artificial reproductive technology · artificial reproductive technology dr. taher elbarbary dr....
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ARTIFICIAL REPRODUCTIVE TECHNOLOGY
Dr. Taher ElbarbaryDr. Herve Lucas
Clinic of Infertility and Gynaecological EndocrinologyGeneva University Hospitals
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For injection:• Intra-Cytoplasmic Sperm Injection (ICSI)
Techniques involving oocyte retrieval:• Gamete Intra-Fallopian transfer (GIFT), Peritoneal Oocyte Sperm Transfer (POST)• Zygote Intra-fallopian Transfer (ZIFT).• In Vitro Fertiliztion (IVF)• Tubal Embryo Transfer (TET)
Techniques involving sperm retrieval:• Testicular Sperm Aspiration (TESA)• Per-cutaneous Epididymal Sperm Aspiration (PESA)• Microsurgical Epididymal sperm Aspiration (MESA)• Non-Scalpel Vasal Sperm Aspiration (NSVSA)
What are assisted reproductive technologies?
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Female Problems.
Male Problems
Who are the candidates of ART ?
* Female problems
* Male problems
Who are the candidates of ART ?
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What are the steps of ART ?Steps of ART
(MESA-TESE)
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Female Problems.
Male Problems
Who are the candidates of ART ?PATIENT STIMULATION
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Female Problems.
Male Problems
Who are the candidates of ART ?
US image of multiple ovarian follicles
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Female Problems.
Male Problems
Who are the candidates of ART ?OOCYTE RETRIEVAL
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Oocyte retrieval
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Female Problems.
Male Problems
Who are the candidates of ART ?
Syringes with cumulus-oocyte complex in follicular fluid
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Cumulus oocyte complex
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Oocyte culture
Oocytes have a higher chance of fertilization if insemination follows retrieval by 4-6 hours
Clinical Gynecologic Endocrinology and Infertility 7th edition. 2000
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Extracorporeal insemination
• Sperm retrieval
• Sperm preparation
• Technique of insemination
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Female Problems.
Male Problems
Who are the candidates of ART ?Technician with sperm preparation
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Day (0): Decoronization of mature oocytes before injection (MII)
ICSI
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Day (0)ICSI
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Day (0): Holding of a single sperm with the injection pipette
ICSI
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Intra-Cytoplasmic Sperm Injection
Day (0)
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Fertilization control
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Observation of zygotes Day (1):Unfertilized oocytes
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Female Problems.
Male Problems
Who are the candidates of ART ?
Observation of zygoteDay (1): Pronuclear stage embryo
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Observation of zygoteDay (1): Pronuclear stage embryo
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Female Problems.
Male Problems
Who are the candidates of ART ?
Day (1) two cell embryo
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Day (2): 4-cell stage embryo quality.
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Female Problems.
Male Problems
Who are the candidates of ART ?
Day (4): Morula stage
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Embryo transfer
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GIFT
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What are the risks of ART?
Risk due to ovarian stimulation
Risk due to oocyte retrieval
Risk due to embryo trnsfer
Risk due toICSI
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What is the success rate of ART?
IVFDeliveries per retrieval ………………………………………………….. 29.1%
ICSIIn women < 35 years without male factor infertility…………………….. 35.7%
In women > 35 years with male factor infertility………………………... 35.1%
In women < 40 years without male factor infertility…………………….. 10.3%
In women > 40 years with male factor infertility………………………... 12.8%
GIFTIn women < 35 years without male factor infertility…………………….. 34.9%
In women > 35 years with male factor infertility………………………... 22.2%
In women > 40 years without male factor infertility…………………….. 09.1%
In women > 40 years with male factor infertility………………………... 11.1%
ASRM/SART registry: 1998 results. Fertil Steril2002
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Female Problems.
Male Problems
Who are the candidates of ART ?
Mechanical assisted hatching
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Assisted hatching
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• The benefits of PGD in infertile couple.
• What is embryo biopsy ?
• Who should have PGD ?
Pre-implantation genetic diagnosis (PGD)
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Female Problems.
Male Problems
Who are the candidates of ART ?
Embryo biopsy
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Ovarian tissue cryopreservation
What are the future prospectives in ART