-making process and offer helpful advice on the most suitable assisted reproductive technology programme for your circumstances. To start with, you need to be sure that your chosen clinic is properly qualified and licensed by the appropriate regulatory body. Then you need to discuss with your infertility specialist the best programme for you – this will depend on the level of your difficulty with fertility, ranging from mild to severe.
Of course, there is no one-size-fits-all solution to assisted reproduction. Having taken advice from your medical professional team, the programme that you choose is very much a matter for you to decide.

Choosing the right clinic

First of all, it is essential that the assisted reproduction clinic you choose is properly qualified, accredited and licenced by the appropriate country-specific regulatory authority. In Europe this is the European Parliament and Council, working with specialist advisory bodies such as the European Society of Human Reproduction and Embryology (ESHRE). However, constituent countries in the EU have their own regulations, which differ significantly from one another on some specific aspects of reproductive technology.
In the United States, programmes need to operate under the guidelines set out by the American Society for Reproductive Medicine (ASRM), be a member of the Society for Assisted Reproductive technology (SART) and report their results to SART and the Centers for Disease Control and Prevention.
Having satisfied yourself that your provider is recognised by the appropriate body and that their published results have been independently audited, it is then a matter of looking at the different treatment options and deciding which one is right for you. There are also issues of cost and convenience, availability of accommodation, plus counselling and patient support, especially if you are considering going abroad for treatment. For example, in many IVI clinics in Spain, an individual mentor who speaks the same language as the patient will accompany them throughout the entire journey.

The next step is deciding which of the assisted reproductive technology programmes available is the most suitable for your circumstances.

If you have mild fertility problems

The simplest assisted fertility treatment of all is Artificial Insemination (AI). The procedure involves stimulating the ovaries to ensure there is an ovum present, preparing a sperm sample to select the best sperm and then depositing the sperm sample inside the patient’s uterus. This respects the natural environment for the gametes as much as possible, while increasing the potential for fertilisation to take place. You can learn more about the procedure in our IVI video about AI.
AI is recommended where the cause of infertility is unknown, where the woman has ovulation problems or an abnormality of the cervix, and for couples where the man has mild or moderate defects in the concentration or motility of his sperm.

IVF: the best-known type of assisted reproductive technology

The well-known In Vitro Fertilisation (IVF) technology involves joining an egg and sperm in the laboratory for fertilisation to take place, followed by a study of the resulting pre-embryos in order to select the good quality ones, and the return of an embryo to the maternal womb. IVF is the treatment of choice when simpler techniques such as AI have failed. It is often recommended where there are problems with the woman’s fallopian tubes or for various reasons a limited number of oocytes are available, for women with advanced endometriosis, or in severe cases of male factor infertility. IVF success rates are improving all the time and there are various additional techniques which, when undertaken as part of the IVF process, improve results. Examples are:

  • Intracytoplasmic Sperm Injection (ICSI) is a technique appropriate for cases of male infertility. The procedure consists of selecting a single sperm from a prepared semen sample or, if necessary, by means of testicular biopsy. The selected sperm is then micro-injected directly into the egg for fertilisation.
  • Preimplantation Genetic Testing-Aneuploidy (PGT-A) is a technique used to identify any chromosomal imbalances. It identifies which embryos are chromosomally healthy and selects these for transfer. This reduces the risk of miscarriage significantly and improves the IVF success rate.
  • Preimplantation Genetic Testing for monogenic diseases(PGT-M) is similar but it prevents the transmission of single gene disorders, allowing only the embryos which are free from these conditions to be selected.
  • Preservation of Fertility is another IVF-based technique which is used by women who wish to preserve their fertility for a later date. This could be for medical reasons, for example for women about to undergo cancer treatment, or for personal and social reasons. It follows the normal IVF pattern, ‘interrupted’ by the cryopreservation of oocytes. When the time is right, these are then thawed, fertilised and replaced in the completion of the IVF cycle.
  • Specialist assisted reproductive technology programmes are also available. For example, in our IVI clinics in Spain, we offer the IVI Baby Plan designed to give peace of mind with an assurance that patients will achieve their goal or have the cost of treatment returned. There is also the ROPA method in which a couple consisting of two women share the IVF process, one being the genetic mother and the other being the birth mother.

Egg or sperm donation

Finally, where one or both partners in a couple are completely unable to use their own oocytes or sperm, there are programmes for egg or sperm donation. Regulations differ depending on the country, for example those around donor anonymity, and so it is essential to check the prevailing regulatory climate at your chosen venue. Technologies continue to advance in this area, for example with the AI-assisted techniques for matching donor to recipient in our IVI Perfect Match 360⁰ programme.
Checking the results of assisted reproductive technology programmes
Having made the choice that is appropriate for you, don’t forget to check that your chosen provider has a good record of success. If you decide to choose IVI, you can be confident that our published figure of over 90% cumulative pregnancy success rate has been independently audited and verified. You can see our results for yourself here.
Over to you. It’s your decision, and if you would like to speak to us at IVI, do get in touch.

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