The Assisted Reproductive Techniques - ART (IVF, IUI, ZIFT, GIFT, ICSI etc.)

Assisted reproductive technology (ART) is used to treat infertility. It includes fertility treatments that handle both a woman's egg and a man's sperm. It works by removing eggs from a woman's body. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the woman's body. In vitro fertilization (IVF) is the most common and effective type of ART.

1. ASSISTED REPRODUCTIVE TECHNIQUES SUBMITTED BY MUAZZAM JAHANGIR (14*) MUHAMMAD ANAS (15 ) SYEDA MUBEEN-UN-NISA (32) SYEDA WARDA WALI (34) SUBMITTED TO: MA’AM TABIBA NADIA NASEEM ﷽

2. WHAT IS INFERTILITY? Unable to conceive after 1 year o f un-protective sex.

3. INFERTILITY INCIDENCE Up to 5,000,000 American couples suffer from infertility every year and 20% of those decide to undergo in vitro fertilization . About one out of every 6 couples is infertile in the US , and Taiwan as well. Infertility due to male factor accounts for at least 40% of infertility cases .

4. W hat is Assisted R eproductive Techniques (ART)? ART is sometimes used as a catchall term for any fertility treatment , from medications to surgery . But in the medical community, ART refers to treatments that manipulate the sperm or the egg to make pregnancy more likely. ART works best in couples who have an issue with sperm or who have a diagnosis that makes it difficult for the sperm to fertilize the egg . Women who ovulate infrequently may also benefit from ART, since an ART cycle greatly increases the odds of a successful pregnancy each cycle. ART is also a viable option in couples who have unexplained infertility . This is because the odds of pregnancy are higher with each ART cycle , and ART can circumvent many common but difficult-to-diagnose problems. Couples who have tried other treatments without success , as well as people attempting to get pregnant without a partner, may also choose ART.

5. HISTORY OF ART In 1978 , First successful birth using IVF. Louise Joy Brown (born 25 July 1978) is an English woman known for being the first human to have been born after conception by in vitro fertilization, or IVF. In 1983 , First pregnancy from IVF using donated Oocyte. First birth from IVF using Cryopreserved Embryos. In 1984 , Introduction of the GIFT procedure. First successful birth using GIFT. In 1986 , First successful birth using ZIFT. In 1987 , Transvaginal US guided Oocyte retrieval. In 1990 , Introduction of PGD for S ex-linked diseases. In 1991 , First birth from IVF with ICSI. In 1993 , First birth from IVF using Testicular Sperm Extraction. In 1997 , First birth from Cryopreserved Oocytes.

6. Who is eligible for ART? Females with Tubal D iseases . Unexplained Infertility . Endometriosis . Immunologic causes of Infertility. Women with Immature Ovarian Failure . Individuals with Male Factor Infertility (e.g., Abnormalities in Sperm Production , Function o r Transport or Prior Vasectomy ).

7. MAJOR TECHNIQUES FOR ART ART techniques include: In Vitro Fertilization (IVF) and Embryo Transfer (ET). Intrauterine Insemination (IUI). Gamete Intrafallopian T ransfer (GIFT). Zygote Intrafallopian Transfer (ZIFT). Intracytoplasmic Sperm Injection (ICSI). In vitro fertilization (IVF) is perhaps the most well-known form of ART, but it’s far from the only option.

8. IN VITRO FERTILIZATION (IVF) In vitro fertilization (IVF) is a relatively new technology that’s been in use for about three decades . It’s also one of the most successful options , boasting a success rate of about 15-25% per cycle . During an IVF cycle, a doctor retrieves eggs from the woman and then fertilize them with sperm . The fertilized egg grows in a petri dish for several days until it becomes an embryo . Then a doctor implants the embryo back into the woman’s uterus . To maximize the success odds of IVF, a woman usually takes fertility drugs to ensure she ovulates on a predictable timeline and to encourage her body to produce multiple extra eggs . For this reason, IVF often produces multiple embryos . This increases the likelihood of having multiple babies .

9. INTRAUTERINE INSEMINATION (IUI) Intrauterine insemination (IUI) fertilizes the egg inside a woman’s uterus . This is a more affordable option than IVF, though it has a lower success rate .  IUI works best for women trying to get pregnant without a partner , for people with unexplained infertility , and when the man’s sperm has issues traveling to the egg , often due to low mobility , but sometimes due to a chemical mismatch between the man’s semen and the woman’s vaginal fluids . IUI requires just one procedure , during which the sperm is implanted into the woman . Some women opt to take fertility drugs before IUI to increase the number of eggs they produce . Fertility drugs increase the chances of success with IUI .

10. GAMETE INTRAFALLOPIAN TRANSFER (GIFT) An intrafallopian transfer fertilizes the egg inside the woman’s fallopian tube . Intrafallopian transfers are good options for couples with unexplained infertility , with sperm mobility issues , or when the woman has an issue with her fallopian tube , such as a blocked tube . A gamete intrafallopian transfer ( GIFT ) transfers sperm and eggs into a woman’s fallopian tube, where the sperm fertilizes the egg . Some couples prefer it because of religious or ethical beliefs dictating that fertilization should occur inside the body . As with other ART options, a woman typically takes fertility drugs prior to the cycle.

