Assisted reproductive technologies

In connection with the growth of male and female infertility, modern assisted reproductive technologies are in great demand today. They give the opportunity to become parents to those people who, half a century ago, did not have any opportunity to conceive and bear a child on their own. Today, ART is actively supported by the state, there are programs for financing and co-financing these methods, due to which expensive procedures have become available under regional and federal quotas.

We will describe in more detail what medical technologies are considered assisted reproductive technologies, what efficacy and advantages they have, in this article.

What it is?

Once upon a time, most of the technologies and methods of infertility treatment that are used today in the world and in Russia were considered something fantastic, impossible in practice. However, over time, everything has changed, and now any married couple with absolutely any form of infertility can count on the fact that they will be given a chance to feel the joy of motherhood and fatherhood.

Reproductive technologies today include the following types of medical care:

ECO (in vitro fertilization);
GIFT (transfer of the partner's sex cells into the woman's fallopian tubes);
ZIFT (surgical transfer of embryos into the fallopian tubes);
ICSI (intracytoplasmic sperm injection);
methodology using donor biomaterial (oocytes, sperm, as well as donor embryos);
surrogacy (bearing the fetus of a couple by a woman - a gestational courier);
deferred parenting programs (cryopreservation of oocytes, spermatozoa, embryos ready for replanting);
AI (artificial insemination with spouse's sperm or donor sperm);
preimplantation genetic diagnosis of embryos;
reduction of embryos with a threatening multiple pregnancy.

According to the World Health Organization (and this organization annually monitors the incidence rates, treatment standards, fertility and the percentage of infertility in all countries of the world), in Russia today, about 15-17% of couples are infertile. Today, there are about five million families on the register of infertile couples, and 70% of them require reproductive assistive care. The number of cases of female infertility has increased by 14% over the past 10 years, and male - by 22%.

IVF gave the basis for all methods. It was there that the development of other areas began, such as pre-implantation diagnostics, ICSI, etc. The world of IVF has existed for over 40 years, in our country - since 1986, although some work has been carried out in research laboratories since the middle of the last century.

Characteristics and methods of carrying out

The goal of all technologies used by reproductive specialists is to obtain healthy offspring in cases where it is impossible to do it naturally. Let's take a look at how the individual methods are conducted and how they differ:

In Vitro Fertilization

This is a technology in which fertilization is carried out outside the female body, in laboratory conditions or, as the people say, in a test tube. A woman undergoes preliminary stimulation of the ovaries, which makes it possible to obtain not one, but several eggs, after which a follicle puncture is performed. Oocytes are taken from their familiar environment and they organize a "meeting" with the sperm of a partner or donor. For several days, the growth of zygotes is monitored, after which 2-3 embryos are transferred into the woman's uterine cavity.

ICSI

This is a type of in vitro fertilization, which is necessary in the presence of severe male factor infertility. The entire treatment cycle proceeds as in conventional IVF, with the only difference being at the stage of fertilization. Eggs and sperm are not just placed in one laboratory dish. The best of tens of millions of infertile man's sperm is placed directly inside the egg through jewelry micromanipulation. As a result, the chances of becoming a dad appear even for those representatives of the stronger sex who have almost no living spermatozoa suitable for in vitro fertilization or naturally.

Donor biomaterial

The program of egg and sperm donation has been developed in our country thanks to state support and the emergence of banks of reproductive materials, as well as specialized agencies. If necessary, IVF, ICSI or other of the methods, it can be carried out using sperm or eggs from anonymous donors, absolutely healthy and preliminarily examined for all infectious and non-infectious diseases.

With this technology, a couple gets a child who is genetically related to only one of the parents. Without donor biomaterial, reproductive techniques could not be used by single men and women who dream of having children.

Surrogacy

This method involves carrying a child, whose biological parents are spouses, conceived from their gametes, by another woman volunteer. Surrogacy can help single men, as well as married couples, if pregnancy can pose a real threat to a woman's life. Often, such methods have to be resorted to by those who, for anatomical reasons or due to age, cannot bear and give birth to children.

Unlike other ART, this technique is not supported by the state at the financial level, but it is not prohibited by law either. Although it is she who causes the most heated debates and discussions in society.

Pre-implantation diagnostics

This is a genetic study of embryos that are cultured after fertilization in the IVF process, but before they are transferred into the uterine cavity. It is indicated when one of the parents has genetic diseases that can be inherited by the offspring, as well as for sex determination in case of detection of diseases that belong to the category of chromosomal linked to the sex chromosome (hemophilia, etc.).

It is carried out using a number of genetic methods, differing in terms of research, cost, technology. More than one and a half hundred different hereditary and chromosomal abnormalities in an embryo, which is only 2-3 days old, are determined with great accuracy. Only healthy children are transferred to the uterus.

Artificial insemination

This technology is quite simple and is the closest to natural conception. It's just that the sperm of the husband or donor is injected directly into the uterus, into the mouth of the tubes. Conception takes place inside a woman's body and pregnancy, if it occurs, is no different from others.

