Assisted Reproductive Technology presentation by Arowojolu Boluwaji S. practices of assisted reproductive technology, controversies of assisted reproductive technology. ART Techniques of ART, role of nurses in ART. regulations of ART. test tube baby. concept of assisted reproductive technology. ovulation induction, invitro fertilization.

1. ASSISTED REPRODUCTIVE
TECHNOLOGY: PRACTICES
AND CONTROVERSIES
SURROUNDING ITS USE
BY
AROWOJOLU BOLUWAJI SAMUEL

2. Assisted Reproductive Technologies (ARTs) refer to
all treatments or procedures that include the in vitro
fertilization (IVF), handling of human oocytes and
sperm or embryos for the purpose of establishing a
pregnancy
ART encompasses a variety of technologies, some
used to initiate pregnancy and others more specifically
used to increase the likelihood and/or to test for the
presence of certain genes so that prospective parents
can choose which embryos to implant after IVF
INTRODUCTION

3. • Explain the concept of assisted reproductive technology
• Describe the techniques involved in assisted reproductive
technology
• Discuss the risks associated with assisted reproductive
technology
• Discuss the regulations and controversies surrounding
assisted reproductive technology
• Discuss the role of nurses in assisted reproductive technology

4. Concept of assisted reproductive technology
Since the first ‘test-tube baby’ Louise Brown was born
in Britain in 1978, more than a million children have
been born through ART
Most women result into the use of ART because of
infertility. Infertility is the inability to conceive after 12
months of unprotected sexual intercourse
Other users of ART are single women and men,
lesbians, gays, transgender couples who which to form
genetically-related families.

5. Techniques involved in assisted reproductive technology
1. Ovulation induction
2. Intrauterine insemination
3. In vitro fertilization
4. Satellite in vitro fertilization techniques

6. 1. Ovulation induction
• Simplest method of ART
• Applied when the woman is unable to release ova
every month e.g. polycystic ovarian syndrome
• Example of drug is Clomiphene and gonadotropins

7. 2. Intrauterine Insemination
Appropriately prepared sperm is
transferred into the woman’s uterus
Indications: mild to moderate sperm
disorders, unexplained infertility, suspicion
of cervical factor infertility, azoospermia
If there is no pregnancy after 3 – 4
inseminations, application of IVF is
considered. Success rate is 18 – 20%.

8. It is the most advanced method of ART.
Fertilization takes place outside the woman’s
reproductive system (in the laboratory)
Indications: obstructed fallopian tubes, disordered
sperms, advanced age of the woman, genetic diagnosis
before implantation, pregnancy into the uterus of a
surrogate mother, repeated failures of simpler ART
methods
3. In vitro fertilization

9. i. Controlled ovarian hyperstimulation: administration of
gonadotropins to obtain more than 1 woman’s ova so as to increase
efficiency and transfer the embryo with the best quality.
ii. Oocyte retrieval (egg collection): eggs contained in the
follicles are collected after stimulation. The husband gives semen at this
stage. Thereafter, vaginal gel (progesterone + low-dose aspirin +
cortisone + antibiotics) is administered for few days to prepare the
endometrium to accept the fertilized egg.
Stages of routine IVF methods

10. iii. In-vitro fertilization: stage of fertilization where
ova and spermatozoa are placed in a culture
medium
iv. Embryo transfer: the fertilized ova is transferred
into the woman’s uterus with the aid of a special
syringe through a thin catheter
v. Post embryo transfer period: the most stressful
period. Woman is under strict supervision and drug
regimen. Pregnancy is established by blood
chorionic gonadotropin level and not by urine

11. 4. Embryo
cryopreservation-
Thawed embryo
transfer
5. Egg
cryopreservation
6. Egg donation
These techniques are the recent advancement in
ART. They include:
4. Satellite in vitro fertilization techniques
1. Intracytoplasmic sperm
injection (ICSI)
2. Assisted Hatching
3. Blastocyst culture
7. Gamete intrafallopian
transfer (GIFT) or
Zygote intrafallopian
transfer (ZIFT)
8. Microsurgical sperm
retrieval
9. Preimplantation
genetic diagnosis

12. I. Intracytoplasmic sperm injection
Essential for couples with serious sperm disorder.
The zona of the oocyte is cut and the spermatozoa is
inserted
II. Assisted Hatching
Applied in a case when the zona pellucida is too hard
which prevent the embryo from escaping in order to
implant
Used in women of advanced age

