Assisted Reproductive Technology (ART)

Assisted Reproductive Technology (ART) is any medical procedure that handles eggs or embryos to achieve a pregnancy. The handling of eggs or embryos defines the group. The place where egg and sperm meet does not matter. Federal law defines ART as all treatments or procedures that handle human eggs (oocytes) or embryos.¹ That legal definition includes gamete intrafallopian transfer. In this procedure, the egg and sperm meet inside the fallopian tube.¹

CDC tracking uses the same definition. It counts every fertility treatment or procedure that handles eggs or embryos to help achieve a pregnancy.² The group includes in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). It also includes donor egg and donor embryo cycles, and embryo biopsy with genetic testing before transfer. Embryo banking, frozen embryo transfer, and cycles with a gestational carrier also belong to it.³

Intrauterine insemination (IUI) falls outside the group, because it handles only sperm. Drugs that stimulate the ovaries also fall outside it when no one plans to collect the eggs.²

ART procedures are bypass technologies. They work around the barrier to pregnancy. No one has to find or treat that barrier first. Consider a woman with undiagnosed endometriosis. After IVF, the endometriosis remains. A couple may have an unevaluated male factor. After ICSI, that male factor remains. The route to conception changes. The underlying condition does not.

RRM and ART start from opposite premises. ART assumes the body cannot succeed on its own and builds tools around that assumption. RRM asks why the body has not succeeded, then addresses the answer.

The two premises lead to different paths of care. Listing them as two choices for one problem hides how differently they see it. See corrective vs. bypass approach.

ART carries more perinatal risk, the risk to the baby around the time of birth, than natural conception. This risk includes more preterm births, more low birth weight infants, and more twins or triplets. A systematic review of controlled studies found this added risk mainly in singleton pregnancies, pregnancies with one baby.

ART singletons had much higher perinatal mortality, death around the time of birth, than naturally conceived singletons. They also had more preterm births and more low birth weight. Twins showed the opposite pattern in the same review. Their perinatal mortality was roughly 40% lower, not higher, than in naturally conceived twins. Rates of very preterm birth and very low birth weight were similar in both groups of twins.⁴

Yearly HFEA data describe outcomes across hundreds of thousands of UK cycles.⁵ Patients deserve accurate outcome data, reported by age, before they consent to any ART procedure.