The document discusses assisted reproductive technology (ART), focusing on in vitro fertilization (IVF) and other methods for addressing infertility. It also highlights ethical issues surrounding ART, including complications from laboratory errors, donor anonymity, and the implications of surrogacy. The advancements in ART have brought about social, legal, and ethical challenges that need to be addressed as techniques evolve.

1. ASSISTED REPRODUCTIVE
TECHNOLOGY
PRESENTED BY:
AKUMBOM EURICE NSHITI (BSN, MPH, PhD Cand.)
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2. Outline
Introduction
Definitions
In vitro fertilization
Other methods of assisted reproduction
Ethical issues
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3. Introduction
• Infertility has traditionally been an area of medicine in which
physicians had limited means to help their patients.
• Infertility is the inability of a sexually active, non-contracepting couple
to achieve pregnancy in one year.
• The landscape of this field changed dramatically with the
announcement of the birth of Louise Brown in 1978 through in vitro
fertilization (IVF).
• However, the explosion of this technology has introduced a myriad of
new social, ethical, and legal challenges.
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4. Definition
Assisted reproductive technology (ART): all treatments or procedures that
involve the in vitro handling of both human oocytes and sperm or of
embryos for the purpose of establishing a pregnancy. (Centre for Disease
Control).
ART involves a number of different procedures to help address fertility
problems and increase the likelihood of pregnancy
These include:
 In vitro fertilization (IVF)
 Gamete intrafallopian transfer (GIFT)
 Zygote intrafallopian transfer (ZIFT)
 Intracytoplasmic sperm injection (ICSI)
 Surrogacy
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5. In vitro fertilization
Definition: IVF is the uniting of egg and sperm in vitro (in the lab).
Subsequently the embryos are transferred into the uterus through the
cervix and pregnancy is allowed to begin.
Who need IVF?
Couple has infertility problem.
 Men with low sperm count, abnormal sperm, no mature sperm,
antibody against sperms etc.
 Women with oviduct obstruction, endometriosis, endocrine imbalance,
reproductive organ infection, antibody against partner’s sperms etc.
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6. In vitro fertilization
Steps
 Collection of oocytes
 Collection of sperms
 IVF of the oocytes
 Implantation of resulting zygote into the uterus
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7. 7

8. In vitro fertilization
1. Collection of oocytes
Conditions
 Females desiring a baby
 Females with functional ovaries
 During a natural menstrual cycle
 During an induced menstrual cycle
 Time determined by monitoring LH
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9. In vitro fertilization
Procedure:
Recovery of oocytes can be done most conveniently by a laparoscopic
instrument that allows the visualization of ovary through a monitor,
aspiration (suction) of the follicular fluid containing the oocytes and the
necessary surgical manipulation of ovary using sensors, laparoscopic
scissors and an aspirating apparatus inserted into the abdomen of the
female via a suitable tube.
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10. In vitro fertilization
2. Collection of sperm
 Abstain from sexual intercourse or masturbation for 2 – 5 days
 Sperm cells can be collected by masturbation, condomistic intercourse,
coitus interruption, surgical aspiration etc.
 Collected about 60-90 minutes prior to fertilization, liquefied (Liquefaction
is the breakdown of the gel portion of the seminal plasma) and
centrifuged (Centrifugation is utilized when processing semen for freezing
or to remove seminal plasma that has been contaminated with urine
during semen collection).
 Resuspended in culture medium, and incubated for 30-60 mins at 37⁰ C.
 The most active sperms are located in the surface of the medium.
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11. In vitro fertilization
Terminologies of sperm analysis
 Oligospermia – sperm concentration <15 million/ml.
 Azoospermia – no spermatozoa in semen.
 Polyzoospermia – ++ high sperm concentration, >200M/m
 Aspermia – no semen volume
 Pyospermia – leukocytes present in semen, >1M/ml
 Hematospermia – red blood cell present in semen
 Necrozoospermia – “dead” sperm
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12. In vitro fertilization
Indicators for donor sperm IVF
 Azoospermia with testicular failure
 Hereditary disease in men
 Severe untreatable isoimmunisation in wife
 Single women, lesbian couples etc.
 Vasectomy
 Husband impotent
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13. In vitro fertilization
3. IVF of the oocytes
Fertilization is started by adding 10,00050,000 motile sperms to about 100
µl to 1 ml culture medium in which the oocytes is being incubated.
The oocytes is examined after 12-13 hourrs for detection of;
 Number of pronuclei and polar bodies
 Granulation of the oocytes and
 Shape of the oocytes
A normally fertilized oocyte (actually a zygote now) contains two pronuclei
and two polar bodies. Any zygote other than this and having abnormalities
and granulation of any kind are rejected.
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14. In vitro fertilization
The first division in the zygote occurs about 24-30 hrs after
insemination, but each subsequent division takes about 10-12 hrs.
Therefore, if an oocyte fails to divide by 30 hrs after insemination, it
should not be used for implantation.
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15. In vitro fertilization
Day 0 Egg retrieval, Sperm collection, and preparation
Insemination in vitro
Day 1: Check eggs for fertilization (the presence of two pronuclei or
PN's)
Day 2: Embryos at the 4-cell or more stage of development
Day 3: Embryos at the 8-cell or more stage of development
Day 4: Embryos at the compacted morula (16-32 cell) stage
Day 5: Embryos at the blastocyst stage of development
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16. In vitro fertilization
4. Embryo transfer
A blastocyst transfer is an embryo transfer which involves transferring
one or more embryos that are at a very advanced stage of
development, the so-called blastocyst stage. This is usually done on the
fifth day after follicular aspiration.
It is at the blastocyst stage of development (five days after fertilisation)
that an embryo would normally move out of the fallopian tube and into
the uterus. Once in the uterus, the blastocyst starts to attach to the
uterine lining in a process known as implantation.
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17. In vitro fertilization
• The advantage of attempting to grow embryos to the blastocyst stage
is that they should have a greater chance of implantation because
the phase of embryo development matches the uterine environment.
As a result, fewer embryos can be replaced, which will minimise the
risk of a multiple pregnancy.
• The disadvantage is that fewer embryos will “survive” or grow to
this phase (probably about 30%-50% of them).
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18. In vitro fertilization
Embryo transfer technique
The patient is orally administered with Valium before embryo
transfer.
The patient is placed in lithotomy (knee chest) position.
A sterile bivalve speculum is inserted to visualize the cervix.
The cervical canal and uterine cavity are aligned.
The embryo is drawn into a Teflon catheter in tissue culture
medium. Teflon is used due to its low adhesiveness
The catheter is inserted into the uterine cavity just short of the
fundus. 18

