A.R.

ASSITED REPRODUCTIVE TECHNOLOGY

 CONTENTS

INFERTILITY
ASSISTED REPRODUCTIVE TECHNOLOGY(A.R.T)
DIFFERENT TECHNIQUE OF A.R.T
 ARTIFICIAL INSEMINATION (AI)
 IN VITRO FERTILIZATION (IVF)
 SARROGACY

NEGATIVE ASPECTS OF ART

RECENT TRENDS OF ART
CONCLUSION
 Infertility
According to WHO -
Clinically infertility defined as inability to conceive after
more than one year of intercourse without contraception.
– It may be seen in both male and female
 reason for infertility
Reasons for infertility in male:
– the different factor that causes infertility in male are-
– Sperm production/sperm count disorders - include azospermia
(no sperm cells are produced) and oligospermia (few
sperm cells are produced). Sometimes, sperm cells are
malformed or they die before they can reach the egg.
– Erectile or ejaculation deficiency- also cause infertility in male
– Ejaculatory disturbances due to ejaculatory failure or
impotence.
– Structural abnormalities- Either the shape or motility of the
sperm is affected preventing the sperm from either swimming to
or binding with the egg.
- Age - The age of male is also a major cause of infertility.
- Aged male have less sperm count and motility rate of sperm is
 Reason for infertility in female

– There are a number of female factors that that

causes infertility in female-
– Ability of the ovaries to produce ova e.g. ovulation
disorders that may prevent an egg from being
released such as Polycystic Ovarian Syndrome
(PCOS).
– Fallopian tube structure e.g. tubal blockage which
prevents ovum and sperm meeting.
– Advanced maternal age is a major cause of infertility
in women. The quality of a woman’s ovum decrease
with age and can limit her ability to conceive
– Quality of the uterine lining e.g. Endometriosis, in
which womb tissue invades and damages
neighbouring reproductive tissue
 ASSISTED REPRODUCTIVE
TECHNOLOGY :1

DEFINATION
Assisted Reproductive technology is defined
as the technology used to achieve pregnancy
in procedures such as artificial insemination,
in vitro fertilization and surrogacy
TECHNIQUES OF A.R.T
Main three technique of ART-
1) ARTIFICIAL INSEMINATION (A.I)
2) IN VITRO FERTILIZATION (I.V.F)
3) SURROGACY
 1) 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.
ARTIFICIAL INSEMINATION
IT MAY BE OF FOLLOWING TYPE

 Intracervical insemination

 Intrauterine insemination

 Intratubal insemination
 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 IUI
INVITRO FERTILIZATION
(IVF)
INVITRO FERTILIZATION

In Vitro Fertilization is the uniting of egg and

sperm in vitro(in the lab).Subsequently the
embryos are transferred into the uterus through the
cervix and pregnancy is allowed to begin.
 It is the technique of letting fertilization of male
and female gametes occur outside the female
body.
STEPS OF IN VITRO FERTILIZATION

 There are generally five major steps in the process of

IVF:
I. Ovary stimulation
II. Oocyte retrieval
III. Sperm retrieval-wash sperm
IV. Fertilization
V. Embryo transfer
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 first promoted, then inhibited
hCG-acts like LH
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 fluid and cellular material is suctioned with the
needle.
– The procedure usually lasts 10-20 minutes
 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 transfered to the uterus

– The ICSI technique is utilized to fertilize mature eggs if sperm

parameters are abnormal. This procedure is performed under a
high-powered microscope
GAMETE INTRA FALLOPIAN
TRANSFER (GIFT)
– 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 first attempt was made by Steptoe
and Edwards.
– It takes on average four to six weeks to
complete the cycle of GIFT
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 confirmation of fertilization.
– GIFT involves a laproscopic surgery.
ZYGOTE INTRAFALLOPIAN
TRANSFER (ZIFT)
– 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 confirmed 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 atleast one normal fallopian tube.
– It is more expensive than GIFT.
– ZIFT involves a laproscopic surgery
INTRA CYTOPLASMIC SPERM INJECTION
(ICSI)
– Sperm is injected directly into the eggs in a
laboratory.
– Used if infertility originates from the male
such as:
– Low numbers of sperm
– 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 IVF 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.
ART Procedures
SURROGACY
 SURROGACY
• 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
1. Traditional surrogacy: It is the simplest and least
expensive form of surrogacy and is also known as
artificial insemination. The surrogate mother uses
an insemination kit to became pregnant using an
intended father’s semen.

2. Gestational surrogacy: It is physically more

complicated and more expensive. Here both the
eggs and sperm are taken from intended father
and mother.
 NEGATIVE ASPECT OF ART
– Due to administration of hormones and drugs, ovarian hyperstimulation
syndrome (OHSS) can occur.

– Risks associated with pregnancy

– Multiple pregnancy
– Increased risk of premature labor etc..

– Can cause premature menopause.

– Increased risk of ovarian cancer, atleast by 3 times when compared to normal

women.
 RECENT TRENDS
– Innovative design of IVF equipment (PLoS ONE, june 2012)

– A novel system for processing embryos during IVF treatment has been
shown to significantly improve the chances of pregnancy by 27%.

– Pioneered by a Newcastle team of fertility experts within the

University and NHS, the innovative design of interlinked incubators
provides a totally enclosed and controlled environment within which
every step of the IVF process can be performed.
 CONCLUSION
– ART has been the answer for many childless couples, resulting in successful
pregnancies and childbirth.

– Today there is a range of infertile treatment that aims to ensure a healthy

sustainable pregnancy.

– But there are still risks, stress and high cost associated with ART.

– With the advent of new technologies, it is hoped that these shortcomings

would be overcome in the near future and every infertile couple would have
the privilege of parenthood.
THANK YOU