Assisted Reproduction Technology

1. REPRODUCTIVE BIOTECHNOLOGY
BY
YAKUB AZEEZAT D.
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2. REPRODUCTIVE
BIOTECHNOLOGY
 This is a technology that improves reproductive
insufficiency through different techniques.
 It is also termed Assisted Reproductive
Technology and it involves equipments and
procedures used in treatment of infertility
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3. INFERTILITY
 Infertility is the biological inability of a couple to conceive
after 1 year of regular unprotected sex without using
contraceptive
 It affects as many as 186million people worldwide
 Male infertility is an underlying cause in approximately 1/3rd
of couples. Female infertility also contributes to 1/3rd of
infertility cases with 1/3rd undetermined or from both
partners
 The chance of conception for young fertile couples is 20-37%
during the first 3 months. The chance of success increases to
80% by one year and 90% after two years of trying.
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4. CAUSES OF INFERTILITY
FEMALE INFERTILITY
 Uterine factors such as Fibroid (Non-cancerous
tumors that develop on or in the walls of the uterus),
cervical polyps, endometriosis.
 Ovarian/tubal factors such as Polycystic ovarian
syndrome (PCOS), Primary Ovarian Insufficiency
(POI), tubal blockage, scar tissues
 Hormonal factors such as hyperprolactinemia
(excesssive prolactin), hypothalamic dysfunction
(results in LH and FSH imbalance)
 Advanced maternal age
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5. MALE INFERTILITY
 azospermia(no sperm cells are produced)
 Oligospermia (low sperm count).
 Teratozoospermia (abnormal cell morphology)
 Asthenozoospermia (poor sperm motility)
 Erectile disorder
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6. CAUSES OF INFERTILITY
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7. ASSISTED REPRODUCTIVE
TECHNOLOGY (ART)
 ART includes medical procedures used to address infertility.
 The process of sexual intercourse is sometimes bypassed and
fertilization of oocytes occurs in the laboratory environment
 The methods of ART include;
a. Invitro fertilization (IVF)
b. Intracytoplasmic Sperm Injection
c. Gametes Intrafallopian tube Transfer (GIFT)
d. Zygote Intrafallopian tube Transfer (ZIFT)
e. Surrogacy
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8. 8

9. INVITRO FERTILIZATION (IVF)
• In Vitro Fertilization is the uniting of egg and sperm in
vitro(in the lab) and subsequently transferring the
embryo into the uterus through the cervix
 It is usually the most common method for female
infertility
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10. PROCEDURES IN IVF
 Ovary stimulation: Drugs are given to stimulate the ovary to
produce more than one ovum. It involves suppression of
spontaneous ovulation and two methods are available:
a. GnRH agonist protocol: Beginning of hyperstimulation
treatment and date of oocyte retrival can be chosen to
conform to personal choice
b. GnRH antagonist: Treatment must be adapted to the
spontaneous onset of previous menstruation 40
c. Oocyte retrieval: Induction of final oocyte maturation is
done by injection of hCG and ovulation would occur
between 38 and 40hours after a single hCG injection.
Oocyte retrival is done 34-36hours after hCG injection
using a transvaginal technique
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11. PROCEDURES IN IVF
 Sperm retrieval and washing: Approximately 3hours to the
procedure, sperm is obtained and washed by separating
seminal fluid and removing inactive cells
 Fertilization: The egg and sperm are fertilized in the
laboratory
 Embryo transfer: One or more embryos are transfer to the
patient’s uterus to improve chances of implantation and
pregnancy
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12. PROCEDURES IN IVF
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13. EGG DONOR
Egg donation is used in IVF mostly due to the high success rate
which is about 55%-63%. It usually involves the egg donor,
recipient (future mother) and sperm donor (future father).
There are various types of egg donor:
 Anonymous donor: They are recruited by the IVF clinic and
identity is unknown to the clients. Its usually for monetary
reasons
 Designated donors: They are brought in by the patients e.g
friend or relative
 Patients who go through IVF taking part in shared oocyte
programmes donating unused eggs to such program
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14. EGG DONOR CONT’D
PROCEDURES INVOLVED ARE
 Donor recruitment and screening which involves carrying
out of physical examinations, blood tests, medical and
psychological history, pelvic ultrasound. A legal contract is
also signed by the parties involved .
 Ovarian stimulation: Involves receiving of hormonal
treatments and this is usually administered by the donor
herself in form of subcutaneous injection for a period of 1-
3weeks.
 Follicular puncture: Approximately 36hours to the
procedure, an HCG injection is administered to produce LH
hormone peak. Oocytes are retrieved surgically through an
ultrasound guided transvaginal procedure
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15. INTRACYTOPLASMIC SPERM
INJECTION (ICSI)
 It involves the direct injection
of sperm into eggs obtained
from invitro fertilization (IVF)
 It is used if infertility
originates from the male
 Fertilization rates of 70-80%
of all eggs injected is achieved
with ICSI
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16. PROCEDURE OF ICSI
 The mature egg is held with a specialized pipette.