This method is recommended for women and men with autoimmune infertility, men with impotence, women with impaired vaginal microflora, which cannot be corrected by other means, cervical factor, single women who do not have a partner but want a child.

GIFT and ZIFT

With GIFT, doctors take the sex cells of partners, mix them and immediately inject them into the fallopian tube. With ZIPT, embryos that were obtained in the laboratory are inserted into the fallopian tube. Both methods are carried out once and are usually combined with diagnostic laparoscopy, although the introduction is quite possible through the vagina, the cervix by introducing a thin and flexible catheter under constant ultrasound control.

Indications and contraindications

Assisted reproductive technologies can help with a wide range of problems with the reproductive system in both men and women. And even with mutual infertility, there are chances to become parents. ART is indicated when other methods and ways of eliminating the causes of childlessness have no effect and are recognized as ineffective. Most often these are:

obstruction of the fallopian tubes, their complete or partial absence;
idiopathic infertility, the causes of which have not been identified;
immunological infertility;
endometriosis;
polycystic ovary syndrome;
most forms of male infertility.

All methods are high-tech, they require special training, experience, and caution from doctors. Therefore, the list of contraindications approved by the Ministry of Health is also quite large:

congenital or post-traumatic uterine malformations that make it impossible to carry (only surrogacy is permissible);
tumors of the organs of the female reproductive system of a benign nature, requiring surgical treatment;
tumors of a malignant nature, regardless of their location in the body;
neoplasms in the ovarian area;
acute inflammation of any of the woman's organs (temporary ban until recovery);
mental illness.

A couple takes a long list of tests before any of the assistive technologies. Reproductive care can be denied in case of significant violations identified during laboratory tests, with untreated genital infections, syphilis, etc.

VTR is carried out only on the basis of clinics and hospital departments that have received the appropriate licenses from the Ministry of Health.

Efficiency

This is the most painful question, since none of the methods gives a 100% probability that pregnancy will occur. About 35% of IVF protocols are successfully completed in Russia. At the same time, babies are worn out before childbirth and only 80% of women who are lucky enough to get pregnant on the first try give birth successfully. The probability of getting pregnant in the second and third protocols is slightly higher, but after three attempts, the probability is significantly reduced.

Intrauterine insemination with the husband's sperm is completed successfully after the first attempt in 11-16% of cases. When using donor sperm, the probability is higher - just over 20%.

GIFT provides about 20% of successful treatment courses, and ZIFT - about 30%. The use of frozen biological material does not reduce the likelihood of IVF success, but, alas, does not increase it.

Problems of ethical and legal regulation

New reproductive techniques raise many legal and legal issues. So, surrogate motherhood is not prohibited in the country, but it is not really regulated by laws, and it was almost impossible to register a child born by a surrogate mother to a single parent until recently. Several major litigation incidents have allowed the courts to develop specific recommendations on this issue, but there are still quite a lot of gaps, loopholes and inaccuracies in the legislative framework.

The situation is even more complicated with moral and ethical problems. Not all religions approve of parishioners participating in IVF programs. Thus, ART is completely rejected by Catholicism. Orthodoxy and Islam allow that only on condition that the gametes of the husband and wife are used for fertilization. The donor biomaterial is categorically rejected, since, according to the ministers of the Russian Orthodox Church and representatives of Islam, it violates the sacredness and sacrament of the marriage union.

Disposal of unnecessary embryos, poor-quality embryos is condemned by Orthodoxy, reduction or preimplantation genetic diagnosis is equated with abortion. But Islam allows it. Surrogate motherhood is categorically not accepted in either religion, considering financial transactions of this kind to be immoral, since they look like child trafficking and the devaluation of motherhood in general.

Judaism is more loyal to ART, allowing its believers to do almost everything except the use of a close relative of infertile parents as a surrogate mother. In Buddhism, any solution to a problem is advocated if it brings happiness and joy to all participants.

In medicine, when it comes to assisted reproductive technologies, they try to adhere to the principles of bioethics. The secret of anonymous donors of germ cells should be respected, the doctor should not divulge to outsiders the fact of reproductive assistance to certain patients. The value of life implies an attitude towards the embryo as a full-fledged person from the very first days of its existence.

It is forbidden to dispose of embryos that have remained superfluous by adding poisons and toxins. The doctor, according to bioethics, can only ignore them until the cell division stops naturally.

Bioethics is quite strict with surrogate mothers who have no right to blackmail their "customers" and demonstrate claims to the child they have born.

In general, the topic of public perception of reproductive care is rather "slippery". Neither officials, nor representatives of the legislature, nor doctors, nor religious leaders, nor the patients themselves can come to a consensus in it. It is impossible to dispute only statistics, which says that about 5 million people live on the planet today, who were conceived and born only thanks to the efforts of doctors and scientists in the field of reproductive medicine and embryology. Without ART, their life would become impossible.