Editing Assisted reproductive technology (section)

== Procedures ==
=== General ===
With ART, the process of [[sexual intercourse]] is bypassed and fertilization of the [[oocyte]]s occurs in the laboratory environment (i.e., [[in vitro fertilization]]).{{citation needed|date=February 2022}}

In the US, the [[Centers for Disease Control and Prevention]] (CDC) defines ART to include "all fertility treatments in which both eggs and sperm are handled. In general, ART procedures involve surgically removing eggs from a woman's ovaries, combining them with sperm in the laboratory, and returning them to the woman's body or donating them to another woman." According to CDC, "they do not include treatments in which only sperm are handled (i.e., intrauterine—or artificial—insemination) or procedures in which a woman takes medicine only to stimulate egg production without the intention of having eggs retrieved."<ref>{{cite web|title=What is Assisted Reproductive Technology? {{!}} Reproductive Health {{!}} CDC|url=https://www.cdc.gov/art/whatis.html|publisher=CDC|date=November 14, 2014|url-status=live|archive-url=https://web.archive.org/web/20171101183209/https://www.cdc.gov/art/whatis.html|archive-date=November 1, 2017}}</ref>

In Europe, ART also excludes artificial insemination and includes only procedures where oocytes are handled.<ref>{{cite journal|last1=European IVF-Monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology|last2=Calhaz-Jorge|first2=C.|display-authors=et al|last10=Wyns|title=Assisted reproductive technology in Europe, 2012: results generated from European registers by ESHRE.|journal=Human Reproduction (Oxford, England)|date=August 2016|volume=31|issue=8|pages=1638–52|pmid=27496943|doi=10.1093/humrep/dew151|doi-access=free}}</ref><ref>{{cite journal|last1=Sorenson|first1=Corinna|title=ART in the European Union|journal=Euro Observer Euro Observer|date=Autumn 2006|volume=8|issue=4|url=http://www.euro.who.int/__data/assets/pdf_file/0019/80371/EuroObserver8_4.pdf?ua=1|url-status=live|archive-url=https://web.archive.org/web/20161129022850/http://www.euro.who.int/__data/assets/pdf_file/0019/80371/EuroObserver8_4.pdf?ua=1|archive-date=2016-11-29}}</ref>

The [[World Health Organization]] (WHO), also defines ART this way.<ref>{{cite journal|last1=Zegers-Hochschild|first1=F|display-authors=et al|last2=for the International Committee for Monitoring Assisted Reproductive Technology and the World Health Organization|title=International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009.|journal=Fertility and Sterility|date=November 2009|volume=92|issue=5|pages=1520–4|pmid=19828144|url=https://www.who.int/reproductivehealth/publications/infertility/art_terminology2.pdf?ua=1|doi=10.1016/j.fertnstert.2009.09.009|url-status=live|archive-url=https://web.archive.org/web/20161129024154/http://www.who.int/reproductivehealth/publications/infertility/art_terminology2.pdf?ua=1|archive-date=2016-11-29}}</ref>

=== Ovulation induction ===
{{Main|Ovulation induction}}
[[Ovulation induction]] is usually used in the sense of stimulation of the development of [[ovarian follicles]]<ref name=advancedfertility>[http://www.advancedfertility.com/inducovu.htm Ovulation Problems and Infertility: Treatment of ovulation problems with Clomid and other fertility drugs.] Advanced Fertility Center of Chicago. Gurnee & Crystal Lake, Illinois. Retrieved on Mars 7, 2010</ref><ref name=flinders>[http://www.flindersivf.com.au/resources/ovulation.induction/ Flinders reproductive medicine > Ovulation Induction] {{Webarchive|url=https://web.archive.org/web/20091003075946/http://www.flindersivf.com.au/resources/ovulation.induction/ |date=2009-10-03 }} Retrieved on Mars 7, 2010</ref><ref>[http://www.fertilitylifelines.com/fertilitytreatments/ovulationinduction.jsp fertilityLifeLines > Ovulation Induction] {{Webarchive|url=https://web.archive.org/web/20130310222621/http://www.fertilitylifelines.com/fertilitytreatments/ovulationinduction.jsp |date=2013-03-10 }} Retrieved on Mars 7, 2010</ref> by [[fertility medication]] to reverse [[anovulation]] or [[oligoovulation]]. These medications are given by injection for 8 to 14 days. A health care provider closely monitors the development of the eggs using transvaginal ultrasound and blood tests to assess follicle growth and estrogen production by the ovaries. When follicles have reached an adequate size and the eggs are mature enough, an injection of the hormone hCG initiates the ovulation process. Egg retrieval should occur 36 hours before ovulation.

