Assisted reproduction

This course is part of the RCOG Core Knowledge series.

Assisted Reproductive Technology (ART) is a blanket term used to describe technologies that help a person or couple conceive with the assistance of medical intervention. Examples of assisted reproduction are:

• Intrauterine insemination (IUI)
• in vitro fertilisation (IVF) - one of the most commonly used and successful treatments available
• IVF with intracytoplasmic sperm injection (ICSI)
• the use of donor sperm (donor insemination) or eggs (egg donation) or embryos (embryo donation) 
• vitrification.

The first pregnancy after the fertilization of a human egg in vitro and the first birth from an in vitro-fertilized embryo were reported in 1976 and 1978, respectively. Since then, more than five million pregnancies have been achieved worldwide by IVF and its modifications, known generically as assisted reproductive technologies (ARTs). As experience has accumulated, success rates have increased, and the indications for these procedures have expanded, such that ART now accounts for 1 to 3 percent of live births in the Europe and United States.

The average age of first-time mothers across the EU increased from 27.6 years in 2006 to 30.2 years in 2022, and the mean age of childbearing has been increasing consistently in Europe since the 1980s. Women under 30 have an 85% chance of conceiving within one year, compared to 66% by age 35 and 44% by age 40, and fertility decreases dramatically after this.

In response to concerns about how rapidly the technologies were developing, in 1991 the UK created the Human Fertilisation and Embryology Authority (HFEA) through the Human Fertilization and Embryology Act 1990 (HFE Act). This was the first statutory body of its kind in the world. The HFEA regulates and inspects all UK fertility clinics and is dedicated to licensing and monitoring the fertility clinics and all UK research involving human embryos, and providing impartial and authoritative information to the public. The introduction of guidelines into clinical practice in general and in assisted reproduction in particular has led to an ever-increasing role for an evidence-based approach to the provision of these services. Clinical guidelines for the assessment and treatment for people with infertility problems were published by the National Institute for Clinical Excellence in 2004 and later updated in February 2013 to streamline services and avoid unnecessary waste of resources. The impact of the HFEA, the Royal College of Obstetricians and Gynaecologists (RCOG) and National Institute for Health and Care Excellence (NICE) publications on the management of the infertile couple has been considerable on UK practice.

In this course, many of the treatment choices and their suitability will be based on the RCOG and NICE publications and the more recent published literature.