 A very delicate, sharp, and hollow needle is used to
immobilize and pick up a single sperm.
 The needle is then carefully inserted through the shell
of the egg and into the cytoplasm of the egg.
 The sperm is injected into the cytoplasm, and the
needle is carefully removed.
 The eggs are checked the following day for evidence of
normal fertilization.
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17. GAMETE INTRAFALLOPIAN
TUBE TRANSFER (GIFT)
 Eggs are removed from a
woman’s ovaries and placed
in one of fallopian tubes
along with the man’s sperm
 The first attempt was made
by Steptoe and Edwards.
 Approximately 25-30% of all
GIFT cycle result in
pregnancy
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18. PROCEDURE OF GIFT
 The Patient must have atleast an healthy fallopian tube
 Using a laparoscope, eggs are then retrieved from the ovaries.
 The male provides a sperm sample the same day that the eggs
are retrieved.
 The eggs are then mixed with the sperm in a catheter.
 The egg and sperm mixture is inserted into the fallopian
tubes with a catheter.
 The woman is then provided with medication to build up the
uterine lining to support implantation of a fertilized egg
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19. ZYGOTE INTRAFALLOPIAN
TUBE TRANSFER (ZIFT)
 It is a treatment used when
blockage of fallopian tubes
prevent normal binding of
sperm to the egg .
 Egg cells are removed from a
woman’s ovaries, and in vitro
fertilized, the resulting
zygote is placed into the
fallopian tube by the use of
laparoscopy
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20. PROCEDURE OF ZIFT
 A woman’s ovaries are stimulated with medications and
eggs are retrieved.
 Those eggs are fertilized in a laboratory in a procedure
identical to IVF, with the exception of the time frame.
 During the ZIFT procedure, fertilized eggs are transferred
through a laparoscopic procedure within 24 hours, versus
3-5 days as used in a regular IVF cycle.
 The final step is to watch for early pregnancy symptoms
 Average pregnancy rates per embryo transfer are 42% in
ZIFT-ICSI cycles and 37% in ZIFT-non-ICSI cycles
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21. ART TECHNIQUES
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22. INTRAUTERINE INSEMINATION(IUI)
 This is a fertility treatment
that involves placing sperm
inside a woman’s uterus to
facilitate fertilization
 It is less invasive and less
expensive compare to IVF
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23. PROCEDURE OF IUI
 Ovulation stimulation medication may be
administered to the woman
 The procedure will be performed around ovulation
period , about 24hours to LH surge
 The collected semen sample will be washed to
separate semen from seminal fluid
 Catether will be used to insert the sperm directly into
the uterus
 It increase the number of sperms reaching the
fallopian tubes and increase chance of fertilization
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25. SURROGACY
 This is an arrangement often
supported by a legal agreement
where a woman agrees to
delivery on behalf of another
person or couple who will be the
child’s parents after birth
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26. TYPES OF SURROGACY
 Traditional surrogacy: The surrogate is impregnated
naturally or artificially, but the resulting child is
genetically related to the surrogate
 2. Gestational surrogacy: An egg is removed from the
intended mother or an anonymous donor and fertilized
with the sperm of the intended father or anonymous
donor. The fertilized egg, or embryo, is then transferred
to a surrogate who carries the baby to term
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27. OTHER ART TECHNIQUES
 Assisted Zona Hatching: This procedure involve making a
small hole in the zona pellucida using micromanipulator to
facilitate zona hatching
NB: Zona hatching is when the blastocyst gets rid of the
surrounding zona pellucida to allow implantation to the
uterus.
 Embryo splitting: This is the formation of twins or multiple
embryos invitro to split an embryo in 2, 4, or 8 cell stage to
increase number of available embryo
 Cryopreservation: It involves the removal of egg from a
woman’s ovary, fertilizing with sperm to form an embryo
which is frozen and can later be removed and placed in the
uterus. This is a type of fertility preservation
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28. RISK FACTORS OF ART
 Miscarriage
 Low birth weight
 Multiple pregnancies
 Birth defects
 Ectopic pregnancy
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29. ETHICAL ISSUES
 Religious response: In Islam, Gad El-Hak’s ART fatwa
includes that IVF is allowed only if the egg and sperm are
from the couples and the fertilized egg is transferred back to
the uterus. A third party donor is not accepted as it is
tantamount to adultery (zina)
The catholic church opposes all kinds of ART as they consider
it to be a replacement of the marital act and therefore
immoral
The Hindus welcome IVF as a gift for those unable to bear
children .
• Society and Culture: Many women of Sub-saharan Africa
choose to foster their children to infertile women.