=== In vitro fertilization ===
{{Further|In vitro fertilization}}
[[File:2902 IVF-02.jpg|thumb|315x315px|Steps of IVF Treatment]]
[[In vitro fertilization]] is the technique of letting [[Human fertilization|fertilization]] of the male and female [[gametes]] (sperm and egg) occur outside the female body.

Techniques usually used in in vitro fertilization include:
* [[Transvaginal ovum retrieval]] (OVR) is the process whereby a small needle is inserted through the back of the vagina and guided via ultrasound into the ovarian follicles to collect the fluid that contains the eggs.
* [[Embryo transfer]] is the step in the process whereby one or several embryos are placed into the uterus of the female with the intent to establish a pregnancy.
Less commonly used techniques in in vitro fertilization are:
* [[Assisted zona hatching]] (AZH) is performed shortly before the embryo is transferred to the uterus. A small opening is made in the outer layer surrounding the egg in order to help the embryo hatch out and aid in the implantation process of the growing embryo.
* [[File:In vitro fertilization.jpg|right|250px|thumb|Intracytoplasmic sperm injection (ICSI)]] [[Intracytoplasmic sperm injection]] (ICSI) is beneficial in the case of male factor infertility where sperm counts are very low or failed fertilization occurred with previous IVF attempt(s). The ICSI procedure involves a single sperm carefully injected into the center of an egg using a microneedle. With ICSI, only one sperm per egg is needed. Without ICSI, you need between 50,000 and 100,000. This method is also sometimes employed when donor sperm is used.
* [[Autologous endometrial coculture]] is a possible treatment for patients who have failed previous IVF attempts or who have poor embryo quality. The patient's fertilized eggs are placed on top of a layer of cells from the patient's own uterine lining, creating a more natural environment for embryo development.
* In [[zygote intrafallopian transfer]] (ZIFT), egg cells are removed from the woman's ovaries and fertilized in the laboratory; the resulting zygote is then placed into the fallopian tube.
* [[Cytoplasmic transfer]] is the technique in which the contents of a fertile egg from a donor are injected into the infertile egg of the patient along with the sperm.
* [[Egg donor]]s are resources for women with no eggs due to surgery, chemotherapy, or genetic causes; or with poor egg quality, previously unsuccessful IVF cycles or [[advanced maternal age]]. In the egg donor process, eggs are retrieved from a donor's ovaries, fertilized in the laboratory with the sperm from the recipient's partner, and the resulting healthy embryos are returned to the recipient's uterus.
* [[Sperm donation]] may provide the source for the sperm used in IVF procedures where the male partner produces no sperm or has an inheritable disease, or where the woman being treated has no male partner.
* [[Preimplantation genetic diagnosis]] (PGD) involves the use of genetic screening mechanisms such as fluorescent in-situ hybridization (FISH) or comparative genomic hybridization (CGH) to help identify genetically abnormal embryos and improve healthy outcomes.
* [[Embryo splitting (disambiguation)|Embryo splitting]] can be used for twinning to increase the number of available embryos.<ref>{{cite journal |vauthors=Illmensee K, Levanduski M, Vidali A, Husami N, Goudas VT |title=Human embryo twinning with applications in reproductive medicine |journal=Fertil. Steril. |volume= 93|issue= 2|pages= 423–7|date=February 2009 |pmid=19217091 |doi=10.1016/j.fertnstert.2008.12.098 |doi-access=free }}</ref>

