Since the first in vitro fertilisation (IVF) baby was born in 1978, an estimated 10 million children have been born worldwide through assisted reproductive technology (ART), according to ICMART/ESHRE estimates.

When simpler fertility treatments have not worked—or are not appropriate for your situation—ART offers highly effective options. This guide explains what ART involves, who it can help, and what you can realistically expect—both in terms of success rates and the emotional journey.

What You’ll Get

• What ART is and how it differs from other fertility treatments

• Overview of IVF, ICSI, and donor programs

• Who is a candidate for IVF, ICSI, and related technologies

• Step-by-step IVF process from stimulation to embryo transfer

• Realistic success rates by age and treatment type

• How to choose a fertility clinic

• Costs, financial considerations, and emotional support

What Is Assisted Reproductive Technology?

According to the Centers for Disease Control and Prevention (CDC), assisted reproductive technology includes all fertility treatments in which eggs (oocytes) or embryos are handled outside the body. This definition specifically excludes procedures where only sperm are manipulated (such as intrauterine insemination) and treatments using ovarian stimulation without planned egg retrieval, because fertilisation in those procedures still occurs inside the body.

At its core, ART involves retrieving eggs from the ovaries, fertilizing them with sperm in a laboratory, and either transferring the resulting embryo(s) to the uterus or freezing them for future use.

The key distinction:

While treatments like ovulation induction and intrauterine insemination (IUI) help conception happen inside the body, ART brings fertilization into the controlled environment of an embryology laboratory—giving specialists precise control over each step of the process.

What Types of ART Procedures Exist?

• In Vitro Fertilization (IVF): Oocytes are retrieved and fertilized in a laboratory setting, where sperm are added under controlled conditions, and embryo(s) are transferred to the uterus.

• Intracytoplasmic Sperm Injection (ICSI): A single sperm is injected directly into each oocyte. Originally developed for severe male factor infertility, ICSI has expanded to encompass approximately two-thirds of all fresh ART cycles in Europe and globally. Used when sperm quality or quantity is compromised, and increasingly applied in broader clinical contexts.

• Frozen Embryo Transfer (FET): Embryos created in a previous cycle, or donor embryos, are thawed and transferred. FET now accounts for the majority of embryo transfers in many high-income countries, including across Europe and the United States.

• Preimplantation Genetic Testing (PGT): Although not an ART procedure itself, PGT is an additional option frequently used alongside IVF/ICSI. Embryos are screened for genetic abnormalities before transfer.

• Donor Programs: Using donor eggs, donor sperm, or donor embryos when needed.

Who Is ART Suitable For?

ART procedures are recommended when simpler treatments have failed or when specific medical conditions make natural conception unlikely. According to clinical guidelines, IVF and related technologies are typically offered in the following situations.

What Are the Primary Indications for ART?

• Tubal Factor Infertility: Blocked or damaged fallopian tubes—IVF directly bypasses this problem.

• Severe Male Factor Infertility: Very low sperm count, poor motility, abnormal morphology, or high sperm DNA fragmentation—ICSI can achieve fertilization with minimal healthy sperm.

• Diminished Ovarian Reserve: Fewer eggs than expected for age, making controlled stimulation and retrieval beneficial.

• Moderate to Severe Endometriosis: When other treatments have not succeeded.

• Unexplained Infertility: After simpler treatments (typically 3–6 cycles of IUI) have not resulted in pregnancy.

• Advanced Maternal Age: Women in their late 30s and older benefit from moving directly to IVF due to declining egg quality and quantity.

How Is ART Used Beyond Traditional Infertility?

ART is also used in situations unrelated to classic infertility.

• Genetic Testing: Couples who are carriers of genetic disorders may use IVF with PGT to select unaffected embryos.

• Fertility Preservation: Patients facing cancer treatment or those who wish to delay childbearing can freeze eggs or embryos.

• Same-Sex Couples and Single Parents: IVF with donor eggs or sperm enables family building.

• Gestational Carrier Arrangements: For individuals who cannot carry a pregnancy.

How Do IUI, IVF, and ICSI Compare?

