ARTIFICIAL REPRODUCTION

INTRODUCTION:-
 Medically assisted human reproductive technologies are a group of high tech
treatment methods used to combat infertility.
 One of the greatest advances in reproductive medicine
 Techniques include

 Intrauterine Insemination (IUI)

 In Vitro Fertilization and Embryo transfer (IVF – ET)

 Gametic Intra-Fallopian Transfer (GIFT)

 Zygotic Intra-Fallopian Transfer (ZIFT)

 Tubal embryo stage transfer (TET)

CAUSES OF INFERTILITY:-
— In males

 Oligospermia – reduced conc. of sperm in semen.

 Azoospermia – Total lack or very low conc. of motile sperm

In females

 Tubal infertility – non functional fallopian tube

 Non functional ovaries

 Non functional uterus

 Endometriosis - Endometrial-like cells in areas outside the uterus

 Idiopathic infertility – reason unknown.

INTRA-UTERINE INSEMINATION:-
 Women (with adequate ovulation & below 40yrs) without damage to fallopian tube
can be treated with IUI.
 Women superovulated by gonadotrophins – multiple egg dev.
 IUI is timed to coincide with ovulation
  Using a thin soft catheter, sperms are placed either in the cervix or in the utrine
cavity.

ADVANTAGES:-
 This procedure can be an effective solution for men with a low sperm count or poor
sperm motility, where the sperm can't make the long journey to the egg.
 Low cost compared to other ART .
DISADVANTAGES

 Timing in the process of insemination is important.

 Low success rate, results are only 10-20 %

 Fallopian tubes must be unobstructed

INVITRO FERTILIZATION:-
 IVF broadly deals with the removal of eggs from a women, fertilizing them in the
laboratory and then transferring the fertilized eggs into uterus a few days later.
 Infertility due to the following causes may be considered for IVF

 Failed ovulation induction

 Tubal diseases

 Endometriosis

 Idiopathic infertility

GENERAL PROTOCOLS:-
 Patient selection

 Manipulation of mensural cycle; superovulation

 Oocyte retrieval

 Preparation of semen sample

 IVF treatment

 Embryo transfer

 Cryopresevation

1) PATIENT SELECTION:-

Criteria

 Woman below 35yrs

 Presence of atleast one functional ovary
 Husband with normal motile sperm count
 The couple must be negative for HIV and hepatitis.
 2) INDUCTION OF SUPEROVULATION

 1 week before next menstural period – leuprolide injection – prevent premature

release of egg.

 Within 2 week of onset of menstural period – FSH injection – stimulates

maturation of multiple eggs.

Then a single injection of HCG (Human Chorionic Gonadotropin) is given – triggers final
stage of egg maturation. Ovulation will occur between 24–36 hours after the HCG injection.

3) OOCYTE RETRIVAL
 Eggs are retreived after 36 hrs of HCG injection.
 Most common - through vaginal route under ultrasound guidance.
 Needle enters the ovarian follicle and aspirate the fluid from them
 It is examined under microscope to identify eggs.

4) PREPARATION OF SEMEN SAMPLE

 Semen collected from the partner.
 Processed and incubated in protein supplemented media for 3-4 hrs – rslts in sperm
capacitation.

5) IVF TREATMENT:-
 Capacited sperms placed in culture with a single oocyte in a petridish.
 Signs of fertilization – presence of 2 pronuclei
—
6) EMBRYO TRNSFER
 4 – 8 cell stage embryos are transferred
 Transferred with the help of a catheter.
 Catheter is passed through the cervical canal and embryos are released to the top
part of the uterus.
 Not more than 3 embryos are transferred.

7) CRYOPRESERVATION:-
 Preservation in frozen state is regarded as cryopreservation.
 Semen, fertilized eggs and embryos can be cryopreserved.
 Human embryos have been successfully preserved in the presence of cryoprotectant
like 1, 2 propanediol or dimethyl sulphoxide or glycerol.
 It was stored at -196OC under liquid nitrogen.
 At appropriate time, the embryos are thawed and is transferred to uterus.
IN-VITRO-FERTILIZATION:-
ADVANTAGES:-

 Fertilization is confirmed before implantation can occur.

 Gives women with damaged oviducts, the opportunity to carry their own fetus.

DISADVANTAGES

 Implantation in the uterus does not always occur.

 Higher risk of twins or triplets, which also increases the risk of complications and
miscarriages.
 Side effects associated with the fertility medication
 Higher risk of ectopic pregnancy, especially in women that have had previous problems
with their oviducts

GAMETE INTRA FALLOPIAN TRANSFER (GIFT)

 It involves the transfer of both sperm and unfertilized oocyte into the fallopian tube.

 This allows the fertilization to naturally occur in vivo.

 Two oocyte along with 2 – 5 lakhs motile sperms are placed in a plastic tube container.

 Then oocyte sperm combination is injected 4cm into the distal end of fallopian tube.

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 atleast one normal fallopian tube.
 GIFT does not allow for visual confirmation of fertilisation.
 GIFT involves a laproscopic surgery.

ZYGOTE INTRA FALLOPIAN TRANSFER (ZIFT)

 ZIFT combines aspects of both IVF and GIFT.

 Fertilization takes place outside the uterus and placed into the fallopian tubes
 Protocols for ovarian stimulation are similar to those used for IVF and GIFT.
 Eggs are collected and fertilized by the partner’s sperm in the laboratory.
 The zygote is transferred to the fallopian tube within 24hrs, when it is at 1 cell stage.

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.

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.

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.
INTRA-CYTOPLASMIC SPERM INJECTION (ICSI):-
NEGATIVE ASPECTS 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.

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 previlage of
parethood.

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.
BIBLIOGRAPHY:-
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— Joseph. C. Daniel, Methods in mammalian embryology, Ist edition, W.H Freeman and
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— From: URL -

— http://www.ncl.ac.uk/press.office/press.release/item/increased-

Swain Dharitri. Obstetrics nursing procedure manual. Jaypee the health sciences
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Jacob Annamma, R Rekha. Clinical nursing procedures: The art of nursing practice. 2 nd edition.
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