update on ART

1. ASSSISTED
REPRODUCTIVE
TECHNIQUES
JOHN PETER

2. 1. INTRODUCTION
2. INFERTILITY
3. TECNIQUES
1. ARTIFICIAL INSEMENATION
2. IN VITRO FRETILIZATION
3. INTRACYTOPLASMIC SPERM INJECTION
4. ASSISTED HATCHING
5. ZIFT, GIFT
6. SURROGACY

3. INTRODUCTION

4. • ART : treatments or procedures that include the handling of
human eggs and sperms or embryos outside the body for the
purpose of establishing a pregnancy
• INFERTILITY : inability to conceive after 1 year of properly
timed unprotected intercourse.

5. • 1978 – first successful birth using IVF
• 1984 - first successful birth using GIFT
• 1986 - first successful birth using ZIFT

6. Dr. PATRICK STEPTOE Dr. ROBERT
EDWARDS

7. • The world’s second and India’s first IVF baby Kanupriya, alias
Durga, was born 67 days later on October 3, 1978, through the
efforts of Dr. Subhas Mukhopadhyay and his two colleagues in
Kolkata.

8. INDIA’S FIRST TEST-TUBE BABY
– DURGA (D0B – 3/10/1978)

9. INDICATIONS OF ART
• Tubal factor infertility
• Endometriosis
• Male factor infertility
• Unexplained infertility
• Ovarian failure and diminished ovarian reserve
• Pelvic malignancy
• Mullerian anomaly
• Genetic risk

10. • In order to conceive
under normal conditions
Healthy sperms Sperm retrieval procedures
(MESA, PESA,TESA.TESE)
Sperm ascent Artificial insemination
(IUI,ICI,IFI)
Healthy ovum Ovulation induction and oocyte
retrieval
Healthy gametes GIFT
Fertilization ICSI, IVF-ET
Healthy zygote ZIFT
Cell division
Implantation Assisted Hatching
Corresponding ART
techniques

11. ovulatory
dysfunction
20%
tubal disease
30%
male infertility
30%
endometriosis
7%
unexplained
6%
others
7%
INFERTILITY

12. ART TECHNIQUES

13. SPERM RETRIEVAL
TECHNIQUES

14. MESA – MICROSCOPIC EPIDIDYMAL
SPERM ASPIRATION
a) Open tubule method

16. PESA – PERCUTANEOUS
EPIDIDYMAL SPERM ASPIRATION

17. TESE – TESTICULAR SPERM
EXTRACTION
INDICATIONS :
1. Failure to find sperm in the epididymis
2. Nonobstructive azoospermia
types
1. Open microsurgical TESE is the best technique in men with
non obstructive azoospermia.
2. Percutaneous core biopsy
3. Percutaneous sperm aspiration(TESA)

18. MICROSURGICAL TESE

19. PERCUTANEOUS CORE BIOPSY

20. TESA

22. ARTIFICIAL INSEMINATION
• Sperm is collected, processed and placed into a woman’s vagina, cervical
canal or in the uterus.
• Sperm can come from partner or an anonymous donor.
Insemination is when sperm is collected and processed.
Artificial Insemination is when the sperm used comes from partner.

23. ARTIFICIAL INSEMINATION
• IUI – Intrauterine
insemination
• IFI – intra fallopian tube
insemination
• ICI – intracervical
insemination
• IVI – intravaginal
insemination

24. INTRAUTERINE INSEMINATION
The seminal fluid is prepared in
the laboratory (washed with
special media)
Injected inside the uterus after
stimulating the ovaries to
produce more eggs per cycle.

