Getting pregnant thanks to assisted reproduction: what are the possibilities?
Assisted reproduction techniques have been developed to give a concrete possibility of becoming a parent to those couples who, with difficulty, try to have a child. What are they and what success rates do they have?
When we reproductive doctors find ourselves in front of a couple with infertility problems, certainly one of the most frequently discussed topics is that of the real success rate to be expected after an ART technique.
Often just talking about this topic risks creating confusion as someone uses different criteria to evaluate the results.
We can use a datum that Americans call ” live birth rate” or the percentage of babies in arms that we give to couples . Using this data, we do not limit ourselves to expressing the percentage of pregnancies obtained but the frequency with which we have achieved the most interesting goal for the couple, namely:
- having brought home a child after undergoing the PMA procedure,
- have completed the pregnancy
- to have given birth.
Therefore, the live birth rate will certainly not be the most positive data but certainly the most decisive and significant one to which reference should be made.
Many centers instead use the data called pregnancy rate which indicates the number of women with positive Beta HCG (ie the pregnancy hormone) obtained after a PMA technique which apparently can be more encouraging. Unfortunately not all pregnancies hesitate with the birth of the child and therefore it is a fact that interests the couple less.
Fertile couple and infertile couple
Let’s start with the definition of ‘fertile couple’, ie a couple who is able to conceive or determine the conception of a child.
This conception depends on the union between the oocyte and the sperm which determines the formation of a cell called the zygote and the subsequent embryonic implantation in the endometrium, the mucous membrane that lines the inside of the uterus.
This mechanism assumes, on the one hand, the functionality of the male reproductive system such as to form spermatocytes capable of fertilizing the oocyte, on the other hand, a female reproductive system that allows ovulation, that the tubes are functional and that an endometrium is present. able to accept the product of conception without further problems.
These passages, so delicate and complex, can only partially give an idea of how many impediments can affect the search for a pregnancy.
In fact, if we take for example a 25-year-old couple with no particular risk factors, they will have about a 30% chance of becoming pregnant.
In light of the above, a couple who have had free and unprotected intercourse for 12 months without becoming pregnant is defined as infertile.
The incidence of this problem is equal to 13% of couples in Western countries and this phenomenon appears to be on the increase.
Risk factors that decrease the couple’s fertility
There are several risk factors, both female and male, to which the couple could be exposed, such as:
- endometriosis,
- micropolycysitic ovary syndrome,
- the varicocele,
- obesity,
- hormonal problems
- the maternal age
Advanced maternal age appears to be the most determining risk factor for obtaining pregnancy given that, over the years, the number of oocytes decreases and their quality worsens.
We think that in Italy, in the last 30 years, the average age of couples who have had their first child has increased from 22 to 32 years . This trend reflects social problems such as the delay in entering the world of work and in achieving economic independence which allows for the formation of a new family nucleus.
For these reasons it is quite easy to imagine why an increasing number of couples who turn to the gynecologist expert in couple infertility and resort to medically assisted procreation techniques (MAP).
Assisted fertilization techniques
Assisted reproduction techniques have been developed to give a concrete possibility of becoming a parent to those couples who, with difficulty, try to have a child. No less important is to underline that infertility is not only a medical problem, but also a social one and with aspects concerning morality and the law, which is why it is talked about so much in the media, sometimes in an unclear way, running the risk of creating misunderstandings.
For example, the children born thanks to ART, which today number more than 5 million in the world, are defined by the mass media as “test-tube babies”, although not all ART techniques from which those children were born they involve a fertilization in the laboratory, or in a test tube.
Once the interview has been carried out, it will therefore be possible to better identify the most specific and suitable path for the couple’s problems, thus indicating 1st and 2nd level PMA techniques.
Intra uterine insemination (IUI)
Intra uterine insemination (IUI) represents a level I ART technique which consists in introducing the partner’s semen carefully refined and free of any impurities, into the woman’s uterus through an intrauterine catheter.
It is indicated in cases of young couples with sterility problems of unknown origin, couples in which the woman suffers from ovulation problems which affect her fertility, couples with a moderate male factor.
IUI can be performed both in women undergoing ovarian stimulation and in subjects in whom the ovarian cycle is natural. Ovarian stimulation, using gonadotropin-based drugs, allows a control of the development of the follicles which is performed with ultrasound.
Success rates are 10-15% for each stimulation cycle. Naturally this datum varies according to the quality of the seminal fluid, the type of stimulation performed and the causes of infertility of the couple as well as the age of the woman.
In Vitro Fertilization (IVF/IVF)
On the other hand, when we talk about level II PMA technique we talk about in vitro fertilization (IVF) . In vitro fertilization is a technique that has allowed the birth of more than one million children worldwide since 1978. Thanks to this technique it is possible to allow the union between the oocyte and sperm in the laboratory.
The stages of treatment are as follows:
- controlled ovarian stimulation to produce more eggs,
- Oocyte pick up , i.e. collection of oocytes,
- semen collection and preparation.
- in vitro fertilization.
Nowadays the most used technique is ICSI (Intra Cytoplasmic Sperm Injection) , in which the sperm is injected directly into the egg. Once formed, the zygote is cultured and after a few days the embryos are transferred into the uterus through an intrauterine catheter.
In fact, today IVF makes it possible to conceive even when the mother is over 40 years of age given that one out of 3 women who resort to this procedure is over 40 years old. Furthermore, it is also indicated if the couple has been diagnosed with female infertility due to other, not so infrequent causes such as endometriosis, absence or lesions of the fallopian tubes, or again, if the infertility originates from a problem of the liquid male seminal.
IVF is a technique whose success depends as much on the age of the woman as on the experience of the specialists who perform it, for this reason it is essential to contact only highly specialized centers in the sector.
Statistics have shown that to date the couples who manage to get pregnant after in vitro fertilization are about 36%.
From these values we pass to a probability of birth of live children of 50% in younger women (<35 years) subjected to at least five cycles, on the contrary in subjects over 40 the frequency of success is greatly reduced. If, on the one hand, this would still suggest performing a large number of cycles, on the other, these are considered “heavy” by many women.
Conclusion
Although the scientific and technological advances of recent years have made great strides in recent years, there is still a lot to be done to allow a greater number of babies in arms for all those couples who yearn to realize their desire for a family. It is equally true that more than 1 million families around the world have managed to make their dream come true thanks to the use of these techniques.
Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.
Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.