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Techniques for Assisted
Human Reproduction
Asist. Univ. Dr. Raluca TulinEndocrinology/ Embryology Specialist
Profle: Anatomy
Embryology Department U!" #arol Davila$
%ptional #ourse &ear '() *eneral !edicine#linical Embryology + Assisted ,uman
Reproduction
Course 3
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• !ore and more c-allenges are beingovercome by scientifc progress
• ot being able to procreate istreated0 by medical tec-ni1ues o2 ART
• 3UT4t-ere 5ill al5ays be a clas-bet5een t-e old and t-e ne5 andproduces ideological disorders o2moral social biological andeconomical natures
ARTAssisted Reproductive Te-ni1ues
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Sterility 'S (n2ertility• Sterility) incapacity o2 becoming pregnant• (n2ertility 6 incapacity o2 -aving c-ildren
meaning 7eeping t-e pregnancy anddeliver a live baby
ART- does not cure (does not unclog fallopiantubes, does not increase sperm motility)- BUT
ALLOW R!A"#$%& T#! &OAL T#ROU OT#!R'!T#O
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3AS(S %" ART
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%t-ers 4• *("T 6 *ametic (ntra "allopian
Trans2er• @("T 6 @ygotic (ntra "allopian Trans2er• TET 6 Tubal Embryo Trans2er
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atural "ertilisation
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8. (ntrauterine insemination o2sperm partner / fresh
• (ndications – "ailure intercourse – (diopat-ic in2ertility – !oderate damage to sperm analysis – Endometriosis mild / moderate – Unilateral tubal de2ects – Anovulation / S%P# – Erectile dys2unction -ypospadias
vaginismus
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8. (ntrauterine insemination o2sperm partner / frozen
• #-ronic diseases re1uiringc-emot-erapy / radiot-erapy / iodinet-erapy / surgery t-at can aCect2ertility ) in 5-ic- case turn to spermcryopreservation partner and using it
later• ,usband being a5ay 2or a long time
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8. (ntrauterine (nsemination spermfrom donor
• (ndications: – Partner sterility – ac7 o2 partner – Partner serious genetic diseases – "inancial impossibility 2or ('"
T-e donor can be anonymous or7no5n
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8. (ntrauterine insemination)STEPS
8. #-ec7ing tubal patency ,S* / A"# ; andsperm parameters . Screening virus ,3' ,#' ,(' 'DR ;
9. Establis-ing t-erapy ) depending on A!, A"#
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8. (ntrauterine insemination• T-e sample is processed to ma7e mobile
sperm selection morp-ologically normal 2ertiliKers potential . T-is 5ay some
pat-ogenic agents are getting eliminated• (2 stored sperm cryopreservation li1uid
nitrogen )8JH L# ; and subse1uentlyt-a5ed
• Sperm 2res- / t-a5ed ; is inserted intot-e uterine cavity
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Sperm preparation
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8. (ntrauterine insemination• %varian stimulation : etroKole M/)
*onadotropins$ #lomip-ene citrate• !onitoring
–
Ultrasound 6 Day 9 A"#; day J D";• %varian triggering6 r,#*• T-e actual insemination )
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8. (ntrauterine insemination
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8. (ntrauterine insemination
•
Disadvantages:8. o5 success rate 8 )9NO;9. !ultiple pregnancy ris7
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=/9G/8H 98
(U( versus('"
IUI baby
IUI baby
IUI baby
10,000 $
5,000 $
9,500 $
IVF baby
IVF baby
IVF baby
43,000 $
13,000 $
16,000 $
Van Voorhis et al. Fert. Steril 1998
Gover e et al. !an"et #000
hili%s et al. &'( )e%ro #000
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9. (n 'itro "ertiliKation
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(n 'itro "ertilisaiton• (ndications:
– "ailure intercourse – (diopat-ic in2ertility – !oderate damage sperm analysis – Endometriosis / S%P# – Tubal de2ects unilateral or bilateral absent 2allopian
tubes ; – Anovulation / S%P# – Erectile dys2unction -ypospadias vaginismus – Advanced age o2 t-e patient – P*S / P*D Preimplantational genetic diagnosis o2
c-ildren resulting 2rom t-e partners-ip or gametes o2one or bot- partners;
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(n 'itro "ertiliKation )STEPS8. #-ec7ing t-e uterine cavity -ysteroscopy ; and sperm
