Assisted Reproductive

Technology
DEFINITION
• Assisted reproductive technology (ART) refers to
fertility treatments and procedures that can help
with difficulties or an inability to conceive. ART
techniques involve the manipulation of eggs,
sperm, or embryos to increase the likelihood of a
successful pregnancy.
In Vitro Fertilization and Embryo
Transfer (IVF-ET)
• The field of reproductive medicine has changed for ever with the birth
of Louise Brown in 1978 by IVF-ET. Patrick Steptoe and Robert
Edwards of England are remembered for their revolutionary work.

• The past decade has witnessed two more dramatic changes in the
technique protocol of IVF-ET. One such change was from natural cycle
to superovulation protocol and the other one was replacement of
laparoscopy by vaginal sonography for ovum retrieval.
IVF with Embryo Transfer
Egg and sperm are retrieved from couple,
donor(s), or both

Combined in a petri dish, incubated for

2–5 days

If fertilization and cleavage occurs,

embryo is transferred through a catheter
to uterus
Clapp DN. 2002.
ART Treatments for Infertility

IVF with embryo transfer

Gamete intrafallopian transfer (GIFT)

Zygote intrafallopian transfer (ZIFT)

Cryopreservation

Intracytoplasmic sperm injection (ICSI)

American Society for Reproductive Medicine. 2003.

American Society for Reproductive Medicine. 2001.
Gamete Intrafallopian Transfer
(GIFT)

Oocytes retrieved via laparoscopy

Oocytes and sperm placed in same catheter

Injected directly into the fallopian tube via

laparoscopy

Embryo travels through the fallopian tube

to the uterus for implantation
Clapp DN. 2002.
Zygote Intrafallopian Transfer (ZIFT)
Combines techniques used in IVF and GIFT

Ova are placed in a petri dish with sperm

If fertilization occurs, the zygote:

• Is injected into fallopian tube
• Travels through tube to uterus
• Implants in uterus

Clapp DN. 2002.

Cryopreservation
Sperm or embryos are preserved by freezing
for replacement in subsequent cycles

Clapp DN. 2002.

Photo source: http://www.dcmsonline.org
Intracytoplasmic Sperm Injection
(ICSI)
• A single sperm is injected directly
into the cytoplasm of the oocyte
• Increases probability of
fertilization
• Intracytoplasmic sperm injection
(ICSI) is a technique used during
in vitro fertilization (IVF) where a
single sperm is injected
directly into the egg for the
purpose of fertilization.
Pronuclear stage tubal transfer
(PROST)
• PROST is similar to ZIFT but involves the
transfer of a fertilized egg to the fallopian tube
before cell division occurs.
 Tubal embryo transfer (TET)
• Tubal embryo transfer (TET) is similar to GIFT and ZIFT
treatment, as it’s also based on the transfer of
embryos. The difference with TET is that the embryos
are at a more advanced stage of development when
they’re transferred than with GIFT or ZIFT.
• With TET, the embryos are transferred back into the
fallopian tubes two days after fertilisation has taken
place in the laboratory. The embryos are at ‘2-cel’l or ‘4-
cell’ stage, whereas in ZIFT, the embryos are
transferred back the day after fertilisation, known as ‘1-
cell’ or ‘zygote’ stage.
Subzonal insemination (SUZI)

• Suzi a method of assisting conception in cases of

infertility caused by the inability of the
spermatozoa to penetrate the barriers
surrounding the ovum. Using in vitro fertilization
techniques, a small number of spermatozoa (no
more than six) are injected through the zona
pellucida into the perivitelline space (which
surrounds the egg membrane). If fertilization
subsequently occurs, the blastocyst is implanted
in the mother’s uterus.
Partial zona dissection (PZD),
• Partial zona dissection (PZD), a method using
mechanical force to open the human zona
pellucida, and zona drilling, which uses acidic
Tyrode’s (AT) medium, were compared in 1-day-
old oocytes prior to reinsemination.
PESA (Percutaneous Epididymal Sperm Aspiration)

• PESA treatment is a surgical procedure

which involves the use of needle and syringe
technique as for a needle biopsy, but the
needle is directly placed into the epididymis.
This often gives good results if there is a
blockage in the vas deferens but the testis is
producing sperms.
TESA (Testicular Sperm Aspiration)

• TESA Treatment is similar to a needle biopsy

but involves placing a needle attached to a
syringe through the skin of the scrotum, and
simply sucking out the fluid from the testicle.
TESE (Testicular sperm extraction)
• This involves opening up the scrotum and
taking a large volume of testicular tissue,
perhaps from several regions of the testicle.
Sperms are then retrieved with the help of a
microscope to collect individual sperms
sperm. This is done under anesthesia.
MESA (Microsurgical Epididymal
Sperm Aspiration)
• An open surgical sperm retrieval procedure
that uses an operating microscope to locate
the tubules of the epididymis precisely, so
that large numbers of sperm can be
extracted.