Assisted Reproductive Technology (ART)

Updated: Mar 21

A path to growth and greater equality

Written by By Dr. Ahnee Min-Yau, L.Ac., DACM, FitPro Wellbeing Speaker

With the start of March, we begin Women’s History month!

I am so inspired and in awe of all the contributions and impact that women have made in our lives, our economy, our society, our culture, our communities, our families, and throughout history! And because International Women’s Day is also coming up on March 8th, a day that “marks a call to action for accelerating women’s equality,” (internationalwomensday.com), I think it's important to spotlight how advancements in women’s healthcare, specifically in Assisted Reproductive Technology (ART) have also enabled new paths to growth and greater equity for women across the board.

So how exactly does ART create greater equity for women?

First, it starts with giving women a choice on when to have children. Biologically, a woman’s child bearing years peak between the late teens and late 20’s, according to the American College of Obstetricians and Gynecologists (ACOG). By age 30, a woman’s fertility (defined as the ability to get pregnant) starts to decline and then swiftly declines once a woman reaches 35, from which the so-called ‘fertility cliff ’ happens, where your chances of conceiving severely drop off and you become ‘advanced maternal age.’ By age 45, fertility has declined so much that getting pregnant naturally is highly unlikely. (ACOG)

However, the good news is that today, the outdated claim that “after age 35 it’s very difficult to get pregnant,” has been replaced with the notion that “fertility lies on a continuum,” says Dr. Sandra Ann Carson, a reproductive endocrinologist and obstetrician-gynecologist at Yale University. Dr. Carson explains that “it’s a gradual descending slope,” not a steep cliff you take a nosedive from. And while the fact remains that women are born with a finite number of eggs that diminish over time, and are greatly reduced after age 35, there are protocols and treatment options using acupuncture, herbal medicine, LED light therapy, nutritional supplementation with DHEA, COQ10 Ubiquinol, and other diet and lifestyle enhancements (stress reduction, regular exercise) that can impact egg quality. Books like: It Starts with the Egg: How the Science of Egg Quality Can Help You Get Pregnant Naturally, Prevent Miscarriage, and Improve Your Odds in IVF (by Rebecca Fest) that provide science-backed treatment options, give hope and inspiration for alternative ways to help support (and dare we say improve) egg quality.

In addition, with ART now very mainstream and demand on the rise, there are remarkable treatments like Inter-uterine Insemination (IUI), In-vitro fertilization (IVF), Egg freezing, Intra-cytoplasmic Sperm Injection (ICSI), donor eggs or donor sperm programs, Pre-genetic Diagnosis (PGD), surrogates, offering various alternative ways to have a child later in life or at a time that best suits the mother. However, as I have seen in my own experience and in my practice helping women conceive using acupuncture to support IVF treatments or optimize egg freezing treatment plans, the reality is that its still a ‘journey’ with no guarantees. With 20.0% of women now having their first child after age 35,” (Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology), fertility complications more than double for women in that age group, causing difficulties for one out of every three couples. And the other reality is that unfortunately, the majority of IVF cycles do require multiple rounds, and with only about two thirds (65.3%) of patients (under age 40) successful after six or more cycles of IVF (Davenport, 2016). So please be clear, while the technology is there and should work, it may not always go as smoothly or work out as one might initially hope for. So there are risks.

We cannot escape our biology: A Western Medicine Perspective of Infertility

As a woman ages, her ability to get pregnant declines. This is known as ‘age-related infertility.’ (Originelle). Age-related infertility is more common among women over the age of 30 where a decrease in the number of eggs that remain in a woman’s ovaries, as well as diminished egg quality, make becoming pregnant more difficult. From a biomedical perspective, there are a series of complications and risks that make it very difficult to get pregnant after age 35. The most common causes for reduced conception rates in women aged 40+ with her own eggs are: 1) higher incidence of miscarriage due to diminished egg quality and due to significantly reduced egg quantity, with poor endocrine readings such as high FSH (follicle-stimulating hormone) or low estrogen levels; 2) less frequent monthly ovulations; 3) reduced cervical mucus secretions; 4) reduced blood perfusion to the ovaries and uterus. Furthermore, a common reason for an increased miscarriage rate is high chromosomal abnormalities (called aneuploidy) in the embryos due to poor egg quality as women age.

Furthermore, the risk of pregnancy loss — by miscarriage and stillbirth — increases as you get older, perhaps due to pre-existing medical conditions of the mother or fetal chromosomal abnormalities [which stem from the decrease in egg quality as women age] (Sherbahn, 2014). It thus boils down to not only egg quantity but also egg quality. At age 30 about 30% of eggs are chromosomally abnormal. By age 40 about 60% are abnormal and by 44 years old 90% are abnormal. (Yang, 2013). Advanced maternal age is widely recognized as increasing the risk for chromosomal abnormalities. These are genetic problems that can cause health problems for the baby, including Down Syndrome, Tay-Sach's disease, cystic fibrosis and others. (Birth Injury Justice).