Understanding how these treatments differ helps you and your fertility team choose the most appropriate path.

Source: SART3 and CDC 2022 ART National Summary

IVF vs. ICSI: Which Is More Appropriate?

A recent large randomized trial found that in patients without severe male factor infertility, conventional IVF and ICSI produced similar cumulative live birth rates (approximately 43% vs. 47%). The study found that younger women (age 32 and under) may actually have slightly better outcomes with conventional IVF.

When is conventional IVF recommended?

• When there is no severe male factor infertility.

• For younger patients (age 32 and under), slightly better outcomes have been observed with conventional IVF.

When is ICSI specifically recommended?

• Sperm count is very low (oligospermia) or absent in the ejaculate (azoospermia).

• Sperm motility or morphology is severely compromised.

• Sperm must be surgically retrieved, such as after a vasectomy, when surgical sperm retrieval is required.

• The previous IVF cycle resulted in fertilization failure.

What Does the IVF Process Look Like Step by Step?

Understanding what happens during an IVF cycle can help reduce anxiety and prepare you for each stage.

Step 1: Ovarian Stimulation (8–14 Days)

Hormones called gonadotropins, which are administered by injection, stimulate the ovaries to produce multiple eggs instead of the single egg that normally matures each month. Regular ultrasounds and blood tests monitor the response.

Step 2: Trigger Shot

When follicles are mature (typically when 2–3 of them reach approximately 18 mm in diameter), an injection of human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH) agonist triggers final egg maturation.

Step 3: Egg Retrieval (15–30 Minutes)

Approximately 34–36 hours after the trigger shot, eggs are retrieved through a transvaginal ultrasound-guided needle aspiration. This is performed under sedation or anesthesia. The number of retrieved oocytes varies depending on patient-related factors and the stimulation protocol used. At a population level, retrieving up to 15 oocytes on average is associated with optimal live birth rates.

Step 4: Fertilization

Eggs are combined with prepared sperm (conventional IVF) or injected with a single sperm (ICSI). Successful fertilization is typically assessed the following day by checking for two pronuclei, which indicates normal fertilization has occurred.

Step 5: Embryo Culture (3–6 Days)

After fertilization, embryos are grown in the laboratory. Most clinics now culture embryos until the blastocyst stage (day 5 or 6), which allows doctors to better select embryos and improve implantation chances in many patients.

Step 6: Embryo Transfer

One or more embryos (typically on day 3 or day 5/6) are transferred to the uterus using a thin catheter guided by ultrasound. The transfer itself typically takes several minutes, though the entire procedure—including patient preparation and ultrasound guidance—may take approximately 15–30 minutes. Current guidelines recommend single embryo transfer for patients with a favorable prognosis to minimize multiple pregnancy risks.

Step 7: Luteal Support and Pregnancy Test

Progesterone supplementation supports the uterine lining. A blood pregnancy test is performed approximately 10–14 days after embryo transfer.

Fresh vs. Frozen Embryo Transfer: What Does the Evidence Show?

Frozen embryo transfer (FET) has become increasingly common. Evidence suggests that, in many patient populations, FET may offer outcomes comparable to or slightly better than those of fresh transfer, with a reduced risk of ovarian hyperstimulation syndrome.

Freezing also allows time for preimplantation genetic testing if desired. When PGT is planned, a biopsy is typically performed on day 5 or 6 of the fresh cycle, after which embryos are frozen while awaiting results. Once results are available, suitable embryos are thawed for transfer in a subsequent FET cycle.

What Are the Success Rates?

Success rates vary significantly by maternal age, diagnosis, and treatment approach. Understanding realistic expectations helps with planning and decision-making.

What Are IVF Success Rates by Age (Using Own Eggs)?

Source: CDC 2022 ART National Summary

What Are Key U.S. Statistics (2022)?

• 37.5% of all ART cycles resulted in live birth.

• 85.9% of embryo transfers were single embryo transfers.

• 36.3 years was the average age of patients using ART.

What Does the European Data Show? (2019 ESHRE Data)

The European Society of Human Reproduction and Embryology (ESHRE) reported over 1 million ART treatment cycles across 40 European countries in 2019.