19. In vitro fertilization
Embryo transfer technique
The embryo is gently inserted in culture medium and the catheter
and cannula are gently withdrawn.
Catheter is examined under the microscope to ensure that the
embryo has been expelled.
The babies produced using these approaches are called test tube
babies.
The first test tube baby was born on July 25, 1978 and was named
Louise Joy Brown.
The Nobel Prize of Medicine for the year 2010 was awarded to
Robert G. Edwards for this outstanding invention 19

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21. In vitro fertilization
IVF success rate
 IVF success rates are the percentage of all IVF procedures
which result in a favourable outcome, which implies
Pregnancy rate (Number of confirmed pregnancies) or Live
birth rate (Number of live births).
Due to advancement in reproductive technology, the IVF
success rates are substantially better today than they were
just a few years ago.
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22. In vitro fertilization
Factors affecting success rate
• Maternal age
• Duration of infertility or sub-fertility
• FSH
• Number of oocytes
• Tobacco smoking
• High body mass index
• Alcohol/caffeine intake
Assignment: Briefly explain how these factors can affect IVF success
rate
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23. Other Methods of Assisted Reproduction
A. Pre-implantation genetic screening or diagnosis (PGS or PGD):
Preimplantation genetic screening (PGS) or preimplantation genetic
diagnosis (PGD) has been suggested to be able to be used in IVF to
select an embryo that appears to have the greatest chances for
successful pregnancy.
B. Embryo splitting: It can be used for twinning to increase the
number of available embryos.
C. Intra cytoplasmic sperm injection It is an in vitro fertilization
procedure in which a single sperm is injected directly into an egg.
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24. Other Methods of Assisted Reproduction
D. Assisted zona hatching: is a procedure 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.
E. Gamete intrafallopian transfer (GIFT): eggs are removed from
the woman, and placed in one of the fallopian tubes, along with
the man's sperm. This allows fertilization to take place inside
the woman's body. Therefore, this variation is actually an in
vivo fertilization, and not an in vitro fertilization. 24

25. Other Methods of Assisted Reproduction
F. Zygote intrafallopian transfer (ZIFT): 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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26. Ethical issues
Laboratory mix-ups (misidentified gametes, transfer of wrong
embryos) have occurred, leading to legal action against the
IVF provider and complex paternity suits.
An example is the case of a woman in California who received
the embryo of another couple and was notified of this mistake
after the birth of her son. This has led to many authorities and
individual clinics implementing procedures to minimise the
risk of such mix-ups.
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27. Ethical issues
The Catholic Church opposes all kinds of in vitro fertilisation
because, as with contraception, it separates the procreative
purpose of the marriage act from its unitive purpose, i.e. to
produce a new life.
Pre-implantation screening: A deaf British couple have
petitioned to create a deaf baby using IVF. Medical ethicists
are against this form of Pre-implantation genetic screening or
diagnosis
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28. Ethical issues
Use of donor eggs/sperms
Parentage: Who are the parents? Are they the ones whose genetic
material (sperm and egg) combine to form the child or the people who
raise the child?
Disclosure: Should children know that one or both of his or her
(rearing) parents did not provide the egg or sperm which brought them
into being?
Should children have access to the donor(s) (genetic parents)?
Should genetic parents have visitation rights?
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29. Ethical issues
Embryo cryopreservation (the process of preserving an embryo at sub-
zero temperatures, generally at an embryogenesis stage)
Left over embryos are cryopreserved, owners don’t get to use them after
all. Four possible fates for these embryos exist
• Thawing and discarding
• Donating to research
• Indefinite storage
• Donating the embryos to another couple for the purposes of uterine
transfer
In the event of divorce who gets custody of the embryo?
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30. Ethical issues
Surrogacy and Gestational carriers
Surrogacy is defined as a woman who agrees to carry a
pregnancy using her own oocytes but the sperm of another
couple and relinquish the child to this couple upon delivery.
A gestational carrier, by contrast, involves a couple who
undergoes IVF with their genetic gametes and then places the
resultant embryo in another woman’s uterus, the gestational
carrier, who will carry the pregnancy and relinquish the child
to this couple upon deliver
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31. Ethical issues
Surrogacy and Gestational carriers
 Significant medical and emotional risks from carrying a pregnancy and
undergoing a delivery
 Child selling enterprise -Some also are concerned that the use of
surrogates and gestational carriers is a form of “child selling” or the
“sale of parental rights”
 Parental rights- Possibility of five parents. Genetic father, genetic
mother, Rearing father, Rearing mother, gestational mother.
 Exploitation and commoditization of children.
 Citizenship of the offspring(international surrogacy)
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32. THANKS FOR LISTENING
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