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What is Assisted Reproductive Technology?

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1 What is Assisted Reproductive Technology?
Amanda J. Weathers

2 Assisted Reproductive Technology
Assisted Reproductive Technology (ART) has been used in the United States since 1981 to help women become pregnant. The most common procedure is through the transfer of fertilized human eggs into a woman’s uterus. Infertility is often defined as not being able to get pregnant after trying for one year. Of the approximately 60 million women of reproductive age in 1995, about 1.2 million, or 2%, had an infertility-related medical appointment within the previous year, and 15% had an infertility-related medical visit at some point in the past. For many people who want to start a family, the dream of having a child is not easily realized.. However, deciding whether to undergo this expensive and time-consuming treatment can be difficult.

3 What is Infertility, Anyway?
                                                                                                       Infertility is a disease that affects the reproductive organs of both men and women. It impairs one of the body’s most basic functions, which is the ability to have children. Infertility affects about 6.1 million women and men in the United States; this is 10 percent of the reproductive-age population. Smoking sexually transmitted infections, age, and an unhealthy body weight can increase risks of infertility. Unlike many other disease like lung cancer or HIV/AIDS, people are rarely informed of the very direct links between their behavior and their reproductive health. One and six couples struggle with infertility issues, with the odds of conceiving against them. Some what recently people have been able to increase their chances of conceiving with Assisted Reproductive Technology techniques. If people decide to use these procedures they can be painful and emotionally draining, however it can be an answer for infertile couples.

4 Human Fertility Over A Lifetime
Your decisions NOW can impact your ability to conceive in the future Infant – Male – doesn’t produce sperm until puberty Female – at birth the girls pair of ovaries contain up to 1,000,000 follicles, which are hollow balls of cells containing an immature egg in the center. Adolescent – Male – men are constantly fertile from the onset of puberty, which is usually around the age of ten. A surge in testosterone triggers the production of an average of 200 million sperm each day. Female – 400,000 eggs are present during her first menstrual period, however only 300 to 500 will develop into mature eggs across her reproductive life. Ovulation occurs about two weeks after the last day of a woman’s menstrual period. A follicle discharges a single egg to the surface of the ovary and it is slowly carried down the fallopian tube into the uterus. If the egg reaches the uterus without fertilization by the sperm it will pass unnoticed. Twenties – Male/ Women are at their peak of fertility. Thirties – Male – Remains about the same as it was in their 20’s. Women – Begin to have a harder time trying to get pregnant and carry a healthy baby. Middle Age – Male – Remain highly fertile Women – fertility begins to decrease.

5 Stats and Facts: Infertility & ART
Infertility affects 6.1 million American women and men, about 10% of the reproductive age population. Twenty-five percent of infertile couples have more than one factor that contributes to their infertility. In approximately 40% of infertile couples, the male partner is either the sole cause or a contributing cause of infertility. Irregular or abnormal ovulation accounts for approximately 25% of all female infertility problems. Most infertility cases 85% to 90% can be treated with conventional medical therapies such as medication or surgery. While vital for some patients, in vitro fertilization and similar treatments account for less than 5% of infertility services. Twelve percent of all infertility cases are a result of the woman either weighing too little or too much. It is possible for women with body weight disorders to reverse their infertility by attaining and maintaining a healthy weight. Men and Women who smoke have decreased fertility. The risk of spontaneous abortion is higher for pregnant women who smoke. Up to 13 percent of female infertility is caused by cigarette smoking. Chlamydia causes about 4 to 5 million infections annually in the United States. If left untreated, chlamydia can cause infertility.   1997 – Report from American Society For Reproductive Medicine. (ART cycles that resulted in pregnancies.) 81% live birth 50.1% singleton and 31.2% multiple births 38% of all ART births were multiple births compared with less than 3% of births in the general population.

6 Common Female Infertility Factors
The most common female infertility factor is an ovulation disorder. Blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis (a sometimes painful condition causing adhesions and cysts). Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids can be associated with repeated miscarriages

7 Common Male Infertility Factors
The most common male infertility factors include azospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. Also a genetic disease such as cystic fibrosis or a chromosomal abnormality causes infertility in men.

8 Female Reproductive Organs
Normal anatomy and regular menstrual cycles are key factors in establishing female fertility. The female reproductive system is mainly internal. The vagina is the passage that leads from the outside of the body to the cervix, which is the opening to the uterus. The uterus is a muscular organ about the size and shape of a pear, which is lined with a rich and nourishing mucous membrane called the endometrium. The uterus is where a fertilized egg attaches itself and develops into a baby. Fertility starts to become a problem for women as they begin to age. For example post menopausal women carry some eggs in their ovaries but they can not be fertilized. Many woman will then take different hormones during menopause in order to ease the process. But this does not maintain a woman’s fertility into old age.

9 Male Reproductive Organs
The male reproductive system is both internal and external. The testes are located within the scrotal sac, the pouch of skin located below the penis. The testes produce sperm and testosterone, the primary male hormone that helps maintain the male sexual characteristics As men age they are still capable of fathering healthy children throughout their lives. Some studies have shown that children conceived by a man over the age of 50 have increased risks for mental illnesses.