13. III. Blastocyst culture
> Normally, implantation occurs at blastocyst stage.
> Some embryos are cultured until they reach the blastocyst stage
so as to ensure their survival.
IV. Embryo cryopreservation – Thawed embryo transfer
> Spare embryos that remains after ovarian stimulation/IVF cycles
are cryopreserved at extremely low temperatures (-196°c) for a
long time.
> A thawed embryo transfer (cryopreserved embryo) is transferred
whenever the couples are ready to have a pregnancy

14. V. Egg cryopreservation
> Eggs of women are preserved at extreme low temperature
used by women who are going to receive chemotherapy that may
damage their ovaries and women who are not planning to have a
family in the near future
VI. Egg donation
> It is an option for women who suffer premature ovarian
function, early menopause, removed ovaries, numerous IVF
failures, explained miscarriages, bad quality embryos
> Egg is donated from another woman and fertilized by the
husband semen.

15. VII. GIFT or ZIFT
GIFT- ova and spermatozoa are inserted through special catheters into
the woman’s fallopian tube to achieve fertilization inside the lumen.
ZIFT- 1 day old embryo is transferred into the fallopian tube.
> Used by women with endometriosis, those who want to perform
diagnostic laparoscopy + IVF the same time, couples who have religious
restrictions against IVF

16. IX. Preimplantation Genetic Diagnosis (PGD)
> Used in couples when 1/both partners have a genetic disease
that has the likelihood of being transferred to the offspring.
> There is alteration of the gene of the embryo before
implantation in the uterus
VIII. Microsurgical sperm retrieval
 It replaced sperm donation in men with azoospermia.
> Sperm is either extracted or aspirated via a microsurgery

17. • A child born through ART is presumed to be the legitimate
child of the couple having been born within the wedlock
and with consent of both spouses with all the attendant
rights of parentage, support and inheritance
• Sperm/oocyte donor do not have parental right over a child
and their anonymity is protected
Legitimacy of a child born through ART

18. 1. Ovarian hyper stimulation syndrome characterized by
• swollen and painful ovaries . Nausea
• vomiting . Bloated abdomen
• Vomiting . Anorexia
• Accumulation of fluid in the abdomen
• Weight gain
• Electrolyte abnormalities
It resolves on its own, severe cases can be managed in hospital
Risks of ART
2. Egg retrieval carries the risk of bleeding, infection, damage
to bowel, bladder or blood vessel

19. 3.Multiple pregnancy
4.Preterm delivery
5. Possible miscarriage
6. Ectopic pregnancy
Risks of ART cont’d

20. Regulations and controversies surrounding ART
Roman catholic church stated that IVF is illicit and should not
be used by the Faithful
There is no law guiding ART in Nigeria despite the long
duration of practice. Most ART centers in Nigeria operate
under the guidelines of Human Fertilization and Embryology
Act (HFEA)
Embryo transfer is limited to about 2 in women under
40years and 3 in women over 40years in UK, Italy allows
only heterosexual couples
Gamete donation is restricted by religious and cultural
traditions. Compensation is restricted so as to protect women
from abuse. To what extent should anonymity of the donor be
protected?

21. Varying years of cryopreservation as in Brazil which
allows for 3years, UK and Finland allow for more than 5
years
Most countries do not allow the destruction of Embryos
e.g. Germany, Italy. All embryos must be implanted into
the woman
Other areas of concerns include: Multiple pregnancies, status
of the conceptus, posthumous reproduction, Surrogacy ,
welfare of the child, accessibility
Regulations and controversies surrounding ART cont’d

22. Regulation in Nigeria
Virtually all forms of ART are now available in Nigeria
There is no law governing the practice of ART in Nigeria
despite the relatively long duration of practice

23. Nurses role in assisted reproductive technology
• Nurses should advocate for the availability of good
information and public participation in shaping policies
about assisted reproductive technologies
• Nurses should give priority to health promotion and disease
preventive approaches to be known causes of infertility which aid
in efficient means of increasing fertility
• Nurses should provide unbiased counseling to clients in referring
them to reproductive specialists as required and in translating
technical medical information to those struggling to make choices
about their use of reproductive technologies

24. Recommendations
• Health providers and program managers should safeguard clients’
health by providing education on the biological causes of infertility
and the links between untreated or improperly treated STIs and
infertility
• Governments should invest in more quality-control and
enact regulatory policies to help prevent exploitation of
patients in low-resource settings
• Seminars and workshops should be put in place so as to
enlighten health care workers especially nurses about
modern ART techniques

25. References
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