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Assisted reproductive technologies (ART) (In vitro fertilisation (IVF)…
Assisted reproductive
technologies (ART)
Definition
ART are fertility treatments where
sperm and oocyte are handled with
the aim of achieving pregnancy
In vitro
fertilisation
(IVF)
Factors
affecting
outcome
Previous conception
Previous pregnancy (inc success)
Previous failed IVF (dec success)
Gynae factors
Hydrosalpinx
Intramural fibroid
Age
Best 25-35y (declines after)
Inc FSH (dec success)
Lifestyle
Smoking
High BMI
Timing
Inc duration of subfertility (dec success)
Indications
Male factors
Male cause of infertlity
Female factors
Tubal disease
Endometriosis
Anovulation
Reduced fecundity due to maternal age
Unexplained fertility >2y
Method
Ovary retrieval
Ova collected by transvaginal aspiration under transvaginal USS guidance
Fertilisation
Ova fertilised by partner sperm in vitro and cultured overnight
Fertilisation check the next day
Ovarian
stimulation
Ovarian stimulation
Recombinant FSH or gonadotrophins
Stimulates oocyte maturation
Response monitored by transvaginal USS
Ovarian downregulation
D21 (luteal phase) of previous cycle
GnRH analogues (long protocol)
GnRH antagonists (short protocol) given with gonadotrophins
Follicle maturation
HCG given 1d before, eggs to be collected 36h later
So follicle will have gone through meiosis II but not released
Embryo transfer
After 3-5d (cleavage or blastocyt stage)
1-2 embryos implanted under USS guidance
Other embryos can be cryopreserved
Next steps
Luteal support (progestrogens)
Pregnancy test at 2wk
Consent
HFEA consent and Child Welfare considered
Intracytoplasmic
sperm injection (ICSI)
Indication
Male factors
Abnormal semen parameters
Failed IVF
Method
Single sperm injected into ooplasm
Sperm retrieved from ejaculate
or surgically from epididymis/testes
If severe oligozoospermia, karyotype and
CF screen prior to procedure
Complications
Concerns of genetic mutation transmission,
as oxidatively induced DNA damage can fertilise oocytes
Higher incidence of Y Chr deletions in
subfertile men, which can be transmitted
to children by ICSI and cause infertility
Intrauterine
insemination (IUI)
Indications
Male factor infertility
Unexplained infertility
Coital difficulty
Same sex couples
Method
Sperm collected and placed inside uterus
Need reasonable sperm motility
May need simultaneous ovarian stimulation if
woman has subfertility
Egg donation
Indications
Female factors
Ovarian failure
Older women (>45y)
Repeat IVF failure
Method
Eggs from fertile woman donated
to subfertile woman
Insemination with partner sperm
HFEA criteria for
gamete donation
Anonymity
Once children 18y they can contact
HFEA for information on the donor
Pre-requisites
No severe medical, psych, genetic disorder
Counselling beforehand
Full infection screen
Known or anonymous to recipient
Ideally <35y
Used in up to 10 families
Sperm donation
Indications
Male factors
Azoospermia and failed surgical recovery
High risk of transmitting genetic disorders (HD)
High risk of trasmitting infection (HIV)
Female factors
No male partner
Same sex couple
Method
Usually interuterine
+/- ovarian stimulation
36h after HCG
Surrogacy
Natural
Method
Insemination with sperm from the male partner
IVF
Indication
Congenital absence of uterus
Post hysterectomy
Medical conditions incompatible with pregnancy
Method
Couple wanting child provide oocyte and sperm
IVF then transfer into the surrogate
Preimplantation
genetic diagnosis
Indication
Couples known to carry a
heritable genetic condition
Method
Embryo biopsy and diagnosis,
transfer of unaffected embryos