Important:
The following figures represent clinical pregnancy rates (confirmed by ultrasound), which differ from live birth rates. Clinical pregnancy rates are generally higher because they include pregnancies that may not ultimately result in a live birth.

Clinical pregnancy rates ranged from 21–25% per egg retrieval cycle for IVF/ICSI, while frozen embryo transfers achieved pregnancy rates of approximately 35% per transfer.

Important:
Success rates vary significantly between clinics. When comparing clinics, consider the types of patients they treat—clinics that accept more challenging cases may have lower overall success rates but provide excellent care.

How Do You Choose a Fertility Clinic?

Selecting the right clinic is one of the most important decisions in the fertility journey. Research shows that patients consider multiple factors when making this choice—success rates are important, but not the only consideration.

What Factors Should You Consider?

• Success rates for your age group and diagnosis: Look at rates specific to your situation, not just overall clinic statistics.

• Treatment options available: Does the clinic offer the specific treatments you may need (donor programs, PGT, fertility preservation)?

• Cost and payment options: Understand the full cost, including medications, monitoring, and any add-ons.

• Location and logistics: Frequent monitoring visits require an accessible location and flexible scheduling.

• Communication and support: How accessible is the medical team? Is there psychological support available?

• Clinic experience and accreditation: Check regulatory oversight and quality certifications.

Be cautious about:
Comparing clinics solely on headline success rates can be misleading. A clinic treating younger, healthier patients will naturally report higher rates than one specializing in complex cases.

What Are the Costs and Financial Considerations?

The financial burden of fertility treatment can be substantial. Understanding the full scope of costs helps with planning and reduces unexpected expenses.

What Drives Costs?

A French national study found that infertility treatment expenditures extend well beyond the IVF procedure itself. In the first semester of treatment, approximately 47% of costs went to ovulation stimulation medications, while in later treatment phases, hospitalizations for ART procedures accounted for about 44% of expenditures.

What Cost Components Should You Consider?

• Fertility medications: Often represent a significant portion of total costs.

• Monitoring (ultrasounds and blood tests): Multiple visits required during stimulation.

• Egg retrieval procedure: Including anesthesia.

• Laboratory fees: Fertilization, embryo culture, ICSI if needed.

• Embryo transfer: Fresh or frozen.

• Cryopreservation: Freezing and long-term storage of genetic material (oocytes, embryos, and sperm), including annual storage fees.

• Optional add-ons: PGT, assisted hatching (a laboratory technique in which a small opening is made in the outer shell of the embryo to potentially aid implantation), and other supplementary procedures.

Important:
The quoted price of an IVF cycle often does not include all components. Ask for a detailed breakdown of all potential costs before starting treatment.

How Do Single vs. Multiple Embryo Transfers Affect Cost?

While transferring multiple embryos may seem to increase the chances of success, research shows that sequential single embryo transfers (SET) can achieve comparable cumulative live birth rates while significantly reducing the medical costs associated with multiple pregnancies.

A U.S.-based cost analysis found that compared to double embryo transfer, sequential single embryo transfer reduced estimated total costs by approximately 34% when accounting for both ART treatment and pregnancy-related medical expenses—primarily by avoiding the higher costs associated with twin pregnancies. This estimate reflects U.S. cost structures and may differ in other healthcare systems.

What Is the Emotional Journey of Fertility Treatment?

Fertility treatment involves more than medical procedures—it is an emotional experience that can affect mental health, relationships, and daily life. Acknowledging and addressing these emotional aspects is now considered a standard part of quality fertility care.

What Are Common Emotional Experiences?

Research examining women undergoing IVF has found that psychological distress fluctuates throughout the treatment cycle. Anxiety often peaks around specific milestones—such as trigger day and before pregnancy testing—while feelings of sadness and guilt (commonly reported emotional responses, rather than reactions that are appropriate or justified) may become more prominent as treatment continues.

The World Health Organization (WHO) recognizes that infertility can cause significant psychological distress, stigma, and strain on relationships. Both women and men undergoing fertility treatment are at risk for elevated anxiety and depression symptoms.

