Assisted Reproductive Technology (ART)

Is the technologies used to assist people in achieving a pregnancy.

 

ART

• Treat infertile couples.

• Treat women who cannot fall pregnant.

• Help women who cannot carry a baby in pregnancy or give birth.

• Reduce the chance of a child inheriting a genetic disease or abnormality.

 

Full counselling prior to treatment is provided to ensure that people are fully aware of treatment’s process and associated risks.

 

ART

 

Simple Therapies often tried initially:

• Ovulation induction.

• Artificial insemination or intrauterine insemination.

• Donor insemination.

 

Advanced Techniques

• In-Vitro Fertilisation (IVF).

• IntraCytoplasmic Sperm Injection (ICSI).

• Pre-implantation Genetic Diagnosis (PGD).

 

 

Eggs naturally form in the ovariesunder the effect of two hormones in the pituitary gland in the brain; Follicle-Stimulating Hormone FSH and Luteinising Hormone LH. The FSH stimulates the growth of follicles in the ovaries ‘fluid-filled sacks containing one egg in each’. One follicle becomes dominant and the other follicles stop developing. Luteinising Hormone LH release causes the egg to mature. When Ovulation occurs ‘the follicle releases the egg’ the fallopian tube captures the egg; which may then be fertilised by sperm.

 

Sperm naturally form in the testes under the influence of Pituitary FSH and LH. The luteinising hormone aids in the production of testosterone, which together with the follicle stimulating hormone, stimulates the production of sperm. In the testes, cells divide over and over again to produce sperm. The sperm matures into the epididymis ‘long coiled tube’ for two to ten days. On ejaculation the sperm moves on to the urethra in the penis.

 

 

Simple Techniques

 

Ovulation Induction

Ovulation induction may be used by women who are not ovulating or are not ovulating regularly, or who are producing only low levels of hormones that are required to enable her to conceive. Ovulation induction involves taking oral tablet which stimulates the production of pituitary follicle-stimulating hormone or FSH injection to stimulate the ovary. This encourages the development of one or more follicles. When the follicles are large enough, Luteinizing hormone LH is administered to release the egg from the follicle. Intercourse around this time, increases the chances of conception.

 

Artificial Insemination or Intrauterine Insemination IUI

The process of artificial insemination involves insertion of a male partner’s semen through the female’s cervix and into the uterus at or near the time of ovulation.

Artificial insemination (intrauterine insemination) can help women who have normal and healthy fallopian tubes, but for some reason cannot achieve conception. This may be due to

 

·        Mechanical difficulties with intercourse; not able to achieve an erection.

·        Structural problems of the penis after trauma or surgery.

·        Use of frozen sperm i.e. male partner’s absence or before cancer treatment.

 

IUI can be performed during

·        Natural menstrual cycle.

·        Hormonal stimulated cycle if the woman has irregular menstrual cycles.

 

If a few attempts with artificial insemination do not achieve pregnancy, the use of IVF or ICSI may be discussed.

 

Donor Insemination

Donor Sperm Insemination is the same as artificial insemination, but the sperm used is that of a donor, rather than the male partner within a relationship. It is utilised when:

• A male partner does not produce sperm, or

• A male partner does not produce normal sperm, or

• There is a high risk of a man passing on a genetic disease or abnormality to a child.

 

Donor insemination may also be used as part of IVF for single women, or women in same-sex relationships.

 

Donor Sperm, Eggs, or Embryos can be used to facilitate ART treatments.

 

Donor Eggs

Treatment with Donor Eggs is advised if a woman

·        Cannot produce eggs or

·        Her eggs are of low quality.

 

This may occur due to

·        Age.

·        Premature Ovarian Failure ‘No eggs in the ovary’.

·         Recurrent Miscarriage.

·        High risk of the woman passing on a genetic disease or abnormality to a child.

 

The egg donor undergoes the initial steps of IVF to collect her eggs. The sperm from the male partner of the recipient woman, or donor sperm, will be combined with the donor eggs. Two to five days later, when embryos are formed, an embryo will be inserted into the woman’s uterus (Embryo Transfer). The recipient woman must take Hormone treatment to prepare the endometrium (lining of the womb) for the embryo transfer, and for approximately 10 weeks after the embryos have been transferred.

 

Donor Embryos

Embryos from couples who choose to donate their frozen embryos that they no longer need after IVF procedures could be available to a person or couple who needs donor sperm and donor eggs. The embryo is transferred into a woman’s uterus after hormonal preparation or few days after ovulation.

 

Advanced Techniques

 

In-Vitro Fertilisation (IVF)

IVF is the process used to conceive a child outside the body. Initially IVF was used to achieving pregnancy for women whose fallopian tubes are damaged or blocked due to disease or sterilization and as a result there is an obstruction between the egg and sperm. Now IVF is used in a range of circumstances to assist with conception. In IVF, the woman’s eggs are collected, along with sperm from the male partner or donor and both are left in a culture dish in a laboratory to allow the egg to be fertilised by the sperm. This creates embryos. An Embryo is then placed back into the woman’s uterus Embryo Transfer (ET). Excess embryos are frozen for use in later transfer procedures.

 

Gamete Intra-Fallopian Transfer (GIFT)

GIFT is a more ‘natural’ form of IVF. Fertilisation occurs in one of the woman’s healthy functioning fallopian tubes instead of laboratory culture dish. The woman’s eggs are retrieved from her ovaries as in IVF and inserted between two layers of sperm in fine tube. This tube is then fed into one of the woman’s fallopian tubes, where the egg and sperm are left to fertilise naturally. Today, GIFT is very rarely used as an option for couples who don’t want to use IVF for religious reasons.

 

Intra-Cytoplasmic Sperm Injection (ICSI)

ICSI follows the same process as IVF but ICSI involves the direct injection of a single sperm into each egg to achieve fertilisation. It is used for the same reasons as IVF, especially when a man has sperm-related problems such as low sperm count or high percentage abnormal forms.

 

Pre-implantation Genetic Diagnosis (PGD)

PGD is offered to

·        Reduce the risk of an individual or couple passing on a specific genetic or chromosomal disease or abnormality to their child.

·        Women older than 38

·        Individuals or couples who have experienced repeated miscarriage

·        Repeated IVF failure.

 

In PGD, embryos are generated through the process of IVF ICSI and then one or two cells from each embryo are screened for abnormality prior to the transfer of the embryo into a woman’s uterus. Only unaffected embryo is transferred. This allows the individual or couple to choose a normal embryo for transfer, rather than face a difficult choice of whether or not to terminate a pregnancy.

 

Surrogacy

Surrogacy is a form of ART in which a Woman (The Surrogate Mother) carries a child for another person or couple with the intention of surrendering the child to that person or couple immediately after birth.

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