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Fertility Treatments

Getting Pregnant > Fertility > Fertility Treatments

(ART) Assisted reproductive technology

is a general term referring to methods used to achieve pregnancy by artificial or partially artificial means. It is reproductive technology used primarily in infertility treatments, otherwise known as 'fertility treatments'. Some forms of ART are also used in fertile couples for genetic reasons. ART is also used in couples who are discordant for certain communicable diseases, e.g. AIDS, to reduce the risk of infection when a pregnancy is desired. Examples of ART include in vitro fertilization, intracytoplasmic sperm injection (ICSI), cryopreservation, and intrauterine insemination (IUI). There is yet no strict definition of the term. Usage of the ART mainly belongs in the field of reproductive endocrinology and infertility.

 

(IVF) In vitro fertilisation  

is a process by which an egg is fertilised by sperm outside the body: in vitro. IVF is a major treatment for infertility when other methods of assisted reproductive technology have failed. The process involves monitoring a woman's ovulatory process, removing ovum or ova (egg or eggs) from the woman's ovaries and letting sperm fertilise them in a fluid medium in a laboratory. When a woman's natural cycle is monitored to collect a naturally selected ovum (egg) for fertilisation, it is known as natural cycle IVF. The fertilised egg (zygote) is then transferred to the patient's uterus with the intention of establishing a successful pregnancy. 

IVF may be used to overcome female infertility in the woman due to problems of the fallopian tube, making fertilisation in vivo difficult. It may also assist in male infertility, where there is a defect in sperm quality, and in such cases intracytoplasmic sperm injection (ICSI) may be used, where a sperm cell is injected directly into the egg cell. This is used when sperm have difficulty penetrating the egg, and in these cases the partner's or a donor's sperm may be used. ICSI is also used when sperm numbers are very low. When indicated, the use of ICSI has been found to increase the success rates of IVF.

 

(TVOR) Transvaginal oocyte retrieval

 also referred to as oocyte retrieval (OCR) or even simply egg collection, is a technique used in in vitro fertilization (IVF) in order to remove oocytes from the ovary of the female, enabling fertilization outside the body. Transvaginal oocyte retrieval is more properly referred to as transvaginal ovum retrieval when the oocytes have matured into ova, as is normally the case in IVF.

Under ultrasound guidance, the operator inserts a needle through the vaginal wall and into an ovarian follicle, taking care not to injure organs located between the vaginal wall and the ovary. The other end of the needle is attached to a suction device. Once the follicle is entered, suction is gently applied to aspirate follicular fluid and with it, hopefully, cellular material including the oocyte. The follicular fluid is delivered to a technician in the IVF laboratory to identify and quantify the ova. Next, other follicles are aspirated. Once the ovarian follicles have been aspirated on one ovary, the needle is withdrawn, and the procedure repeated on the other ovary. It is not unusual to remove 20 oocytes as women are generally hyperstimulated in advance of this procedure. After completion, the needle is withdrawn, and hemostasis is achieved. The procedure usually lasts from 20–60 minutes.

 

(AZH)  Assisted zona hatching

is a procedure of assisted reproductive technology in which a small hole is made in the zona pellucida, using a micromanipulation, thereby facilitating for zona hatching to occur. Zona hatching is where the blastocyst gets rid of the surrounding zona pellucida to be able to implant in the uterus.

 

(ICSI) Intracytoplasmic sperm injection

, pronounced "eeksee" or "icksy") is an in vitro fertilization procedure in which a single sperm is injected directly into an egg.

ICSI is generally performed in addition an in vitro fertilization procedure to extract often several oocytes from a woman.
The procedure is done under a microscope using multiple micromanipulation devices (micromanipulator, microinjectors and micropipettes). A holding pipette stabilizes the mature oocyte with gentle suction applied by a microinjector. From the opposite side a thin, hollow glass micropipette is used to collect a single sperm, having immobilised it by cutting its tail with the point of the micropipette. The oocyte is pierced through the oolemma and into the inner part of the oocyte (cytoplasm). The sperm is then released into the oocyte. The pictured oocyte has an extruded polar body at about 12 o'clock indicating its maturity. The polar body is positioned at the 12 or 6 o'clock position, to ensure that the inserted micropipette does not disrupt the spindle inside the egg. After the procedure, the oocyte will be placed into cell culture and checked on the following day for signs of fertilization.
In contrast, in natural fertilization sperm compete and when the first sperm penetrates the oolemma, the oolemma hardens to block the entry of any other sperm. Concern has been raised that in ICSI this sperm selection process is bypassed and the sperm is selected by the embryologist without any specific testing. However, in mid-2006 the FDA cleared a device that allows embryologists to select mature sperm for ICSI based on sperm binding to hyaluronan, the main constituent of the gel layer (cumulus oophorus) surrounding the oocyte. The device provides microscopic droplets of hyaluronan hydrogel attached to the culture dish. The embryologist places the prepared sperm on the microdot, selects and captures sperm that bind to the dot. Basic research on the maturation of sperm shows that hyaluronan-binding sperm are more mature and show fewer DNA strand breaks and significantly lower levels of aneuploidy than the sperm population from which they were selected. A brand name for one such sperm selection device is PICSI.


(GIFT) Gamete intrafallopian transfer

 is a tool of assisted reproductive technology against infertility. Eggs are removed from a woman's ovaries, and placed in one of the Fallopian tubes, along with the man's sperm. The technique, which was pioneered by endocrinologist Ricardo Asch, allows fertilization to take place inside the woman's uterus.
With the advances in IVF the GIFT procedure is used less as pregnancy rates in IVF tend to be equal or better and do not require laparoscopy when the egg is put back.

It takes, on average, four to six weeks to complete a cycle of GIFT. First, the woman must take a fertility drug to stimulate egg production in the ovaries. The doctor will monitor the growth of the ovarian follicles, and once they are mature, the woman will be injected with Human chorionic gonadotropin (hCG). The eggs will be harvested approximately 36 hours later, mixed with the man's sperm, and placed back into the woman's Fallopian tubes using a laparoscope.

 

(AI) Artificial insemination

is a means of attaining pregnancy not involving sexual intercourse. A couple having trouble getting pregnant can benefit from the exact timing and placement of the sperm. It can overcome instances where a woman's immune system can reject her partner's sperm as invading molecules.[1] In the case of an impotent male, donor sperm may be used. It is also a means for a woman to conceive when two women wish to parent a child, or a single woman does not have a male partner, when she does not want a male partner, or when a male partner's physical limitation impedes his ability to impregnate her by sexual intercourse. Women who have issues with the cervix such as cervical scarring, cervical blockage from endometriosis, or thick cervical mucus may also benefit from artificial insemination since the sperm must pass through the cervix to result in fertilization.

 

Cytoplasmic transfer

is an assisted reproductive technology (ART), fertility technique whereby cytoplasm from a donor egg is injected into an egg with compromised mitochondria. The resulting egg is then fertilized with sperm and implanted in a womb, usually that of the woman who provided the recipient egg and nuclear DNA.

Cytoplasmic transfer was created to aid women who experience infertility due to deficient or damaged mitochondria, contained within an egg's cytoplasm. Deficient mitochondria can lead to recurrent implantation failure, high levels of embryo fragmentation and overall poor embryo development. The incidence of compromised mitochondria increases with advanced maternal age, thought to occur near the age of thirty-five. Consequently, it has been found advantageous for young women to donate cytoplasm to older women, creating rejuvenated eggs. This is particularly desirable for couples or women who wish to genetically contribute to any resulting embryo, given cytoplasmic transfer does not interfere with the primary nuclear DNA input from the recipient egg.

 



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