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Assisted

Reproductive
Technology

Prof.Zouhair Amarin

AbedAllah Abulataifeh
Husam Salhab
Mohammad Altaher
Omar AbuAlhaija
Objectives:
• Introduction
• Infertility
• Methods
1- Artificial Insemination
2- In Vitro Fertilization
3- IntraCytoplasmic Sperm Injection
4- Assisted Hatching
5 ZIFT, GIFT
6 Freezing
7- Sex Selection
• Succeeding Factors
• Complications
• Statistics
Introduction
Definition Treatments or procedures that include the
handling of human eggs and sperm or embryos for
the purpose of establishing a pregnancy

Infertility is inability to conceive after 1 year of


properly timed unprotected intercourse.

fecundity rate :likelihood of achieving pregnancy in a


given month in a couple with normal fertility is
approximately 20% per month.

cumulative pregnancy rate after 12 months is 93%


In order to get pregnant under normal
conditions:
Healthy sperms  Sperm retrieval procedur es
Sperm ascent  Artificial insemination
An ovum  ovulation induction and oocyte
retrieval.
Fertilization  ICSI
Cell division.
Implantation  Assisted hatching
Causes of Infertility
1.Artificial Insemination

Intravaginal insemination.
Intracervical insemination.
Intrauterine insemination.
Intratubal insemination.
Intra Uterine Insemination (IUI)
1.The seminal fluid is prepared in the laboratory (washed
with special media)
2.Injected inside the uterus after stimulating the ovaries
to produce more eggs per cycle.
Indications :
- slight deficiency in the number or motility of sperms

- in cases of negative post coital test.


2.In Vitro Fertilization (IVF)
The first successful IVF
case was in 1978 when a
British woman delivered a
baby called Louise Brown in
28 of July 1978 in Oldam in
England by cesarean
section.
It had taken nearly a
century of research to
achieve that.
IVF Indications:
-Women with blocked fallopian tubes
-Ovulation problems
-Seminal problems for the man: sperm
transport, motility……
-Unexplained infertility cases.
-Presence of seminal antibodies in the
woman’s body
IVF
What are the steps done in IVF?
1 Ovarian stimulation
2 Vaginal ultrasound:
- monitor the number and size of the follicles .
- adjust the dose of the injections accordingly.
3 HCG Hormone injection is given for final maturation
of the eggs.
4 Oocytes (eggs) retrieval is done 34-37 hours after
taking the HCG injection.
5 The fluid collected from the follicles in special tubes is
examined by the embryologist and the eggs are
isolated.
6 The semen sample is taken in the same day and the
eggs fertilized either using the conventional IVF or
ICSI
IVF
IVF:
Oocyte Retrieval
By using the vaginal ultrasound, Transabdominal
ultrasound or laparascpe.
Under general or local anaesthetic.
Conventional IVF
1 Eggs mixed with thousands of sperms in a special dish
2Special incubators simulating natural conditions.
3- The fertilization is observed in the laboratory
4 After fertilization is assured and cell division observed
the embryos (USUALLY 3) are returned to the woman’s
uterus through the cervix using a special catheter
(done from 2-5 days)
5 Luteal phase support.
IVF Genetic Screening
Methods For Improving IVF

-Transfer embryos at blastocyst stage


-Culture fertilized ova and early embryos with
cells that normally surround the oocyte, so
they can provide growth factors.
-Screen early embryos for chromosome
abnormalities and implant only those with
normal karyotypes.
3.Intracytoplasmic Sperm Injection (
ICSI ):
The ovum (egg) is injected with a single sperm, taken
from the husband’s sperm (after preparation in the
lab).
A special needle is used to go through the wall of the
egg and the sperm is introduced into the
cytoplasm of the egg.
The fertilization is observed later and after the
division occur, the Embryos are transferred into
the woman’s uterus.
ICSI Indications:
-Severe problems in the seminal fluid as in
severe deficiency in number or motility of
the sperms or both.
-In cases when there are no sperms in the
seminal fluid but there are in testicles
(absent duct). In these cases the sperms
are taken from either the epididymis or
the testes (PESA , TESA).
ICSI (PESA )
-Percutaneous Epididymal Sperm Aspiration
Indications:
-Absence of the vas deferens
-Past Infections which result in obstruction
-Cases who had vasectomy and surgical
reversal failed
ICSI (TESA, TESE)
Testicular Sperm Aspiration :
Done by aspiration using a needle or surgical
extraction (Taking a very small piece from the
testes ).
Indications:
-Absence of sperms in the epididymis
-Absent or obstructed epididymis
4.Assisted Hatching :
Indications:
-Repeated implantation failure in special cases
when the wall of the Embryo is thick
Assisted Hatching
A small hole is made in the wall of the Embryo
using either a needle ,special chemical or laser
beam.
5.ZIFT,GIFT
GIFT involves laparoscopically placing mature eggs
into the healthy fallopian tube along with
washed sperm
In the case of ZlFT, the zygotes are placed directly
into the fallopian tubes via laparoscopy or
transcervical fallopian tube catherization.
6. Freezing
1 Embryo freezing :
-When there are excess embryos they are frozen to be used
for future embryo transfer.
-The success of this procedure depends on the quality of the
Embryos .

2 Oocyte Freezing :
-This is less successful at the present time and still in
research (the eggs gets destroyed in the freezing
procedure).
Freezing Continue
3-Freezing seminal fluid and testicular tissue :
-Men who have problems giving a sample when needed at
eggs retrieval day .

-When the man has no sperms in his seminal fluid and the
sperms has to be obtained from the testis . The sperms
or testicular tissue can be frozen to be used at a later
date.

-Men who have testicular disease and might have surgical


removal of the testis.

-Men who have cancer and will need chemotherapy or radio


therapy or both .
7.Sex Selection and genetic screening:
-It is possible to select the sex of the baby by
taking a cell biopsy from the embryo and using
either PCR or FISH Techniques to determine
the sex embryos
-Detect certain chromosomal abnormalities and
transferring the healthy desired Embryos .
Pregnant …or not?

- Blood test: 12-14 days after the embryo transfer


- The ultrasound :18 days after Embryo transfer

Gestational age = Developmental age + 2 weeks

Day 0 14 28

-LMP -Ovulation &


Fertilization
-GA
-Embryo transfer
- DA
COMPLICATION:

-Miscarriage(15%)
-Multiple gestation pregnancies (25%)
-Ectopic and heterotropic(2-5%)
-Increase the risk of prematurity and C/S
-Statistics -Success rates
-The most important factor female patient's age.
-Varies from center to center.
-On average, with IVF, successful delivery is
achieved in 28% of cases.
Thank You

VS