Lecture 63
Obstetrics and Gynecology
Assisted Reproductive Technology
Assisted reproductive technologies
Assisted reproductive technologies (ART) include
many techniques that allow gamete manipulation
outside the body, and have evolved greatly over
the past two decades.
- Multifactorial: 40%.
- Unexplained: 28%.
- Anovulation: 18%.
- Tubal disease: 14%.
- Endometriosis: 9%.
The Major Causes of Male Infertility
Infertility Increases with Age
Assisted Reproductive Technologies
(ART) Expand Childbearing Options
Definition
Directly retrieving eggs from ovary followed by manipulation
and replacement. Generally employed for inadequate
spermatogenesis. Aside from intrauterine insemination,
ARTs can utilize patient or donor egg and/or sperm.
• Hormones can induce ovaries to produce many
oocytes which can be collected, sorted, and
frozen for future use
• Sperm can be pooled, or retrieved through
microsurgery and frozen in sperm banks
Methods of Assisted Reproduction
Intrauterine Insemination
Washed sperm is injected into the uterus.
Must have a normal tube for fertilization to take place.
Injection of a
single sperm
into an egg.
ICSI
In which case is it mandatory to fertilize
the ovum with ICSI during IVF cycle?
A. When the ovum is from donor to decrease
infection rate
B. Ovum from a female of age more than 40y
C. Sperm source from TESA
D. Ovum underwent zona hatching
E. Sperm tested by Comet prior to fertilization
In which case is it mandatory to fertilize
the ovum with ICSI during IVF cycle?
A. When the ovum is from a donor to decrease
infection rate
B. Ovum from a female of age more than 40y
C. Sperm source from TESA (testicular sperm
aspiration)
D. Ovum underwent zona hatching
E. Sperm tested by Comet prior to fertilization
(checks for DNA damage)
High quality 3 day old embryo
Embryo Transfer
Frozen Embryos
Embryos may be taken
from an individual and
stored for later use.
Once ready to use, they
can be thawed and then
placed into the uterus.
This allows a higher chance
of pregnancy.
Some Ways Gametes Can Be Combined
1. Father is infertile. Mother is
inseminated by donor and
carries child.
+ =
+ =
4. Both parents are infertile, but mother is able to carry child. Egg
and sperm from donors are combined in laboratory (also see
number 4, column at left).
+ =
KEY + =
Sperm from father 6. Both parents are fertile, but mother is unable to carry child.
Egg from mother and sperm from father are combined. Embryo is
Egg from mother
transferred to donor.
Baby born of mother
+ =
Sperm from donor 7. Father is infertile. Mother is fertile but unable to carry child.
Egg from donor Egg from mother is combined with sperm from donor. Embryo is
transferred to surrogate mother.
Baby born of donor
(Surrogate) + =
IVF has Resulted in the Birth
of Millions of Children
Gamete Intrafallopian Transfer (GIFT)
Cost