10 What are the choices when using Assisted Reproductive Technology?
Many couples have a difficult time admitting there may be an infertility problem. After each menstrual period and still no signs of becoming pregnant there is a high percentage that a couple is infertile.This is when ART comes into the picture.                                             Assisted Reproductive Technologies can be defined by the first procedure that was developed, which was In Vitro fertilization. IVF removes the human egg from the ovary, and fertilizes it with a mans sperm in a lab. To conclude this process the fertilized egg or the embryo it placed back in the uterus. However today’s ART also refers to many other procedures that have been tailored to individual patient’s unique conditions. IVF is basically a four step process. First, you take medications to make multiple follicles begin to develop on your ovaries. This step is referred to as ovarian stimulation, or superovulation. Step two involves monitoring follicular growth by ultrasound, to determine egg growth and uterine lining development. When it is determined that the follicles and the uterine lining are appropriately mature, a trigger shot of Human Chorionic Gonadotropin is then administered. 36 hours after the trigger shot, the third step begins with retrieval of the eggs by ultrasound-guided-needle aspiration, an in-office procedure. A sperm specimen is then washed and prepared for insemination. The washed sperm is then placed in a dish with the eggs, and they are placed in an incubator for 18 hours. After 18 hours, the embryos are observed for normal fertilization, under a microscope, where the pronucleus of egg and sperm can be seen. The embryos are then incubated for further development into multi-cell embryos. The fourth and final step involves transferring the embryos into the uterine cavity via a catheter inserted through the cervix. The number returned varies with the desires of the patient, under the guidelines of age categories; under 35 years old, up to three embryos; years and older, up to four embryos. Additional embryos may be frozen and stored for future use.

11 Top 7 Ways to Make a Baby Using Assisted Reproductive Technology
Artificial insemination -- of mother with father's sperm Artificial insemination -- of mother with donor sperm In vitro fertilization (IVF) -- using egg and sperm of parents IVF -- with Intra-Cytoplasmic Sperm Injection (ICSI) IVF -- with frozen embryos GIFT – Gamete Intrafallopian transfer ZIFT – Eggs combined with sperm and placed in fallopian tubes All of these ART or Assisted Reproductive Technologies are medical interventions in the processes of reproduction, including ovulation, fertilization, and implantation of the fertilized eggs into the uterus. Numerous Reproductive technologies have allowed infertile couples to have children, but it has raised ethical and legal questions regarding the involvement of third parties as donors or surrogates and the propriety of altering natural processes of procreation. More than 40,000 infants were born in 2001 as a result of assisted – reproductive technology According to the Centers for Disease Control and Prevention the highest success rates were reported in patients who used donor eggs and freshly fertilized embryos. There was a 56% pregnancy rate, 47% live birth rate, and 27% singleton live – birth rate)

12 Artificial Insemination
Artificial insemination: Introducing semen into the uterus or oviduct by other than natural means. Artificial Insemination is the process in which male gametes, the spermatozoa, are collected and introduced artificially into the female genital tract for the purpose of fertilization. Other artificial methods for achieving fertilization have since been devised. Artificial insemination was first developed for breeding cattle and horses. Spermatozoa are collected from a chosen male and frozen, then thawed and used to impregnate females.

13 In Vitro Fertilization
In vitro fertilization: Taking eggs from a woman, fertilizing them in the laboratory with a man's sperm, and returning the resulting embryos to her uterus several days later. In Vitro Fertilization (IVF), an assisted reproductive technology (ART) in which one or more eggs are fertilized outside a female's body. This technique has been used extensively in animal embryological research for decades, but only since 1978 has it been successfully applied to human reproduction. In human reproduction the process involves stimulation of the growth of multiple eggs by the daily injection of hormone medications. It is also possible to conduct IVF without the use of the hormone medications; a single egg would develop and be retrieved. The eggs are then recovered by one of two methods: sonographic egg recovery, which is the more common of the two, which uses ultrasound guidance to retrieve the eggs, or laparoscopic egg recovery, in which retrieval is made through a small incision in the abdomen. Once the eggs are retrieved, they are placed in a special fluid medium, then semen that has been washed and incubated is placed with the eggs and left for approximately 18 hours. The eggs are removed, passed into a special growth medium, and then examined about 40 hours later. If the eggs have been fertilized and developed normally, the embryos are transferred to the woman's (or a surrogate's) uterus. The probability of viable pregnancy is approximately 20 percent with one IVF cycle.

14 Intra-Cytoplasmic Sperm Injection
Intra-cytoplasmic sperm injection - is a lab procedure to help infertile couples undergo in vitro fertilization due to male factor infertility. This was a technique that was developed in 1992, in order to deal with male infertility. Doctors collect a single live sperm and inject it directly into the cytoplasm of the mother’s egg. ICSI is routinely performed in cases where the man has extremely low sperm counts. The resulting embryo is then inserted into the uterus using IVF procedures.