25. GIFT

26. GAMETE INTRAFALLOPIAN
TRANSFER
• In gamete intrafallopian transfer
(GIFT), eggs are removed from the
woman, and placed in one of the
fallopian tubes, along with the
man's sperm. This allows
fertilization to take place inside the
woman's body.
• Therefore, this variation is actually
an in vivo fertilization, and not an
in vitro fertilization.
A mixture of a woman’s eggs and
sperm are placed into the
fallopian tube

28. IVF

29. IN VITRO FERTILIZATION
• Process refers to the fertilization outside the body.
• Most effective and successful ART, IVF is most often
recommended when fallopian tubes of woman are blocked or in
case when men produce too few sperm. In this process, doctor
prescribed drug that causes the ovaries to produce multiple eggs.
• When eggs are mature enough, they are removed trough a
surgical procedure and are put in a dish in the lab along with the
sperm for fertilization. After 3 to 5 days, healthy embryos are
then implanted in the woman’s uterus.

31. FERTILIZATION
• Semen is collected by
mastrubation
• Sperm preparation
• Incubation in high protien
media for 0.5-4hr
• Each oocyte incubated with
50-100 thousand motile sperm
in 5% CO2 in air,
98%humidity,37°C for 12-18hr

33. INTRACYTOPLASMIC SPERM
INJECTION
• Intracytoplasmic sperm injection (ICSI) is an in vitro
fertilization procedure in which a single sperm is injected
directly into an egg.
• • This procedure is used to overcome male infertility
problems, although it may also be used where eggs cannot
easily be penetrated by sperm, and occasionally as a method of
in vitro fertilization, especially that associated with sperm
donation.

36. PROCEDURE
• Single sperm is immobilized
• Drawn in to pipette
• Oocyte is stabilized
• Polarbody is 6/12 o’ clock position
• Oocyte is entered 3 o’clock
• Pipette pierce zona and oolemma
• 50-70% fertilization

37. INDICATION OF ICSI
• Male factor
• Oligospermia <5%
• Asthenospermia <5%
• Teratospermia <4%
• Poor IVF/failed IVF
• PGD

38. PGS
• Assisted reproductive technology, allows in vitro fertilized
(IVF ET) embryos for preimplantation genetic screening (PGS)
evaluation.
• The is not used to look for a specific disease but a technique to
identify embryos at risk.

39. PREIMPLANTATION GENETIC
DIAGNOSIS
(PGD)

40. EMBRYO TRANSFER
• Can transfer zygote to blastocyst
• Day 3 cleavage embryo
• 6-8cells equal size

41. ASSISTED HATCHING

42. ASSISTED HATCHING
In vivo zona dissolves on zona- endometrial interface
In vitro embryo make opening in zona and escapes ,leaving
behind an empty zona
Methods
Zona drilling with acidic tyrode’s solution
partial zona dissection with micro glass needle
Laser photo ablation
Enzymatic Hatching
Use of Piezo –micromanipulator
poor prognostic factor

43. Indication
failed IVF
Disadvantage
Hatching may cause embryo damage
The risk of monozygotic twinning increases

44. OFFSPRING FROM IVF
• • Prematurity
• • LBW
• • Delayed neurological devolopment
• • Congenital bith diffects- two time higher
• NTD
• Alimentary atresia
• Omphalocele
• Hypospadias

45. ICSI
Genetic/epigenitic abnormalities
Sex chromosomal abnomalities
1. angelman syndrome
MR
Delayed motor development
poor balance
abnormal movement
absent speech
2.Beckwithweidman syndrome
Macrosomia
Macroglossia
Midline abdominal wall defect
predisposition to embryonal Ca

46. ZIFT

47. ZYGOTE INTRAFALLOPIAN
TRANSFER
• Zygote intrafallopian transfer (ZIFT) is an infertility
treatment where a blockage in the fallopian tubes are the
cause.
• 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.
• Embryo transfer is done by laparoscopy 4 cm inside the
fimbria

48. • Indications :
difficult IVF
Ectopic pregnancy

50. SURROGACY

51. GESTATIONAL SURROGACY
• Two types:
– Egg donor surrogacy
– Gestational surrogacy
• Indication
• Absence of uterus
• Irreparable uterus
• Congenital
• Ascherman Syndrome
• life threatening medical disorder
• Surrogate mother
• related/nonrelated
• parous
• healthy

53. THANK YOU…..