What Is the Value of Psychological Support?

ESHRE guidelines emphasize that emotional and psychological support should be a standard component of fertility care—not something optional or "extra."

Studies have found that patients report more positive treatment experiences when clinics offer on-site mental health counseling. Having mental health professionals integrated into the fertility care team can help with:

• Managing treatment-related stress and anxiety.

• Processing difficult news and treatment setbacks.

• Supporting communication and relationships between partners.

• Making informed decisions about treatment continuation.

• Coping with pregnancy loss if it occurs.

• Dealing with unsuccessful stimulation cycles, cycles that did not result in viable embryos, or PGT results showing no euploid embryos available for transfer.

What you can do:
Ask your clinic about available psychological support services. Many clinics now have counselors available, and some fertility professional societies indicate whether clinics provide mental health services in their directories.

So, What Should You Do Now?

If you are considering ART, here is a structured approach:

Step 1: Confirm Your Diagnosis

Ensure both partners have been fully evaluated. Understanding the specific cause(s) of infertility guides the choice of the most appropriate ART approach.

Step 2: Understand Your Options

Discuss with your fertility specialist whether IUI might still be appropriate, or whether proceeding directly to IVF/ICSI is recommended based on your specific situation.

Step 3: Research Clinics

Look beyond headline success rates. Consider location, available treatments, costs, and the support services offered.

Step 4: Plan Financially

Get detailed cost estimates. Understand what your insurance covers (if anything) and explore financing options if needed.

Step 5: Prepare Emotionally

Consider what support you will need during treatment. Identify resources—whether clinic counselors, support groups, or your personal network.

→ Compare fertility clinics worldwide: MedicalNavigator.com/fertility-clinics

Too Long, Didn’t Read

• ART includes treatments where eggs or embryos are handled outside the body—primarily IVF and ICSI.

• Success rates depend heavily on age: women under 35 have the highest chances (40–50% per embryo transfer).

• ICSI accounts for approximately two-thirds of all fresh ART cycles globally and is specifically beneficial for severe male factors; for cases without severe male factors, conventional IVF may work equally well.

• Single embryo transfer is now standard practice to avoid multiple pregnancy risks.

• Do not compare clinics on success rates alone—understand the full picture.

• Emotional support is a recognized standard of quality fertility care.

  
  

References

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3. Society for Assisted Reproductive Technology (SART). ART: Step-by-Step Guide. 

4. National Institute for Health and Care Excellence (NICE). Fertility problems: assessment and treatment. Clinical guideline [CG156]. Published: 20 February 2013. Last updated: 06 September 2017.

5. Centers for Disease Control and Prevention (CDC). 2022 ART National Summary. December 2024.

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7. Human Fertilisation & Embryology Authority (HFEA). Choose a clinic. 

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10. Human Fertilisation & Embryology Authority (HFEA). Costs and funding.

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12. Crawford S, Boulet SL, Mneimneh AS, et al. Costs of achieving live birth from assisted reproductive technology: a comparison of sequential single and double embryo transfer approaches. Fertil Steril. 2016;105(2):444-50.

13. ESHRE Psychology and Counselling Guideline Development Group. Routine psychosocial care in infertility and medically assisted reproduction—A guide for fertility staff. ESHRE Guidelines.

14. Zanettoullis AT, Mastorakos G, Vakas P, Vlahos N, Valsamakis G. Effect of Stress on Each of the Stages of the IVF Procedure: A Systematic Review. Int J Mol Sci. 2024;25(2):726.

15. Wu L, Sun L, Wang J, et al. Psychological distress among women undergoing in vitro fertilization-embryo transfer: A cross-sectional and longitudinal network analysis. Front Psychol. 2023;13:1095365.

16. World Health Organization. Infertility Fact Sheet. November 2023.

17. Sax MR, Lawson AK. Emotional Support for Infertility Patients: Integrating Mental Health Professionals in the Fertility Care Team. Women. 2022;2(1):68-75.

This guide is for informational purposes only. Always consult qualified healthcare providers for personalized recommendations. For full details, read our Medical Disclaimer.