Guideline sources The following summarized guidelines for the evaluation and management of assisted human reproduction are prepared by our editorial team based on guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC 2014). 1 1 1 2 3 Definition Assisted human reproduction or assisted reproductive technology refers to any procedure that involves handling eggs, sperm, or both outside the human body (in vitro) including IVF and intrauterine insemination, and ovarian stimulation with gonadotropin or medications. 1 Epidemiology Assisted human reproduction is used to address primary or secondary infertility, fertility preservation after gonadotoxic treatments in reproductive-age patients, to enable same-sex couples and single women and men to conceive and have biological children, and to facilitate the services of surrogate gestational carriers. 1 Disease course Reproductive problems or infertility is addressed through assisted human reproduction, which includes IVF (IVF), intratubal transfer of gametes (GIFT), intratubal transfer of zygotes (ZIFT), tubal transfer of preimplantation embryos (TET), gamete or embryo donation, cryopreservation, and micromanipulation. 2 https://web.pathway.md/diseases/recY3AYaTCWq2YHMX 1/4 6/23/23, 3:12 AM Assisted human reproduction Pathway Prognosis and risk of recurrence In assisted human reproduction, early mortality increases multiple pregnancies with each additional fetus corresponding to a relative risk of 2.4 for triplets, 3.3 for quadruplets, and 10.3 for quintuplets. 3 Guidelines 1. Diagnostic investigations Genetic testing: offer genetic/clinical counseling, karyotype assessment for chromosomal abnormalities, and Y-chromosome microdeletion testing to all men with severe oligozoospermia or azoospermia (sperm count < 5 million/hpf) prior to IVF with intracytoplasmic sperm injection. B 2. Surgical interventions Elective single embryo transfer: provide elective single embryo transfer in couples with good prognosis for success. B Cryopreserved embryos fertilized in vitro: there is increasing evidence that pregnancy outcomes are better for cryopreserved embryos fertilized in vitro than for fresh embryo transfers. This finding supports a policy of elective single embryo transfer for women with a good prognosis, and may reassure women who are considering IVF. B Intracytoplasmic sperm injection: Advise women and couples considering assisted human reproduction and concerned about perinatal outcomes that: intracytoplasmic sperm injection does not appear to confer increased adverse perinatal or maternal risk over standard IVF the use of donor oocytes increases successful pregnancy rates in selected women, but even when accounting for maternal age, can increase the risks of low birth weight and preeclampsia. B 3. Patient education Genetic counseling: counsel couples thoroughly about the significant risks of multiple pregnancies associated with all assisted human reproductive treatments. B 4. Follow-up and surveillance Serial imaging assessment: counsel patients being evaluated for any assisted reproductive technology procedure on the slightly increased risk fo congenital structural abnormalities, with emphasis on known confounding factors such as infertility and BMI. B https://web.pathway.md/diseases/recY3AYaTCWq2YHMX 2/4 6/23/23, 3:12 AM Assisted human reproduction Pathway References 1. Okun N, Sierra S. Pregnancy outcomes after assisted human reproduction. J Obstet Gynaecol Can. 2014 Jan;36 1 64 83. Open 2. R Fernandez Pelegrina, A G Kessler, R G Rawlins. Modern approaches to the treatment of human infertility through assisted reproduction. 1991 Aug;10 2 75 81.1991 Aug;10 2 75 81. Open 3. Hamisu M Salihu, Muktar H Aliyu, Dwight J Rouse et al. Potentially preventable excess mortality among higher-order multiples. 2003 Oct;102 4 679 84.2003 Oct;102 4 679 84. Open 4. Joyce Harper, Joep Geraedts, Pascal Borry et al. Current issues in medically assisted reproduction and genetics in Europe: research, clinical practice, ethics, legal issues and policy. Hum Reprod. 2014 Aug;29 8 1603 9. Open 5. Ana Garc a-Blanco, Vicente Diago, David Herv s et al. Anxiety and depressive symptoms, and stress biomarkers in pregnant women after in vitro fertilization: a prospective cohort study. Hum Reprod. 2018 Jul 1;33 7 1237 1246. Open 6. European Society of Human Genetics, European Society of Human Reproduction and Embryology. The need for interaction between assisted reproduction technology and genetics: recommendations of the European Societies of Human Genetics and Human Reproduction and Embryology. Hum Reprod. 2006 Aug;21 8 1971 3. Open 7. Andr Van Steirteghem. Assisted reproductive techniques and human reproduction. Hum Reprod. 2009 Nov;24 11 2675. Open 8. C Gnoth, E Godehardt, P Frank-Herrmann et al. Definition and prevalence of subfertility and infertility. Hum Reprod. 2005 May;20 5 1144 7. Open 9. Satvinder Purewal, Sarah C E Chapman, Olga B A van den Akker. Depression and state anxiety scores during assisted reproductive treatment are associated with outcome: a meta-analysis. Reprod Biomed Online. 2018 Jun;36 6 646 657. Open 10. Bettina Toth, Dunja Maria Baston-B st, Hermann M Behre et al. Diagnosis and Treatment Before Assisted Reproductive Treatments. Guideline of the DGGG, OEGGG and SGGG S2k Level, AWMF Register Number 015 085, February 2019 Part 2, Hemostaseology, Andrology, Genetics and History of Malignant Disease. Geburtshilfe Frauenheilkd. 2019 Dec;79 12 1293 1308. Open 11. Bettina Toth, Dunja Maria Baston-B st, Hermann M Behre et al. Diagnosis and Therapy Before Assisted Reproductive Treatments. Guideline of the DGGG, OEGGG and SGGG S2k Level, AWMF Register Number 015 085, February 2019 Part 1, Basic Assessment of the Woman. Geburtshilfe Frauenheilkd. 2019 Dec;79 12 1278 1292. Open 12. A. Salonia, C. Bettocchi, J. Carvalho et al. EAU Guidelines on Sexual and Reproductive Health. EAU. 2023. Open 13. Shannon M Bates, Ian A Greer, Saskia Middeldorp et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141 2 Suppl):e691S-e736S. Open https://web.pathway.md/diseases/recY3AYaTCWq2YHMX 3/4 6/23/23, 3:12 AM Assisted human reproduction Pathway 14. Monika Sarkar, Carla W Brady, Jaquelyn Fleckenstein et al. Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021 Jan;73 1 318 365. Open https://web.pathway.md/diseases/recY3AYaTCWq2YHMX 4/4