AssistedReproductiv

e 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

IntroductionDefinition 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 procedures

Sperm ascent Artificial insemination An ovum ovulation induction and

oocyte retrieval. Fertilization ICSICell 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

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

IVF:Oocyte RetrievalBy 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 2- Special 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

A small hole is made in the wall of the Embryo using either a needle ,special chemical or laser beam.

Assisted Hatching

5.ZIFT,GIFTGIFT 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.

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).

6. Freezing

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 .

Freezing Continue

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

Day 0 14 28

-Ovulation & Fertilization

-Embryo transfer

- DA

-LMP

-GA

Gestational age = Developmental age + 2 weeks

COMPLICATION:

-Miscarriage(15%)-Multiple gestation pregnancies (25%)-Ectopic and heterotropic(2-5%)-Increase the risk of prematurity and C/S

-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.

-Statistics

Thank You

VS