=== Pre-implantation genetic diagnosis ===
A [[pre-implantation genetic diagnosis]] procedure may be conducted on [[embryo]]s prior to [[Implantation (human embryo)|implantation]] (as a form of [[embryo profiling]]), and sometimes even of [[oocyte]]s prior to [[Human fertilization|fertilization]]. PGD is considered in a similar fashion to [[prenatal diagnosis]]. PGD is an adjunct to ART procedures, and requires in vitro fertilization to obtain [[oocytes]] or [[embryo]]s for evaluation. Embryos are generally obtained through blastomere or blastocyst biopsy. The latter technique has proved to be less deleterious for the embryo, therefore it is advisable to perform the biopsy around day 5 or 6 of development.<ref name=Sullivan-Pyke2018>{{cite journal |last1=Sullivan-Pyke |first1=C |last2=Dokras |first2=A |title=Preimplantation Genetic Screening and Preimplantation Genetic Diagnosis. |journal=Obstetrics and Gynecology Clinics of North America |date=March 2018 |volume=45 |issue=1 |pages=113–125 |doi=10.1016/j.ogc.2017.10.009 |pmid=29428279}}</ref> [[Sex selection]] is the attempt to control the sex of offspring to achieve a desired sex in case of X chromosome linked diseases. It can be accomplished in several ways, both pre- and post-implantation of an embryo, as well as at birth. Pre-implantation techniques include PGD, but also [[sperm sorting]].{{citation needed|date=February 2022}}

=== Others ===
Other assisted reproduction techniques include:
* [[Mitochondrial replacement therapy]] (MRT, sometimes called mitochondrial donation) is the replacement of [[mitochondria]] in one or more cells to prevent or ameliorate disease. MRT originated as a special form of IVF in which some or all of the future baby's [[mitochondrial DNA]] comes from a third party. This technique is used in cases when mothers carry genes for [[mitochondrial diseases]]. The therapy is approved for use in the United Kingdom.<ref>{{Cite journal |last=Scully |first=Jackie Leach |date=January 2017 |title=A Mitochondrial Story: Mitochondrial Replacement, Identity and Narrative |url=https://pubmed.ncbi.nlm.nih.gov/27973722/ |journal=Bioethics |volume=31 |issue=1 |pages=37–45 |doi=10.1111/bioe.12310 |issn=1467-8519 |pmid=27973722|hdl=1959.4/unsworks_66960 |hdl-access=free }}</ref><ref name=NAS2016ethics>{{cite book|editor1-last=Claiborne|editor1-first=Anne|editor2-last=English|editor2-first=Rebecca|editor3-last=Kahn|editor3-first=Jeffrey|title=Mitochondrial Replacement Techniques: Ethical, Social, and Policy Considerations|date=2016|publisher=National Academies Press|doi=10.17226/21871 |pmid=27054230 |isbn=978-0-309-38870-2|url=https://www.nap.edu/read/21871/chapter/1|last1=Claiborne |first1=A. |last2=English |first2=R. |last3=Kahn |first3=J. }} [http://nationalacademies.org/hmd/reports/2016/Mitochondrial-Replacement-Techniques Index page] {{Webarchive|url=https://web.archive.org/web/20181126135516/http://www.nationalacademies.org/hmd/reports/2016/Mitochondrial-Replacement-Techniques |date=2018-11-26 }} with links to summaries including [http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2016/Mitochondrial%20Replacement%20Techniques/mito%20ethics%20infographic_FINAL.pdf one page summary flyer] {{Webarchive|url=https://web.archive.org/web/20171030233717/http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2016/Mitochondrial%20Replacement%20Techniques/mito%20ethics%20infographic_FINAL.pdf |date=2017-10-30 }}.</ref><ref name=2015CreeRev>{{cite journal|last1=Cree|first1=L|last2=Loi|first2=P|title=Mitochondrial replacement: from basic research to assisted reproductive technology portfolio tool-technicalities and possible risks.|journal=Molecular Human Reproduction|date=January 2015|volume=21|issue=1|pages=3–10|pmid=25425606|doi=10.1093/molehr/gau082|doi-access=free}} {{open access}}</ref>
* In [[gamete intrafallopian transfer]] (GIFT), a mixture of sperm and eggs is placed directly into a woman's fallopian tubes using laparoscopy following a transvaginal ovum retrieval.
* [[Reproductive surgery]], treating e.g. [[fallopian tube obstruction]] and [[vas deferens obstruction]], or reversing a [[vasectomy]] by a [[reverse vasectomy]]. In [[surgical sperm retrieval]] (SSR), the reproductive urologist obtains sperm from the vas deferens, epididymis or directly from the testis in a short outpatient procedure.
* By [[cryopreservation]], eggs, sperm and reproductive tissue can be preserved for later IVF.