Assisted reproductive technology (ART) refers to any fertility treatment in which eggs or embryos are physically handled outside the body to help achieve a pregnancy. The most common form is in vitro fertilization (IVF), which accounts for the vast majority of ART procedures performed today. A single IVF cycle typically costs between $15,000 and $30,000, with medications making up a large share of that expense.
The term has a specific medical and legal definition. ART includes procedures where eggs are surgically retrieved from the ovaries, combined with sperm in a laboratory, and then transferred into a uterus. It also covers egg and embryo freezing and egg and embryo donation. What it does not include are treatments that only involve sperm, like intrauterine insemination, or fertility medications taken without a planned egg retrieval.
How IVF Works, Step by Step
IVF is a multi-stage process that typically spans several weeks. Before stimulation begins, your doctor may prescribe birth control pills or estrogen to prevent ovarian cysts and synchronize your cycle. This prep phase gives the medical team control over timing and helps maximize the number of eggs that mature together.
The next phase is ovarian stimulation, where you take injectable hormones that encourage a full group of eggs to mature at once rather than the single egg your body would normally release. During this time, you’ll have ultrasounds and blood draws every few days so your doctor can track how your ovaries are responding. Most stimulation phases last between 8 and 14 days. The dosing is personalized based on your age, hormone levels, and how you’ve responded to stimulation in the past if you’ve done a previous cycle.
Once the eggs are mature, they’re retrieved through a minor surgical procedure. In the lab, they’re combined with sperm to allow fertilization. If fertilization is successful, the resulting embryos develop for five or six days before being frozen. You’ll then undergo an embryo transfer, where one embryo is placed into the uterus. Transfers can happen shortly after retrieval (a fresh transfer) or in a later cycle using a frozen embryo.
ICSI: When Standard Fertilization Isn’t Enough
In conventional IVF, eggs and sperm are placed together in a dish and fertilization happens on its own. Intracytoplasmic sperm injection, or ICSI, takes a more direct approach: a single sperm is injected directly into an egg using a microscopic needle. It was developed in 1992 specifically for couples dealing with male factor infertility, but its use has expanded well beyond that.
ICSI is now commonly used when there’s unexplained infertility, a low number of eggs retrieved, advanced maternal age, a previous cycle where eggs failed to fertilize, or when embryos need genetic testing. A large meta-analysis found that ICSI produced roughly 30% higher fertilization rates per egg compared to conventional methods in couples with unexplained infertility. Perhaps more importantly, complete fertilization failure, where none of the eggs fertilize, was over eight times more likely with conventional insemination than with ICSI.
Other ART Procedures
Two older techniques still technically fall under the ART umbrella but are rarely performed today. Gamete intrafallopian transfer (GIFT) involves collecting eggs, placing them in a catheter alongside sperm, and injecting both directly into the fallopian tubes using a surgical procedure called laparoscopy, which requires general anesthesia. Fertilization then happens inside the body rather than in a lab.
Zygote intrafallopian transfer (ZIFT) is a hybrid: eggs are fertilized in the lab like IVF, but the resulting zygotes are surgically placed into the fallopian tubes instead of the uterus. Both procedures carry higher costs and surgical risks than standard IVF, and they provide less information about how embryos are developing. For these reasons, they’ve been almost entirely replaced by IVF.
Genetic Testing of Embryos
One of the major advances tied to ART is the ability to screen embryos for genetic conditions before transfer. There are three main types of preimplantation genetic testing, each designed for a different purpose.
- Testing for chromosome count (PGT-A) checks whether embryos have the correct number of chromosomes. Extra or missing chromosomes are a leading cause of miscarriage and implantation failure. This type of testing is typically recommended for people over 35, those with recurrent miscarriages, or couples who have had multiple failed transfers.
- Testing for inherited diseases (PGT-M) screens for specific genetic conditions that run in a family, such as cystic fibrosis, Huntington’s disease, or Duchenne muscular dystrophy. It can be used for any single-gene disorder where the responsible gene is known and the family’s pattern of inheritance is clear. The goal is to select embryos that are unaffected or, in the case of recessive conditions, are healthy carriers.
- Testing for structural changes (PGT-SR) looks for chromosomal rearrangements like deletions, duplications, and translocations. This is relevant for people who carry balanced chromosome rearrangements, which often cause no symptoms in the carrier but can lead to miscarriage or developmental issues in offspring.
Single Embryo Transfer and Multiple Births
In the early decades of IVF, doctors routinely transferred two or more embryos at once to improve the odds of pregnancy. The tradeoff was a high rate of twins and triplets, which carry serious health risks. Twins are significantly more likely to be born premature, and twin pregnancies increase the chance of complications for the mother as well. Beyond the medical risks, multiple births create financial and emotional strain that can increase rates of depression and anxiety in parents.
Elective single embryo transfer has become the standard approach to reduce these risks. A large study comparing women who had two separate singleton pregnancies after IVF with women who had one twin pregnancy found dramatically better outcomes for both mothers and babies in the singleton group. Improvements in embryo freezing mean that transferring one embryo at a time no longer comes at a meaningful cost to your overall chance of having a baby. It simply means the process may take an additional transfer cycle.
Third-Party Reproduction
ART also encompasses arrangements where someone other than the intended parents contributes eggs, sperm, or embryos, or where a gestational carrier (surrogate) carries the pregnancy. Egg donation is common when a person’s own eggs are unlikely to result in a viable pregnancy, whether due to age, premature ovarian insufficiency, or genetic concerns. Donor eggs are fertilized via IVF, and the resulting embryos are transferred to either the intended parent or a gestational carrier.
The legal landscape for surrogacy and donor-conceived children varies significantly by state. Some states grant pre-birth parentage orders to intended parents regardless of marital status, sexual orientation, or genetic connection to the child. Others impose strict limitations. Louisiana, for example, only permits gestational surrogacy for married heterosexual couples where both partners are genetically related to the child. In most states with modern parentage laws, gamete donors are not considered legal parents and have no rights or responsibilities related to the child. If you’re pursuing third-party reproduction, the legal requirements in your specific state will shape what’s possible and what protections you have.
Risks of Ovarian Stimulation
The most significant medical risk specific to ART is ovarian hyperstimulation syndrome (OHSS), which occurs when the ovaries overrespond to stimulation medications. In its mild form, OHSS causes abdominal bloating and discomfort. Moderate cases involve those same symptoms plus nausea, vomiting, and fluid accumulation in the abdomen visible on ultrasound.
Severe OHSS is rare but serious. It can cause fluid buildup around the lungs, breathing difficulty, blood clotting problems, and reduced kidney function. Modern protocols have made severe OHSS less common than it once was, partly because freezing all embryos and delaying transfer (rather than doing a fresh transfer) allows hormone levels to come down before a pregnancy adds further stimulation to the ovaries. Your clinic will monitor your response closely during stimulation and adjust medication doses if your ovaries are responding too aggressively.
What ART Costs
A single IVF cycle in the United States ranges from $15,000 to $30,000, with fertility medications driving a large portion of that total. These medications, the injectable hormones used during ovarian stimulation, can cost several thousand dollars on their own. Add-ons like ICSI, genetic testing, and embryo freezing increase the price further. Many people need more than one cycle, so total out-of-pocket costs can climb quickly.
Insurance coverage for ART varies widely. Some states mandate that insurers cover fertility treatments, while others offer no such requirement. Even in states with mandates, the specifics of what’s covered, how many cycles, and whether donor or surrogacy arrangements qualify, differ between plans. It’s worth checking your policy’s exact language and contacting your insurer directly before starting treatment.