Assisted reproductive technology

1. ASSISTED
REPRODUCTIVE
TECHNOLOGY (ART)

2. The ART encompasses
all the procedures that
involve manipulation
of gametes and
embryos outside the
body for the treatment
of infertility

3. • IVF – ET (In vitro fertilization and embryo transfer)
• GIFT ( Gamate intra fallopian transfer)
• ZIFT (Zygote intra fallopian transfer)
• POST (Peritoneal oocyte and sperm transfer)
• TET ( Tubal embryo transfer zone)
• SUZI ( Subzonal insemination)
• AH (Assisted hatching)
• IVM (In vitro maturation of oocyte)

4. IN VITRO FERTILIZATION AND
EMBRYO TRANSFER (IVF-ET)

6. INDICATIONS OF IVF
• Tubal disease
• Unexplained infertility
• endometriosis
• Male factor infertility
• Multiple factors (female
and male)
• Failed ovulation induction
• ovarian failure
• Non functional uterus
• Women with genetic risk

7. PATIENT SELECTION (IDEAL)
• Age < 35 years
• Presence of ovarian reserve (D-3, serum FSH <10 IU/L).
• Husband—normal seminogram.
• Couple must be screened negative for HIV and hepatitis.
• Normal uterine cavity as evaluated by
hysteroscopy/sonohysterography.

8. PRINCIPAL STEPS OF AN ART CYCLE
• Down regulation using GnRH agonist.
• Controlled ovarian hyperstimulation (COH).
• Monitoring of follicular growth.
• Oocyte retrieval.
• Fertilization in vitro
• Transfer of gametes or embryos.
• Luteal support with progesterone.

9. • Suppression drugs prevent spontaneous ovulation
• GnRH Agonists. It suppresses LH surge preventing eggs
from being released before they are mature for egg retrieval

10. • Ovarian stimulation is used to produce multiple
mature follicles, rather than the single egg normally
developed each month.
• Produces many good follicles to be Fertilized.
• Multiple eggs are stimulated because some eggs
will not fertilize or develop normally after
fertilization.
• Regular monitoring by ultrasound scan is done.

11. • The oocyte maturation is performed, generally by an
injection of human chorionic gonadotropin (hCG).
Commonly, known as the "trigger shot.“
• The egg retrieval is performed at a time usually between 34
and 36 hours after hCG injection.
• Egg retrieval is usually accomplished by transvaginal
ultrasound aspiration.

12. • Fertilization is started by adding 10,000-50,000 motile
sperms to about 100 µl to 1 ml culture medium in which the
oocytes is being incubated.
• Fertilisation check is performed the next day approximately
18 hours after sperm injection or insemination of the eggs.
• Usually 65% to 75% of mature eggs will fertilize after
insemination
• They are cultured in special incubators to support division
and development.

13. • Embryo transfer may be performed on day 2, 3 or 5 post
fertilization.
• One or more embryos suspended in a drop of culture
medium are drawn into a transfer catheter, a long, thin
sterile tube with a syringe on one end.

14. GAMETE
INTRAFALLOPIAN
TRANSFER (GIFT)

15. • It is a more invasive and expensive procedure
• In this procedure, both the sperm and the
unfertilized oocytes are transferred into the
fallopian tubes.
• Fertilization is then achieved in vivo.

16. PREREQUISITE FOR GIFT PROCEDURE
• Normal uterine tubes

17. TECHNIQUE
• Superovulation is done
• Two collected oocytes along with approximately 200,000–
500,000 motile sperm for each fallopian tube are placed in a
plastic tube container.
• It is then passed through laparoscope and inserted 4 cm
into the distal end of the fallopian tube where the
combination is injected.