OG28.4 | Assisted Reproduction Techniques — Summary & Reflection

KEY TAKEAWAYS

Assisted reproduction techniques span a spectrum from IUI (sperm placed in uterus — bypasses cervix only; indicated for mild male factor, unexplained infertility, cervical factor) through IVF (controlled ovarian stimulation + oocyte retrieval + laboratory fertilisation + embryo transfer — bypasses tubes entirely; indicated for tubal factor, moderate male factor, failed IUI, severe endometriosis) to ICSI (single sperm injected into oocyte — bypasses zona penetration; indicated for severe male factor, azoospermia with surgical retrieval, prior IVF fertilisation failure). IVF live birth rates are strongly age-dependent: ~40% per transfer at <35 years, declining to ~2% at >44 years. Donor oocytes restore success rates to ~35–45% regardless of recipient age. Key risks include OHSS (GnRH antagonist protocol + agonist trigger + freeze-all prevents severe cases), multiple pregnancy (managed by eSET), and ectopic pregnancy. In India, ART is regulated by the ART Act 2021 (clinics, donors, age limits) and the Surrogacy Regulation Act 2021 (altruistic only, close relative surrogate); PCPNDT Act prohibits sex selection including preimplantation.

REFLECT

Return to Ritu and Anand from the opening. Ritu has no tubes (salpingectomy done); Anand has severe oligoasthenospermia. You have explained IVF with ICSI, including the ~35–40% chance of live birth per cycle at their ages (~30s), the need for 10–14 days of injections, the oocyte retrieval under sedation, and the emotional demands. Anand asks: 'Can you guarantee we'll get a baby on the first try?' Reflect on how you would answer this honestly and compassionately. What number do you give, and how do you contextualise it? Now consider: if they ask about using a surrogate because Ritu is anxious about pregnancy, what do you tell them under the Surrogacy Regulation Act 2021? Is Ritu medically eligible for surrogacy? (Kolb: Reflect on the boundary between hope and false hope in clinical communication — ART is powerful but not guaranteed, and the clinician's language shapes the patient's expectations and resilience for what may be a long journey.)