ART technuques iui ivf icsi picsi sperm collection

ART technuques iui ivf icsi picsi sperm collection

1. ART techniques

2. ART ART is any treatment or procedure that involves the in vitro handling of human oocytes and sperm or embryos for the purpose of establishing a pregnancy. It includes mainly: Intra Uterine Insemination (IUI) In-vitro fertilisation (IVF) Intracytoplasmic sperm injection (ICSI) – for male infertility Gamete Intra Fallopian tube transfer (GIFT) Zygote Intra Fallopian transfer (ZIFT)

3. Intra Uterine Insemination (IUI) The rationale is that increasing the density of both eggs and sperm near the site of fertilization will increase the likelihood of pregnancy

4. Indications for IUI Male subfertility Cervical factor Ejaculatory failure Idiopathic/Unexplained Infertility

5. INTRA UTERINE INSEMINATION (IUI) Simple and safe treatment Overcomes the natural barriers to the passage of the sperms from the vagina to the fallopian tubes A prepared semen sample with adequate numbers of motile normal sperms are directly placed in the uterine cavity Done at the predicted time of ovulation Insemination could be done with either the husband’s semen or from a donor

6. Controlled Ovarian Hyper Stimulation before IUI To increase the number of oocytes obtained (Increased chance of fertilization) Increased Steroid production (Increased chances of implantation) It may correct subtle ovulatory disorders, such as luteinized un-ruptured follicle syndrome, not detected with routine diagnostic studies

7. Ovarian Stimulation Protocols Clomiphene citrate or similar drugs u-HMG or highly purified u-HMG Purified u-FSH or highly purified u-FSH Recombinant FSH (r-FSH) Combinations

8. Optimum Ovarian Stimulation For IUI 2 - 4 follicles with Ø 18 – 19 mm. Estradiol blood level : 150-250 pg /ml per  15 mm follicle Endometrium  9 mm thick & trilinear. IUI between Cycle D13 and D16,depending of follicular maturity. Cancellation:  6 follicles  15 mm irrespective of E2 level Estradiol  1500 pg /ml

9. Cases in which IVF may be recommended Blocked or damaged fallopian tubes. Defects in sperm parameters. Women with ovulatory problems. Women with endometriosis. Cervical problems. Couples who have unexplained infertility. Failure of IUI

10. IVF: At a glance

11. IVF: Step 1 The ovaries are stimulated with FSH, in order to cause ripening of several follicles. This is called Controlled Ovarian Stimulation (COS) Successful COS requires very precise day-by- day adjustment of the hormonal dose This can only be achieved with the use of FSH in combination with GnRH analogues – GnRh agonist or GnRh antagonist Allowing the continuous growth of a large number of follicles whilst preventing a spontaneous LH surge through the suppression the natural secretion of FSH and particularly LH A premature LH surge can cause early ovulation and jeopardize the success of the treatment cycle

12. IVF: Step 2 When ultrasound monitoring indicates that the follicles are large enough to contain an egg that has matured sufficiently, hCG is injected to induce final follicular maturation

13. IVF: Step 3 The eggs are collected about 34 - 36 hours after the hCG injection Egg collection is usually carried out via the vagina under ultrasound guidance utilizing a long hollow needle, although egg collection by laparoscopy (via the abdominal wall) may occasionally be used.

14. IVF: Step 4 The eggs are then fertilized with the sperm and the first cell divisions are monitored.

15. IVF: Step 5 Embryos are transferred into the uterine cavity 2-6 days after in vitro fertilization Usually, more than one embryo is transferred to increase the chance of a successful pregnancy To avoid the risk of multiple births, it is generally recommended that a maximum of two to three embryos be transferred Remaining embryos may be cryopreserved

16. Intracytoplasmic Sperm Injection ( ICSI )– For Male Infertility IMSI: Intra Cytoplasmic Morphologically Selected sperm Injection is a variation of ICSI that uses a higher-powered microscope to select sperm.