11. ZYGOTE INTRAFALLOPIAN TRANSFER (ZIFT) An intrafallopian transfer fertilizes the egg inside the woman’s fallopian tube. Intrafallopian transfers are good options for couples with unexplained infertility , with sperm mobility issues , or when the woman has an issue with her fallopian tube , such as a blocked tube . A zygote intrafallopian transfer ( ZIFT ) is similar to IVF. Eggs are removed from the woman’s body and fertilized in a lab setting , then transferred into the woman’s body when they grow into embryos . But unlike with IVF, the embryos are deposited into the fallopian tube . As with other ART options, a woman typically takes fertility drugs prior to the cycle.

12. INTRACYTOPLASMIC SPERM INJECTION (ICSI) Intracytoplasmic sperm injection ( ICSI ) removes one or more eggs from the woman’s body . Then a mature egg is injected with a single healthy sperm. When the eggs develop normally, they are transferred back to the woman’s body. ISI works best when there are serious sperm issues. For example, a man with very low sperm motility or very few quality sperm might select this option. Sometimes a man has normal sperm count and morphology, but significant DNA damage that decreases fertility or increases the risk of an early miscarriage. ICSI allows a doctor to select the healthiest sperm and implant it in the egg. A woman typically takes fertility drugs to boost egg production and normalize her cycle before an ICSI implantation .

13. OTHER TECHNIQUES INCLUDE Other assisted reproduction techniques include: Mitochondrial replacement therapy (MRT , sometimes called mitochondrial donation) is the replacement of mitochondria in one or more cells to prevent or ameliorate disease . MRT originated as a special form of IVF in which some or all of the future baby's mitochondrial DNA comes from a third party . This technique is used in cases when mothers carry genes for mitochondrial diseases . The therapy is approved for use in the United Kingdom . Reproductive surgery , treating e.g.  fallopian tube obstruction  and  vas deferens obstruction , or reversing a vasectomy  by a  reverse vasectomy . In  surgical sperm retrieval  (SSR) the reproductive urologist obtains sperm from the vas deferens , epididymis or directly from the testis in a short outpatient procedure. By  cryopreservation , eggs, sperm and reproductive tissue can be preserved for later IVF.

14. OTHER TECHNIQUES INCLUDE Donation of gametes, Surrogacy, Adoption, Stem cells research,

15. ART: NOT THE ONLY OPTION… IVF revolutionized the world of infertility. It’s received so much attention that many couples think it’s the only or the primary option for treating issues with fertility. But ART is not the only option. In fact, many couples opt to pursue less invasive treatments prior to trying ART . For many, the right medication or medical procedure can greatly increase the chances of fertility. There are dozens of fertility treatments that may help, but some of the most effective non-ART methods include: A procedure designed to clear blocked tubes . Hormones to support and encourage ovulation. Hormone treatments to address other issues in a woman's cycle, such as a too-short luteal phase . Treating underlying medical conditions such as insulin resistance . Fertility education can also be helpful. Some couples are not correctly timing intercourse to maximize their chances of fertility. Others may be using lubricants that make it more difficult for the sperm to travel to the egg . Still, others may have lifestyle risk factors , such as obesity , smoking , or drug use , that increase the risk of miscarriage and infertility. Infertility is a complex challenge , and it demands complex solutions . Often the best strategy is a multi-pronged approach to medication, lifestyle changes, and a few tweaks in intercourse timing .

16. USAGE OF ART As a result of the 1992 Fertility Clinic Success Rate and Certification Act, the CDC is required to publish the annual ART success rates at U.S. fertility clinics. Assisted reproductive technology procedures performed in the U.S. has over than doubled over the last 10 years , with 140,000 procedures in 2006 ,  resulting in 55,000 births . In Australia, 3.1% of births are a result of ART . The most common reasons for discontinuation of fertility treatment have been estimated to be: postponement of treatment (39%), physical and psychological burden (19%, psychological burden 14%, physical burden 6.32%), relational and personal problems (17%, personal reasons 9%, relational problems 9%), treatment rejection (13%) and organizational (12%) and clinic problems (8%).

17. RISKS ASSOCIATED WITH ART The majority of IVF-conceived infants do not have birth defects. However , some studies have suggested that assisted reproductive technology is associated with an increased risk of birth defects .   Artificial reproductive technology is becoming more available. Early studies suggest that there could be an increased risk for medical complications with both the mother and baby . Some of these include low birth weight , placental insufficiency , chromosomal disorders , preterm deliveries , Genetic disorders , gestational diabetes , and   pre-eclampsia.

18. RISKS ASSOCIATED WITH ART The use of ART has increased dramatically worldwide and has made pregnancy possible for many infertile couples. However , perinatal risks associated with any ART and ovulation induction pregnancy remain, particularly in multifetal gestations . To promote optimal outcomes, obstetrician–gynecologists and other health care providers should complete a thorough medical evaluation and address maternal health problems or health conditions before initiating ART and, when proceeding with ART, make every appropriate effort to achieve a singleton gestation . Patients should receive appropriate counseling about the risks associated with ART , especially risk associated with multifetal pregnancy and the option in such cases for multifetal reduction .

19. REFERENCES Text book of Gynaecology 7 th edition, Rashid Latif Khan . Guide lines by Tabiba Nadia Naseem . Google search engine.