Symposium on RECENT ADVANCES IN ASSISTED REPRODUCTIVE TECHNOLOGY

Transcription

1 Symposium on RECENT ADVANCES IN ASSISTED REPRODUCTIVE TECHNOLOGY Dr Niel Senewirathne Senior Consultant of Obstetrician & Gynaecologist De zoyza Maternity Hospita 1

2 ART - IVF & ICSI 2

3 Infertility No pregnancy has occurred after 1 year of regular unprotected sexual intercourse 1 in 6 couples remains unintentionally childless 3

4 Treatments available in ART Gamete Intrafallopian transfer [GIFT] In-vitro Fertilisitation [IVF] Intracytoplasmic Sperm Injection [ICSI] Assisted Hatching [AH] Ovum Donation Embryo Donation Cryopreservations 5

5 In Vitro Fertilization Test tube babies 6

6 History In 1978 Louise Brown, first IVF baby was born as a result of collaborative work by Robert Edwards, a scientist from Cambridge and Patrick Steptoe, a gynaecologist in Lancashire 7

7 In July 1978, Louise Brown 8

8 Origin of IVF Most of the technological steps needed for Louise Brown s conception had been developed years earlier in veterinary medicine 9

9 History 1981 Elizabeth Carr, first IVF baby in USA 1983 First birth after egg donation 1985 First birth from cryopreserved embryo 1985 Transvaginal ultrasound for follicle monitoring 1990 First report of births after PGD 1990 First report of egg donation to older mothers 1992 First human birth after ICSI 10

10 Success rate of IVF? Success rates vary and are often exaggerated To attract more clients Probably around 30 % successful (under the age of 36 years ) At 43 years - success rate 5% Female age - the most powerful predictor of success in IVF Also - Smoking, obesity, poor diet, occupational hazards has a significant impact on IVF outcome. 11

11 Indications Failed IUI (after 4 6 trial IUI) Severe tubal disease/blockage Severe endometriosis Significant male factor(poor sperm quality) Unexplained infertility Others-genetic disorders/cancers 12

12 Male infertility related to sperms Low sperm count: milliliter of semen. 10 million sperms per Poor sperm motility: sperm will be unable to swim through cervix to meet the egg in the fallopian tube. Poor morphology: individual sperm is unable to penetrate the outer layer of an egg & to get fertilized. 13

13 Principals of IVF is simple 1. Controlled ovarian stimulation 2. Ovum Pick up 3. Fertilization in Culture Media 4. Embryo Development 5. Embryo Transfer 6. Luteal phase support 14

14 What is IVF cycle? 15

15 Controlled ovarian Stimulation A. Long GnRH Agonist Protocols B. Short GnRH Agonist Protocol C. Ultra-short GnRH Agonist Protocol D. GnRH Antagonist Protocol? Natural Cycle 16

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17 B. SHORT GnRH AGONIST PROTOCOL Menses (day 1) Oocyte collection GnRH agonist starts day 2 to day of hcg ganodotrophin stimulation from day 3 to day of hcg hcg 18

18 C. ULTRA-SHORT GnRH AGONIST PROTOCOL Menses (day 1) Oocyte collection GnRH agonist from day 2 for 3 days gonadotrophin stimulation from day 3 to day of hcg hcg 19

19 D. GnRH ANTAGONIST PROTOCOL Menses (day 1) Oocyte collection Gonadotrophin stimulation From day 2 to day of hcg Single injection antagonist day 9 hcg 20

20 Egg collection About 34hours after an injection of hcg, the eggs are recovered by sucking them from the follicle into a very fine needle inserted through wall of the vagina with the help of transvaginal sonography. 21

21 Collect eggs from the woman cont 22

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23 Oocyte retrieval 24

24 Oocyte retrieval 25

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27 Insemination of Egg & Sperm The eggs are brought together with the prepared sperm (as per IUI) in a culture media in a laboratory. Eggs & sperm remain in this special fluid in an incubator at 37 C, 6% CO2 atmosphere. 28

28 Fertilization After about hrs of sperm insemination, a check is made to see whether fertilization has occurred or not? If 2 PN and / or 2 PB seen then it consider as fertilization occurred Again fertilized eggs are incubated for more 24 hrs in fresh culture media at 37 C 6% CO2. 29

29 Fertilized eggs are incubated 30

30 Embryo Development About after 48 hrs of insemination, when fertilized eggs grows in to 4 8 cell stage, is known as Embryo development 31

31 Blastocyst Culture Allowing fertilized eggs (Embryos) to develop into multi cellular stage for 4 5 days outside the body (inside laboratory) in special culture media called Blastocyst culture. Embryos reach upto Blastocyst shows highest viability of particular Embryo and may required less no. to transfer 32

32 Blastocysts 33

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34 Transfer embryos into uterus of woman Using a flexible transfer catheter into which the embryos are loaded suspended in 50 μl of culture medium 2-3 embryos are transferred Insertion of the transfer catheter to about 1 cm below the fundus Abdominal ultrasound is used to monitor catheter placement 35

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36 Luteal Phase Supplementation Progesterone supplemention hcg Administration 37

37 Complications Ovarian hyperstimulation Higher order pregnancy Ectopic pregnancy Ovaum retrieval complications Ovarian abscess, bowel damage rate <1% 38

38 Intra Cytoplasmic Sperm Injection 39

39 ICSI Male factor infertility (very less count, motility, abnormal morphology etc.) Obstructive Azoospermia. Failed Fertilization through IVF. Egg quality is not good (thick zona etc.) 40

40 ICSI ICSI is a further development of IVF. ICSI is the injection of a single sperm into each viable egg, the objective being to increase the chance of fertilization & development of embryo used in conjuction with a IVF procedure 41

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43 THANKYOU 44