Lastly, the quantity of remaining eggs is also very important, especially when going through IVF, because the quantity of eggs remaining influences response to ovarian stimulating medications. This is why many reproductive endocrinologists start a fertility patient with tests to measure Follicle Stimulating Hormones (FSH) and Anti- Mullerian Hormone (AMH) levels. Normal AMH levels (1.5 to 4.0 ng/ml) are associated with better response rates to fertility treatments. Low–Normal AMH levels (1.0 to 1.5 ng/ml) are associated with decreased ovarian reserve, and less favorable response treatment. Poor response was observed in serum AMH levels of <1 ng/ml, the normal response in 1–4 ng/ml, and good response in >4 ng/. (Vijay et al, 2022 ) More eggs remaining means more eggs which can be retrieved with the in vitro cycle, and more eggs to work with in an IVF cycle gives a higher chance for successful pregnancy.

ART brings hope and can be a game changer:

Despite all these risks and opportunities for failure in ART, there are many successes. Along with these successes, ART can and has been a true game changer for many. Women can and do sacrifice the timing of when they start their family, which can change the trajectory of their life path, which has implications on their impact in our world. These choices don’t just affect women, but all the lives they may touch because of it. Here are 3 ways that ART paves a way for a path to greater growth and equity:

By leveraging treatments like egg freezing, IVF, donor egg with IVF, it allows women to delay the start of their family and use that delay and extra time to focus on their personal growth and development whether its to: a) focus on their career, b) allow more time to find the right partner to start a family with, c) grow financially to help support the household, or d) use that time to help them figure out if they even want to have children. Becoming a mom and starting a family can in many cases create different priorities for a woman, unleash a new role and identity as ‘mother, caregiver, homemaker,’ all of which can change the trajectory of that woman’s life.
The technology also allows the opportunity for those struggling with fertility issues (health conditions like PCOS, endometriosis, blocked tubes, poor ovarian reserve, recurrent miscarriage, etc) to leverage treatments like IUI, IVF, or IVF with donor egg, to help level the playing field so that those who have specific infertility issues or physiological limitations have a chance to start a family too. In addition to ART, other integrative healing therapies like: acupuncture, herbal medicine, targeted nutrition with supplements, mind-body therapies and treatments that support mental and emotional health have also been found to further the success of ART techniques.
ART also gives hope and access to those that desire to have a family (and can afford the treatments), and who may come from a variety of communities, to create the family they’ve always wanted. Whether its a single woman looking for a donor sperm to start her family, a recovering cancer patient who has finished chemo treatments and is now in a place where she wants to have a baby using eggs she froze in her early 20’s before her cancer treatments, to same sex couples who want to create their modern families, or the couple who married later in life but still want to start a family, it provides more of us the chance to experience the joys of parenthood and building a family.

While accolades and credit are given to Dr. Robert Edwards, who was awarded the 2010 Nobel Prize for the development of human in-vitro fertilization (IVF) therapy, at its core, it relies mostly (in my humble opinion) upon the woman and her body. She is the one who has to undergo the relentless hormone injections, repeat blood tests and ultrasounds and endure the often risky protocols of hyper-stimulation of their ovaries to over-produce follicles (against what nature intended) and then go through the emotional roller coaster of harvesting, freezing, and fertilizing the eggs, and then patiently wait for the genetic testing results and fertilization reports to reveal the likelihood of survival rate. And we certainly can’t forget the wait —the agonizing 2 weeks after an IVF or IUI transfer, to hear if the embryo successfully implanted, only to have to wait another 9 months of creating and carrying this precious life in her belly and then push out this new being into the world, enduring hours if not days of contractions, labor and childbirth! And that is just the beginning….

It should be recognized then, at the core of all that makes this happen, it is women! It is in fact, women who carry this responsibility, biological burden or medical miracle (however you choose to view it), and it is in fact, the female reproductive system that has to be hyper-stimulated, modified, adjusted, repressed, tweaked, to realize this opportunity. We are now able to give women more choice and control in their family planning using ART (and soon enough through other technologies like stem-cells to grow follicles)! And the reach and impact is profound, because we are now able to treat a medical condition afflicting not just women, but a universal health issue with estimates that 8 to 12% of couples worldwide are infertile. (Bovin et al 2007). Large numbers of people are affected by infertility in their lifetime, according to a new report published today by WHO, with about 17.5% of the adult population – roughly 1 in 6 worldwide.

Happy International Women’s Day everyone!

Let us never forget the reproductive miracles that women provide, of which that alone is spectacular, life changing, and makes an unforgettable mark in this world!

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