parameters .9. Screening virus ,3' ,#' ,(' 'DR ;
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%varian stimulation• (t aims to ac-ieve a -ig-er number o2 oocytes to be
transvaginal e tracted 2rom t-e patientQs ovaries• (t is important to suppress normal ovulation
because once t-ey leave t-e ovary oocytes can notbe recovered
• Ultrasound monitoring ovaries and endometrium;and serologic Estradiol / Progesterone ;
• #omposed o2 9 p-ases: – Do5n)regulation pituitary; 6 s5itc-ing oC t-e pituitary
gland – %varian stimulation 8N)89 days;
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Principles o2 ovarianstimulation
• %varian stimulation: – ,!* – "S, M/) ,; – ,#* Trigger)s-ot
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,yper stimulation 's aturalovulation
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Under generalanest-esia- Transvaginal or
laparoscopically$- 9N)
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Stages o2 embryonic development
#-ec7ing 2ertiliKation8H)8G -ours a2terinsemination / (#S(
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@ygote
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,o5 big are t-ey
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Ris7s o2 ('"• !ultiple pregnancy• %varian -yper)stimulation• Emotional stress• ac7 o2 pregnancy
Uni1ue pregnancy post ('" 6 cost to Englis- *overnmentappro .
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Embryo)trans2er
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!ultiple pregnancy6 "(' ma>or ris7
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8=) ('" 8)8)9)9)G• adya Suleman
5-o gave birt- tooctuplets in anuary9NNJ -ence itsnic7name%ctomom . using invitro 2ertiliKation aprocedure t-at -adused success2ullybe2ore giving birt-to ot-er H c-ildren
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• 9NNI reality)s-o5 Jon & Kate Plus 8 - ate
se tuplet birt- t-ree boys Aaden #ollinand oel and t-ree daug-ters ea- Ale is and ,anna-
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anuary 9NN
Romania Adriana(liescu HH ears
9NNH SpainHHyears.!aria del #armen3ousada de araDied o2 stomac-cancer 5-en -er
9N8N triplets 6(ndia3-ateri Devi HHyears
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#ryopreservation o2 embryos
• W-en maternal uterus preventsimplantation too t-in post)progestin increased ovarianstimulation ;
• E cess embryos remaining a2terembryo trans2er ;
• T-e uterus is not 2unctional• T-e 5oman 5ill 2ollo5 in t-e near
2uture anticancer treatments
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3an7 o2 embryos
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(n vitro 2ertiliKation ) 5it-donor oocytes
8. Sterile partner9. ac7 o2 partner
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• 3ot- partners are sterile but t-e uterus is intact• *enetic diseases o2 bot- partners• #ountries 5-ere adoption processes are cumbersome• (t is t-e legal mot-er 5-o gives birt- . egal 2at-er is
-er -usband t-e legal presumption ; or -er partner t-e recognition ;
(n vitro 2ertiliKation ) 5it- donatedembryos
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*estational carrier 'S Surrogatemot-er
• *estational carrier 6 carryingt-e c-ild o2 t-e couple spermrecipient M oocyte recipient;*estational carrier is notgenetically related to t-e c-ild.
• Surrogate mot-er6 t-e c-ild
bearing sperm recipient M-er ovocyte;. (t is geneticallyrelated to t-e c-ild . #anresort to (U(
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• egal mot-er is t-e one5-o gives birt- to t-ebaby. T-e -usband is t-elegal 2at-er o2 t-e babyi2 s-e is not married t-ebaby can be recogniKedby a benefciary 2at-er."or t-e benefciarymot-er to become alegal mot-er adoptionprocedures must be2ollo5ed.
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('" 5it- (#S(• (#S( 6(ntracytoplasmic Sperm (n>ection• (ndications:
– Severely impaired sperm parameters – "ertiliKation 2ailures in t-e -istory o2 t-e
couple – !a7ing !A,R 5it- testicular tissue biopsy :
• TESE 6 Testicular Sperm E traction;• !ESA !icroscopic Epididymis Sperm Aspiration;• PESA Percutaneous Epididymis Sperm Aspiration;• !)TESE !icro)TESE;
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(n>ection
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,o5 itQs actually done4
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