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30. ETHICAL ISSUES
Since ART allows this women to have their own children, it
imposes new idea to the culture. This could result in
decreased resources for large families and ultimately hinder
community’s growth
 Profit desire of the industry: The IVF industry has been
described as a market-driven industry. In 2008, a California
physician transferred 12 embryos to a woman who gave birth
to octuplets. This led to acccusations that a doctor is willing
to endanger the health of people for money
 Transgender parents: There is a misconception about
children of transgender parents not being good compared to
cisgender parents. However, a study was done in france and it
shows that children of both transgender and cisgender
parents have the same level of childhood development and
psycho-emotional health
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31. CONCLUSION
 ART has been the answer for many childless
couples, resulting in successful pregnancies and
childbirth.
 Today there is a range of infertile treatment that
aims to ensure a healthy sustainable pregnancy.
 There are still risks, stress and high cost associated
with ART but with the advent of new technologies,
it is hoped that these shortcomings would be
overcome in the nearest future and every infertile
couple would have the privilege of parenthood.
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32. REFERENCES
 Al-Inany, H. G., Youssef, M. A., Ayeleke, R. O., Brown J., Lam, W. S., Broekmans, F. J., (2016).
“Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. The Cochrane
Database of Systemic Reviews, 4(8): CD001750.
 Alan, O. S. (2015). Acupuncture for IVF and Assisted Reproduction. The fundamentals of ART,
pg143-159.
 Almeling R. (2007). Selling genes, selling gender: Egg agencies, sperm banks and the medical
market in genetic material. American Sociological Revciew. 72(3):319-40
 Ayeleke, R. O, Asseler, J. D, Cohlen, B. J, Veltman-Verhust, S. M (2020). “Intrauterine insemination
for unexplained subfertility”. The Cochrane Database of systematic Reviews, 3: Cd001838.
 Bhatia Kalsang, Martindale Elizabeth , Rustamov Oybek, Nysenbaum Anthony M. (2009).
“Surrogate pregnancy: an essential guide for clinicians”. The Obstetrician & Gynecologist, 11(1), 49-
54.
 Condat, A., Mamou, G., Lagrange, C., Mendes, N., Wielart, J., Poirier, F. (2020). Transgender
fathering: Children’s psychological and family outcomes. PLOS ONE, 15(11):e0241214.
 Brinsden, P. R. (2005). Gift (Gamete Intrafallopian Transfer). East Sussex, UK: CHILD: The National
Infertility Support Network.
 Drah B, (2012). Orphans in sub-saharan Africa: The Crisis, the interventions and the
Anthropologist. Africa Today. 59(2)3-21
 Edgar, D. H, Gook, D. A. (2012). A critical appraisal of cryopreservation (slow cooling versus
vitrification) of human oocytes and embryos, 18 (5), 536-554
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33. REFERENCES
 Farquhar C., Majoribanks J., Brown J., Fauser B., Lethaby A., Mourad S. (2017). Management of
ovarian stimulation for IVF: narrative review of evidence provided for World Health Organization
guidance. Reprod Biomed Online, 5(1), 3-16.
 Gargus , E. S., Rogers, H. B., Mckinnon, K. E., Edmonds, M. E., Woodruff, T. K. (2020). Nat.
Biomes. Eng. 4, 381.
 Ginsburg Elizabeth (2018). “Procedure for intrauterine insemination (IUI) using processed sperm.
 Haddad M., Stewart J., Xie P., Cheung S., Trout A., Keating D. (2021). Thoughts on the popularity
of ICSI. J Assist Reprod Genet, 38(1), 101-23.
 Hartman, H. E. (2019). Earning while giving: Rhetorical strategies for navigating multiple
institutional logics in reproductive commodification. Journal of Busines Research. 105:405-419.
 Haas, J. M. (2012). Begotten not made: A catholic view of Reproductive Technology.
 Imrie Susan, Jadva Vasanti. (2014). “The long term experiences of surrogates: relationships and
contact with surrogacy families in genetic and gestational surrogacy arrangements”. Reproductive
Biomedicine Online, 29(4), 424-435.
 Inhorn, M. C., Patrizio, P. (2015). Infertility around the globe: new thinking on gender,
reproductive technologies and global movements in the 21st century. Hum Reprod Update, 21(4),
411-26.
 Jones, H. W, Edwards, R. G, Seidel, G. E. (1993). Fert Steril, 61, 423-426
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34. REFERENCES
 Kumar N., Singh A. K. (2015). Hum J. Reprod. Sci., 8,191.
 Makar, R. S., Toth, T. L. (2002). “The evaluation of infertility”. American Journal of
Clinical Pathology. 117, 95-103
 Martins, W. P, Rocha, I. A, Ferriani, R. A, Nastri, C. O. (2011). Assisted hatching of human
embryos: A systematic review and meta-analysis of randomized controlled trials. Human
Reproduction Update, 17(4), 438-453.
 Toner, J. P. (November 2002). “Progress we can be proud of : US trends in assisted
reproduction over the first 20years. Fertility and sterility, 78(5), 948-950
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35. THANKS
FOR
LISTENING
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