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Dr. ZEINAB ABOTALIB MRCOG, DGO, Consultant Obs/Gyna Infertility & IVF

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Presentation on theme: "Dr. ZEINAB ABOTALIB MRCOG, DGO, Consultant Obs/Gyna Infertility & IVF"— Presentation transcript:

1 Dr. ZEINAB ABOTALIB MRCOG, DGO, Consultant Obs/Gyna Infertility & IVF
Assisted Conception Dr. ZEINAB ABOTALIB MRCOG, DGO, Associate Professor & Consultant Obs/Gyna Infertility & IVF

2 Assisted Conception IUI: intrauterine insemination IVF: in vitro fertilization ICSI: intracytoplasmic sperm injection GIFT: gamete intrafallopian transfer ZIFT: zygote intrafallopian transfer PESA: percutaneous epididymal sperm aspiration

3 Assisted Conception ET: embryo transfer TESE: testicular sperm extraction SUZI: subzonal sperm injection PGD: preimplantation genetic diagnosis

4 Assisted Conception Objective To bring sperm and oocyte close to each other to promote chances of fertilization and, ultimately, achieve a pregnancy

5 Assisted Conception Main types: IUI: intrauterine insemination IVF: in vitro fertilization ICSI: intracytoplasmic sperm injection

6 Assisted Conception Required procedures Superovulation Sperm preparation Assisted fertilization

7 Superovulation Hormonal manipulation to enhance ovulation and release multiple oocytes during ovulatory cycle

8 Superovulation Drugs used: Human menopausal gonadotropin
Taken from urine of postmenopausal women Follicle stimulating hormone (FSH) and luteinizing hormone (LH) activity Recombinant FSH Recombinant LH

9 Superovulation- protocol
Gonadotropin for 9-11 days Monitoring follicular development by transvaginal ultrasound Follicles mm in diameter 10,000 IU hCG Oocytes maturation Ovulation


11 Sperm Preparation Select PMNS Remove seminal plasma, WBC, and bacteria
Sperm capacitation Coating of sperm with seminal plasma proteins Allow sperm to become fertile In vivo or in test tube


13 Intrauterine insemination
Sperm sample deposited in uterus just before release of an oocyte (s) in a natural or stimulated cycle Soft catheter Give hCG at injection or up to 24 hrs later Sperm volume: ml Pregnancy rates Around 15% per cycle

14 Gamete intrafallopian transfer
Laparoscopic technique in which oocyte and sperm placed in fallopian tube, allowing in vivo fertilization Procedure Superovulation US guided transvaginal oocyte retrieval mil sperm with 2-3 oocytes


16 In vitro fertilization - IVF
Taking oocytes from woman Fertilizing them in lab with her partner's sperm Transferring resulting embryos back to her uterus 3 or 5 days later

17 IVF Procedure Superovulation Insemination Embryo transfer
Luteal support

18 IVF - Superovulation Gonadotropin stimulation
Monitoring follicular development US guided transvaginal oocyte retrieval Oocyte fertilization with sperm



21 IVF - Insemination Containers used
Test tubes, Petri dishes, multi-well dishes Each oocyte inseminated with mil PMNS Fertilization detected hrs later by presence of 2 pronuclei in oocyte cytoplasm 2 polar bodies in perivitelline space

22 IVF - Insemination Syngamy (combination of maternal and paternal pronuclei 24 hrs after insemination Further cleavages occur at 24 hr intervals




26 IVF - Embryo transfer Embryos transferred to uterus on 2nd or 3rd day after in vitro insemination 4-8 cells embryos 2-3 embryos transferred in 20 µl of culture fluid Transabdominal US to see fluid placed in uterus Cryopreserve excess embryos


28 IVF - Luteal support Progesterone (P4) necessary for pregnancy maintenance Premature luteolysis in some superovulatory regimens P4 supplementation until menses occur or woman has positive pregnancy test

29 Intracytoplasmic sperm injection - ICSI
Injection of single sperm into single oocyte in order to get fertilization Procedure Superovulation US guided transvaginal oocyte retrieval IVF Oocytes injected with sperm using special microscopes, needles and micromanipulation equipment






35 ICSI - Indications Low sperm concentration, motility, abnormal morphology Antisperm antibodies Fertilization failure after conventional IVF Ejaculatory disorders absence of vas deferens or obstruction of ejaculatory ducts

36 Assisted Hatching Indications Couples having IVF with
Female partner's age over 37 Poor quality embryos Excessive fragmentation Slow rates of cell division

37 Assisted Hatching – Procedure
Embryo held with a specialized holding pipette A needle used to expel an acidic solution against ZP A small hole made in ZP Embryo washed and put back in culture in incubator ET shortly after hatching procedure Hope for the best




41 Further Advances And Uses Of Assisted Conception Technology
Cryopreservation of Sperm Embryo Oocyte Ovarian tissue Growth of human follicles and oocytes in vitro In vitro maturation and transplantation of human spermatozoa

42 Assisted Reproductive Technology (ART)
Dr. Abdelsalam Talafha American Board Certified, Comparative Veterinary Obstetrics and Gynecology

43 ART Infertility Inability to conceive after 1 year of unprotected and regular sexual intercourse Primary infertility Couples have never had children Secondary infertility Couples initiated conception in the past and then had difficulty

44 ART Infertility Female partner: 35% Male partner: 35%
Both partners: 20% Unknown cause: 10% Infertility more common with increasing age

45 ART USA women infertility rate Ages 20-24: 4.1% Ages 25-29: 5.5%
80% of infertility cases can be diagnosed 85% of cases can be successfully treated

46 ART Female infertility Disorders of ovulation: 27%
Fallopian tube disorders: 22% Pelvic adhesions: 12% Endometriosis: 5% to 15% Hyperprolactinemia: 7%

47 ART Male infertility Abnormal semen parameters
Count, motility, morphology Infertility treatment Correcting underlying abnormality ART

48 ART Main techniques IUI IVF - embryo transfer ICSI Assisted hatching

49 Preimplantation Genetic Diagnosis (PGD)
Identify genetic conditions in embryo before ET Hemophilia Cystic fibrosis Aneuploidy

50 PGD Hemophilia Hereditary bleeding disorder
Absence of a blood protein essential for clotting Types A: lack of factor VIII Type B: lack of factor IX

51 PGD Cystic fibrosis Genetic disease
Defective gene causes body to produce abnormally thick, sticky mucus that obstruct Lungs Pancreas

52 PGD Aneuploidy Having less than or more than normal diploid number of chromosomes Monosomy Trisomy Triploidy

53 PGD Performed with IVF 8-cell stage (3 days old) embryo biopsy
Obtain 1-2 blastomeres for genetic


55 Three day old embryos





60 PGD Genetic analysis Multicolor fluorescence in situ hybridization (FISH) Polymerase chain reaction (PCR)

61 FISH Detects Number of chromosomes Sexing embryos
Sex chromosome aneuploidy Whole-chromosome paints for detection of rearrangements and identification of marker chromosomes Analyze polar bodies

62 FISH Fuorescent probes that bind to specific chromosomes are labeled with biotin for detection by specific fluorochrome-conjugated antibodies under a fluorescent microscope

63 Interphase nucleus X Y

64 Triploid Normal Diploid Tetraploid Missing chromosomes

65 PGD Double trisomy Monosomy

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