Assisted Reproductive Technologies: Infertility

INFERTILITY
ASSISTED REPRODUCTIVE
TECHNOLOGIES
REG NO : 11201023 A.ANEES FATHIMA ROLL NO : 44

CONTENTS :
Infertility
Assisted Reproductive techniques
Different Techniques of A.R.T
Health Hazards of A.R.T
Conclusion
INFERTILITY :
According to WHO
Clinically - infertility is defined as inability to conceive after more

than one year of intercourse without contraception.
- It may be seen in both male and female

ASSISTED REPRODUCTIVE TECHNOLOGY
DEFINITION :
Assisted Reproductive technology is defined as the

technology used to achieve pregnancy in procedures
such as artificial insemination, in vitro fertilization and
surrogacy
It comprises of procedures that involve manipulation

of gametes and embryos outside the body for the
treatment of infertility
METHODS OF ASSISTED REPRODUCTIVE
TECHNOLOGIES
A.R.T
GIFT ZIFT
IVF-ET ICSI
[ gamete [ zygote
[ in vitro fertilization [ intracytoplasmic SURROGACY
intrafallopian intrafallopian
and embryo sperm injection]
transfer] transfer]
transfer ]
IN VITRO FERTILIZATION
Definition:
IVF (in vitro fertilization) is a method in which egg
cells are fertilized by sperm cells outside the mother's
womb (in vitro). The resulting embryos are then
transferred back into the uterus.
INDICATIONS OF IVF
• Fallopian tubes block or absent
• Unexplained infertility
• Endometriosis
• Oligospermia / azoospermia
• Advanced reproductive age
• Women with normal ovaries but no functional uterus [ mullerian agenesis ]
• Women with genetic risk
• Ovarian failure
• Failed ovulation induction
• Multiple factors [ male and female ]
IDEAL PATIENT SELECTION
Age : <35 years
Presence of ovarian reserve [ D3, serum FSH<10

IU/L ]
HUSBAND — normal seminogram
Couple must be screened negative for HIV and

Hepatits
Normal uterine cavity as evaluated by

hysteroscopy
STEPS IN IVF :
1. Follicle suppression [ using GnRH agonist ]

2. Controlled ovarian hyper stimulation
3. Monitoring of follicular growth
4. Aspiration of eggs from follicles [ oocyte retrieval ]
5. Fertilization, incubation and selection of embryos [ IVF, ICSI ]
6. Embryo transfer
7. Luteal support with progesterone
8. Pregnancy test
OVARY STIMULATION
Different hormones are given to female in order
stimulate formation of more than one ovum.
Formation of more than one ovum for multiple

zygote or embryos to increase the probability for
getting a healthy embryo.
Drugs or hormone like Clomiphene (clomid), hMG

(pergonal), FSH-(metrodin) ,GnRH agonists
(lupron)-FSH/LH rst promoted, then inhibited
hCG-acts like LH
fi
OOCYTE RETRIEVAL
It is a technique used to remove oocyte from the ovary of
the female enabling fertilization outside the body
PROCEDURE:
• Under ultrasound guidance, the operator inserts a needle
through the vaginal wall and into an ovarian follicle, taking
care not to injure organs located between the vaginal
wall and the ovary.
• The other end of the needle is attached to a suction
device.
• Then the follicular uid and cellular material is suctioned
with the needle.
• The procedure usually lasts 10-20 minutes
fl
SPERM RETRIEVAL
Approximately three hour before the procedure, a semen sample from the
male donor is obtained .
The sperm is then washed and prepared for loading into the same catheter
into which several of the female's best eggs will be placed .
The eggs are obtained by transvaginal needle aspiration (no surgical incision)
via an ultrasound
FERTILIZATION
• After retrieval of sperm, eggs and sperm are brought together in a
laboratory glass dish to allow the sperm to fertilize an egg.
• If sperm parameters are normal, approximately 50,000 to 100,000 motile
sperm are transferred to the dish containing the eggs.This is called
standard insemination.
• Once fertilization takes place one or more healthy embryos are
transferred to the uterus
• The ICSI technique is utilised to fertilize mature eggs if sperm parameters
are abnormal. This procedure is performed under : high-powered
microscope
GIFT [ GAMETE INTRAFALLOPIAN TRANSFER ]
• It is a tool of assisted reproductive technology

against infertility.
• Eggs are removed from a woman's ovaries, and
placed in one of fallopian tubes, along with the man's
sperm.
• The rst attempt was made by Steptoe and
Edwards.
• It takes on average four to six weeks to complete
the cycle of GIFT
fi
ADVANTAGES
• There is no much human intervention in the actual fertilization of the

eggs.
• Because fertilisation takes place within the fallopian tube, GIFT offers an
option for people whose religious beliefs prohibit conception outside the
body.
DISADVANTAGES
• Can be performed only if woman have at least one normal fallopian tube.
• GIFT does not allow for visual con rmation of fertilization.
• GIFT involves a laparoscopic surgery.
fi
ZIFT [ ZYGOTE INTRAFALLOPIAN
TRANSFER ]
• It is an infertility treatment used when a
blockage in the fallopian tubes prevents the
normal binding of sperm to the egg.
• Egg cells are removed from a woman's ovaries,
and in vitro fertilized. The resulting zygote is
placed into the fallopian tube by the use of
laparoscopy.
• It has the success rate of 64.8% in all the
cases.
ADVANTAGES
• Fertilization can be con rmed before they are implanted into the fallopian
tube.
• Allows a developing embryo to travel into the uterus on its own, which may
be important to those who wish their baby to develop as naturally as
possible
DISADVANTAGES
• Can be performed only if woman have at least one normal fallopian tube.
• It is more expensive than GIFT.
• ZIFT involves a laproscopic surgery
fi
ICSI [ INTRA CYTOPLASMIC SPERM INJECTION ]
• Sperm is injected directly into the eggs in a

