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    Assisted Reproductive Technology

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    Surya Setiawan
    This document provides an overview of assisted reproductive technology (ART) procedures including intrauterine insemination (IUI), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), and gestational surrogacy. It discusses the indications, requirements, procedures, and prognostic factors for each technique. The document also covers ovarian stimulation regimens, sperm retrieval methods, embryo transfer, cryopreservation, and the principles of GIFT and ZIFT.

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    © All Rights Reserved
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    Assisted Reproductive Technology

    Uploaded by

    Surya Setiawan
    31 views21 pages
    This document provides an overview of assisted reproductive technology (ART) procedures including intrauterine insemination (IUI), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), and gestational surrogacy. It discusses the indications, requirements, procedures, and prognostic factors for each technique. The document also covers ovarian stimulation regimens, sperm retrieval methods, embryo transfer, cryopreservation, and the principles of GIFT and ZIFT.

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    This document provides an overview of assisted reproductive technology (ART) procedures including intrauterine insemination (IUI), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), and gestational surrogacy. It discusses the indications, requirements, procedures, and prognostic factors for each technique. The document also covers ovarian stimulation regimens, sperm retrieval methods, embryo transfer, cryopreservation, and the principles of GIFT and ZIFT.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    31 views21 pages

    Assisted Reproductive Technology

    Uploaded by

    Surya Setiawan
    This document provides an overview of assisted reproductive technology (ART) procedures including intrauterine insemination (IUI), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), and gestational surrogacy. It discusses the indications, requirements, procedures, and prognostic factors for each technique. The document also covers ovarian stimulation regimens, sperm retrieval methods, embryo transfer, cryopreservation, and the principles of GIFT and ZIFT.

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    ASSISTED REPRODUCTIVE TECHNOLOGY

    Surya Setiawan

    Supervisor :
    Prof. Dr. dr. Nusratuddin Abdullah Sp.OG, Subsp.FER, MARS

    DIVISI FERT IL ITAS, END OKRINOLOGI DAN RE PRODUKSI


    DE P A R T E M EN OB ST ET R I DA N GI N EKOLOGI
    FA K U L T A S KEDOKT ERA N U NI V E R S I T A S HA S A N U D D I
    N
    STAIRCASE APPROACH TO EMPIRICAL
    INFERTILITY TREATMENT
    INTRAUTERINE INSEMINATION (IUI)

    (IUI) is an assisted conception technique that involves the deposition of a


    processed semen sample in the upper uterine cavity, overcoming natural
    barriers to sperm ascent in the female reproduction tract.
    Requirements of IUI

    • At least one open and healthy fallopian tube (Patent).


    • Adequate number of motile sperm,
    • absence or suspicion of cervical, pelvic or intrauterine
    infection.

    INDICATION OF IUI
    IUI & IVF

    IUI Combine with Ovarian
    Stimulation
    -Simple, non-invasif
    -High multiple pregnancy rates

    IVF
    -High pregnancy rates
    -Low risk of serious maternal
    and neonatal complications
    OVARIAN STIMULATION
    REGIMEN
    CLOMPHENE CITRATE A RO MATA S E GONADOTROPIN
    INHIBITOR
    (First line for induction (For Older woman with
    (second line if not
    and ovulation) diminished ovarian
    respond to CC)
    function)
    IUI PROCEDURE
    SPERM COLLECTING
    semen specimen collecting after two or


    three days of sexual abstinence

    SPERM PROCESSING
    • separate sperm from prostaglandin-rich
    prostatic secretions and seminal fluid
    • maximizes the number of motile sperm for
    insemination, removes cellular debris, and
    concentrates the specimen

    MONITORING OVULATION
    USG
    urinary LH monitoring INSERTION
    • 24 hours after positive LH urinary detection
    • 0.3 to 0.5 mL of washed, processed, and
    POSTPROCEDURE
    concentrated sperm into the intrauterine cavity
    • The patient may resume her normal activities after insemination
    by transcervical catheterization • A urinary or serum pregnancy test is performed two weeks after IUI
    ASSISTED REPRODUCTIVE
    TECHNOLOGY


    IVF ICSI GIFT
    In Vitro Fertilization Intracytoplasmic Sperm Injection Gamete Intrafallopian Transfer

    ZIFT
    Zygot Intrafallopian Transfer
    PROCESS IN
    ART (IVF)

    PROGNOSTIC FACTOR

    Maternal Age 
    • Progressive decline in response to ovarian stimulation
     fewer oocytes
    • Increase aneuploidy

    Ovarian Reserve
    Poor response :
    - FSH level : > 10IU/L
    - Low AFC
    - Estogen level : > 60-80 pg/mL
    - AMH : 0.2-0.7 ng/mL
    EVALUATION BEFORE IVF

    Pati ent Ideal for IVF :

    1. Age < 35 years


    2. Presence of ovarian reserve (serum FSH<10 IU/L).
    3. Husband—normal seminogram.
    4. Normal uterine cavity as evaluated by
    hysteroscopy/sonohysterography
    OVULATION STIMULATION REGIMEN


    • GnRH analogues
    • Antagonist or agonist
    • Prevent spontaneous ovulation before
    oocyte retrieval
    • hCG
    • Induce oocyte maturation
    OOCYTE
    RETRIEVAL

    • Oocy te s retr i eva l : 34 - 36 h ou rs af te r hCG tr i g ge r


    • Pe r for me d v i a t ra n sva g i n a l a sp i rati on gu i d e d
    USG T VS u n d e r IV s e d ati on
    IVF CONVENSIONAL VS ICSI VS
    IMSI

     ICSI Indication :
    • Severe oligospermia (< 5
    million Sperm/mL)
    • Teratospermia (<4%
    normal sperm/ml
    • Couples with previous
    failed or poor fertilization
    with conventional IVF
    SPERM RETRIEVAL
    Testicular Sperm Aspiration (TESA)
    • A fine needle inserted into the
    testis to aspirate sperm
    Percutaneous Epididymal Sperm
    Aspiration (PESA)

    • A fine needle inserted into the
    epididymis to aspirate sperm
    Testicular Sperm Extraction
    (TESE)

    • Surgical removal of testicular tissue


    in attempt to collect sperm
    Microdissection testicular Sperm
    (MESE)

    • Microsurgery of the seminiferous


    tubules to identify sperm
    production area and extract sperm
    Number of embryo transfer
    • E m b r y o transfer m o s t c o m m o n
    EMBRYO

    p e r fo r m e d 5 d ays aft er o ocy tes retrieval
    or 3 d ay s
    TRANSFER

    Procedure
    • P a i n free
    • Pe r f o r m e d w i t h transfer
    cat h eter u n d e r t ra n s a b d o m i n a l
    USG
    • G O A L : deliver e m b r y o to t h e
    u te r u s in a n a c c u rate
    EMBRYO CRYOPRESERVATION

    Embryos can be frozen at any stage from
    zygote to blastocyst and remain viable
    for several years
    GESTATIONAL SURROGACY

    INDICATION
    • W o m e n w i t h o u t func ti ona l
    u te r u s (congenital, HT)
    • Irreparably d a m a g e d
    ute r u s
    • Medi ca l co n d i ti o n

    Principle
    Transfer e m b r y o to t h e u ter u s of a
    w o m a n willing to carry a
    p r e g n a n c y o n beha l f of a n
    inferti le c o u p l e
    GIFT AND ZIFT
    Principle : Oocytes and
     zygotes transferred to the
    fallopian
    tube via laparoscopy instead
    of into the uterus

    Oocytes or zygotes deposited


    at a level 4cm proximal to the
    fi mbria

    THANK YOU

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