Assisted Reproductive Techniques (Art)

INTRODUCTION:

All methods of ART, by definition, involve interventions to retrieve oocytes.
It is usually illustrated in contrast to sexual intercourse as the method of reproduction. Hence, it covers a wide range of different fertility treatments.

Different methods of ART:

Components of a typical ART cycle :

Controlled ovarian hyperstimulation using gonadotropins, follicular development monitoring with TVS and assessment of serum estradiol levels.
Prevention of premature LH surge and ovulation.
Oocyte maturation using hCG.
Oocyte retrieval.
Fertilization by IVF or ICSI.
In vitro embryo culture.
Luteal support or endometrial preparation using progesterone supplementation.
Transfer of fresh embryos with possible cryopreservation of excess embryos.
First trimester pregnancy monitoring.

IUI – Intra-Uterine Insemination

Simplest forms of ART.
Involves collection of the sperm, preparing the sperm in the lab and then inserting the prepared sperm into the uterus of the woman close to the time of ovulation.
Before this takes place tests of tubal patency will have to be performed.
Lower success rate
Indicated in Couples without fertility problems, such as single women and same-sex couples.

IVF – In Vitro Fertilisation

Best known form of ART.
Collection of sperm and eggs and placed together in a petri dish in the laboratory.
The embryologists then observe if fertilization takes place and following this if the embryo undergoes cell division.
Good quality embryos are inserted back into the uterus from day 2 to day 5.
Different ways of doing IVF:
Natural Cycle IVF:Mother was given no drugs during fertility treatment.
Conventional IVF:Ovaries are usually suppressed 10 days before the woman’s natural menstrual cycle and this is followed by high dosages of fertility drugs in order to stimulate the growth of multiple follicles and embryos and embryos.
Mild IVF:Performed in a woman’s natural cycle.Small dosages of Fertility drugs are given with the aim to produce high quality eggs.

IVM – In Vitro Maturation

Collect immature eggs from a woman’s ovaries during a natural (unstimulated) cycle.
Mature these eggs in the laboratory
Perform ICSI to achieve fertilization.

Vitrification – ‘The Fast-freezing Method’

Method we use to freeze eggs, sperm and embryos
Essentially, in this ART, the cells are frozen much more quickly than they were in the old methods, and thereby avoid the creation of damaging ice-crystals.

ICSI – Intra-Cytoplasmic Sperm Injection

ICSI is used to achieve normal fertilisation where there is a male factor problem.
It involves an embryologist selecting a single sperm, removing the tail and then injecting it into the egg.
However, it is an invasive procedure and used if it is absolutely necessary.
In traditional IVF, natural selection chooses the best sperm to fertilise the egg.
ICSI is reliant on human choice.

GIFT:

Woman’s eggs are retrieved from ovaries and inserted between two layers of sperm in fine tubing.
This tubing is then fed into one of the woman’s fallopian tubes, where the egg and sperm are left to fertilise naturally.

Zygote intrafallopian transfer (ZIFT)

Indicated 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 fertilised.
The resulting zygote is placed into the fallopian tube by the use of laparoscopy.

POST:Peritoneal oocyte and sperm transfer:

Sperm and eggs are directly placed into the peritoneal cavity near the fallopian tubes.
Immediately after transvaginal ultrasound guided egg collection has been performed.

TESA

Percutaneous method which requires No/Local anesthesia and retrieves sperms from the testis

MESA

Indicated in post testicular azoospermia.
Done when one need’s to know the nature of obstruction or if surgical correction of the obstruction is to be performed at the same time of sperm recovery.
Very large number of sperms are usually retrieved so that cryopreservation and avoidance of repeat surgery may be possible

PESA:

Percutaneous epididymal sperm aspiration can also be used in cases of Post testicular azoosperma but it is a blind procedure.
Bleeding from epididymal injury and postsurgical fibrosis can occur.

TESE

Exam Question

GIFT, ZIFT, IVF and ET are assisted reproduction technique
Aspiration of sperms from testes is done in TESA
In TESA sperms are aspirated from the testes
Ovulation stimulation ,Oocyte retrieval & Transfer of unfertilized egg into the fallopian tube are steps of GIFT

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