laboratory.
• Used if infertility originates from the male
such as:
1. Low numbers of sperm
2. Low sperm motility
• Single spermatozoan is directly injected into
the cytoplasm of the oocyte through the
micropuncture of zona pellucida.
ADVANTAGES
Can be useful when very low numbers of motile sperm are

present and when there are problems with sperm binding and
penetration.
DISADVANTAGES
Altering the nature's selection process for sperm can lead to an

increase risk of developmental and health issues for ICSI
children, as well as a higher risk of miscarriage because of the
poorer genetic material involved.
TUBAL EMBRYO STAGE TRANSFER (TET)
• It combines IF with tubal transfer

• Embryos are placed into the women's fallopian tube.
• The embryos are transferred back into the woman 2 days after fertilisation. This is at
the '2 cell or 4 cell' stage.
• TET allows embryos to make their way to the uterus for implantation.
• Its advantage over ZIFT is that it allows for the assessment of fertilization and embryo
quality.
• Success rate higher than ZIFT.
Surrogacy is when another woman carries and gives birth to a baby for the couple who
want to have a child.
It is the carrying of a pregnancy for intended parents.
In this a woman agrees to became pregnant and deliver a child for a contracted party
TYPES
• Traditional surrogacy: It is the simplest and least expensive form of

surrogacy and is also known as arti cial insemination. The surrogate
mother uses an insemination kit to became pregnant using an intended father's
semen.
• Gestational surrogacy: It is physically more complicated and more
expensive. Here both the eggs and sperm are taken from intended father and
mother.
fi
ARTIFICIAL
INSEMINATION
It is the deliberate introduction of sperm into the female's uterus or
cervix for the purpose of achieving pregnancy through in vivo
fertilization by means other than sexual intercourse
INTRACERVICAL INSEMINATION
• It involves injection of unwashed or raw

semen into the cervix with the
needleless syringe.
• A vaginal speculum is used to hold open
the vagina so that cervix may be
observed and then syringe is inserted
the plunger is pushed forward and
semen is emptied deep in the vagina
INTRAUTERINE INSEMINATION
• The seminal vesicle is prepared in the

laboratory (washed with special
media).
Injected inside the uterus with
catheter after stimulating the ovaries
to produce more eggs per cycle.
• The catheter used here is known as
TOM CAT
INTRATUBAL INSEMINATION
• It involves injection of the washed sperm into the fallopian tube.

• It should not be confused with the GIFT. where both the eggs are mixed
outside the women's body and then immediately inserted into fallopian tube..
• Less used than IU
INDICATIONS ARE :
(a) Irreparable uterine factor;

(b) When pregnancy may cause signi cant health risks;
(c) Women with recurrent unexplained miscarriage;
(d) Prior hysterectomy.
fi
HEALTH HAZARDS OF A.R.T
• Birth defects: Most of the ART procedures are not associated with any increased
risk of fetal congenital malformations or birth defects.
• ICSI is associated with increased chromosomal abnormalities of the
offspring.
• Increased miscarriage, multiple pregnancy, ectopic and heterotrophic
pregnancy, placenta praevia and low birth weight babies, premature
pregnancy and premature menopause have been observed.
• Perinatal mortality and morbidity are high.
• Ovarian hyper stimulation syndrome though rare but is a known health risk.
• Increased risk of ovarian cancer by 3 times
• Psychological stress and anxiety of the couple are severe. It is especially so
when there is failure in the treatment or with a pregnancy loss.
ART HAS BEEN THE ANSWER FOR MANY CHILDLESS
COUPLES, RESULTING IN SUCCESSFUL
PREGNANCIES AND CHILDBIRTH
BUT THERE ARE STILL RISKS, STRESS AND HIGH
COST ASSOCIATED WITH ART

Assisted Reproductive Technologies: Infertility

Uploaded by

Copyright:

Available Formats

Assisted Reproductive Technologies: Infertility

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Assisted Reproductive Technologies: Infertility

Uploaded by

Copyright:

Available Formats

INFERTILITY

REG NO : 11201023 A.ANEES FATHIMA ROLL NO : 44

Assisted Reproductive techniques

Different Techniques of A.R.T

Health Hazards of A.R.T

Clinically - infertility is defined as inability to conceive after more

- It may be seen in both male and female

Assisted Reproductive technology is defined as the

It comprises of procedures that involve manipulation

Age : <35 years

Presence of ovarian reserve [ D3, serum FSH<10

HUSBAND — normal seminogram

Couple must be screened negative for HIV and

Normal uterine cavity as evaluated by

1. Follicle suppression [ using GnRH agonist ]

Formation of more than one ovum for multiple

Drugs or hormone like Clomiphene (clomid), hMG

• It is a tool of assisted reproductive technology

• There is no much human intervention in the actual fertilization of the

• Sperm is injected directly into the eggs in a

Can be useful when very low numbers of motile sperm are

Altering the nature's selection process for sperm can lead to an

• It combines IF with tubal transfer

• Traditional surrogacy: It is the simplest and least expensive form of

• It involves injection of unwashed or raw

• The seminal vesicle is prepared in the

• It involves injection of the washed sperm into the fallopian tube.

(a) Irreparable uterine factor;

You might also like