15 Gamete Intrafallopian Transfer (GIFT)
Eggs are combined with partner’s sperm in a dish and then taken to a lab They are surgically injected into your fallopian tubes using a laparoscope Fertilization then occurs inside your body and the embryo implants naturally. In gamete intrafallopian transfer is a the technique is similar to IVF, but the harvested eggs and sperm are placed directly into the fallopian tubes, with fertilization occurring in the woman's body .

16 Zygote Inrafallopian Transfer (ZIFT)
The eggs are mixed with partner’s sperm, and then they are surgically place in your fallopian tubes. But then your doctor will wait until fertilization occurs to place the embryos inside you. In zygote intrafallopian transfer is a procedure that is similar to GIFT, but the beginning-stage embryos or zygotes are placed directly in the fallopian tubes. With super ovulation uterine capacitation enhancement, which is what the woman is experiencing because of her daily hormone medications to stimulate the growth of multiple eggs. Once the eggs have reached the right stage, intrauterine inseminations are done using the partner's specially treated sperm. Donor oocyte programs are available in some places; donated eggs are used by women unable to use their own eggs to achieve pregnancy. Assisted reproductive technology is used to retrieve eggs from donors and replace embryos in the recipient.

17 Frozen Embryos Frozen embryos: Specialists may freeze additional embryos from a woman's cycle for later use. They may also freeze embryos of a donor in order to have them ready to place in a surrogate mother's uterus at the appropriate moment in the surrogate's natural or hormone-replaced cycle. In 1984 a procedure was reported from Australia, with the embryo first being frozen for two months before it was successfully implanted.

18 ART Procedures Types of ART Procedures –United States 2002
Fresh-nondonor 74.2% (85,826 cycles) Frozen-nondonor 14.2% (16,383 cycles) Fresh-donor 8.0% (9,261 cycles) Frozen-donor3.4% (3,922 cycles) New Treatment Procedures 0.1% (146 cycles) The number of ART clinics in the United States in 2002:428 Number of ART cycles reported for 2002 was 115,392

19 Kids are the Last Thing on my Mind Why Does this Affect Me?
                                                                           If you wait to consider your fertility until you’re ready for a family, you may be too late. Just because you aren’t ready for children now it doesn’t mean you should hurt your chances of ever having them. What you do now, even years before you are ready to have children can impact your future ability to conceive. For the best chances for fertility don’t smoke , practice safe sex , maintain a healthy body weight, and pay attention to your body. Myth – Infertility is a woman’s problem Fact- This is untrue because infertility is a female problem in 35% of the cases, and a male problem in 35%of the cases. It is a combined problem in 20% of the couples, and 10% is unexplained. Myth – Everyone seems to get pregnant at the drop of a hat. Fact – More than 5 million people at the childbearing age in the US experience infertility. Myth – You’ll get pregnant if you’re just patient. Fact – Infertility is a disease, and at least 50% of people who are evaluated respond to treatment. Those who do not seek help have a “spontaneous cure rate” of about 5%after a year of infertility.

20 Prenatal Tests Ultrasound: An ultrasound provides a non-invasive way to see inside the uterus using high-frequency sound waves to create visual images. Ultrasound can often detect major problems such as spina bifida and anencephaly, and it provides a way to measure the size of the fetus. In some cases IVF can result in multiple births, and this technique allows doctors to know what to expect.

21 It’s a Girl… The goal of every couple dealing with infertility is to have a positive pregnancy test. Although ART can be very expensive and time consuming, this cutting edge technology can change a person’s life. The first method of artificial insemination which mixed the sperm and ovum in a nutrient medium outside the woman's body, followed by implanting the fertilized egg into her uterus resulted in the first test tube baby. This technique is used when a woman's fallopian tubes are blocked, and, as a result, the spermatozoa cannot reach the ovum. The first baby born as a result of such a procedure was the English “test-tube baby,” Mary Louise Brown, in 1978. However since then there have been many success in Assisted Reproductive Procedures, and many baby boy and girls are born every year. To this date there are about 250,000 IVF children that have been born.

22 Bibliography American Family Physician. “Assisted Reproductive Technology Statistics.” InfoTrac Web. 1 February 2005. American Society for Reproductive Medicine. “Protect your Fertility.” < 22 October 2005. Arizona Center for Reproductive Endocrinology and Fertility. “The Female Reproductive System.” Baby Center Editorial Staff. “Fertility treatment: Assisted Reproductive Technologies.” Babycenter Medical Advisory Board fertilityproblems/4093.html. Center for Advanced Reproductive Services. Connecticut Fertility Center. “Fertility Myths.” Center for Fertility and Gynecology. “In Vitro Fertilization.” Kelly, Raina. “Health Going Straight for IVF.” Newsweek < National Infertility Association. “What are my choices?” < treatment/index.jsp?name= treatment>. Nova Online. “18 ways to make a baby.” April Shaykh, Marwan. “Assisted Reproductive Technology.” Jacksonville Medicine,

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