curs3-tradus_engleza.pptx

8/17/2019 curs3-tradus_engleza.pptx

1/51

Techniques for Assisted

Human Reproduction

Asist. Univ. Dr. Raluca TulinEndocrinology/ Embryology Specialist

Profle: Anatomy

Embryology Department U!" #arol Davila$

%ptional #ourse &ear '() *eneral !edicine#linical Embryology + Assisted ,uman

Reproduction

Course 3


2/51

• !ore and more c-allenges are beingovercome by scientifc progress

• ot being able to procreate istreated0 by medical tec-ni1ues o2 ART

• 3UT4t-ere 5ill al5ays be a clas-bet5een t-e old and t-e ne5 andproduces ideological disorders o2moral social biological andeconomical natures

ARTAssisted Reproductive Te-ni1ues


3/51

Sterility 'S (n2ertility• Sterility) incapacity o2 becoming pregnant• (n2ertility 6 incapacity o2 -aving c-ildren

meaning 7eeping t-e pregnancy anddeliver a live baby

ART- does not cure (does not unclog fallopiantubes, does not increase sperm motility)- BUT

ALLOW R!A"#$%& T#! &OAL T#ROU OT#!R'!T#O


4/51

3AS(S %" ART


5/51


6/51

%t-ers 4• *("T 6 *ametic (ntra "allopian

Trans2er• @("T 6 @ygotic (ntra "allopian Trans2er• TET 6 Tubal Embryo Trans2er


7/51

atural "ertilisation


8/51


9/51


10/51

8. (ntrauterine insemination o2sperm partner / fresh

• (ndications – "ailure intercourse – (diopat-ic in2ertility – !oderate damage to sperm analysis – Endometriosis mild / moderate – Unilateral tubal de2ects – Anovulation / S%P# – Erectile dys2unction -ypospadias

vaginismus


11/51

8. (ntrauterine insemination o2sperm partner / frozen

• #-ronic diseases re1uiringc-emot-erapy / radiot-erapy / iodinet-erapy / surgery t-at can aCect2ertility ) in 5-ic- case turn to spermcryopreservation partner and using it

later• ,usband being a5ay 2or a long time


12/51

8. (ntrauterine (nsemination spermfrom donor

• (ndications: – Partner sterility – ac7 o2 partner – Partner serious genetic diseases – "inancial impossibility 2or ('"

T-e donor can be anonymous or7no5n


13/51

8. (ntrauterine insemination)STEPS

8. #-ec7ing tubal patency ,S* / A"# ; andsperm parameters . Screening virus ,3' ,#' ,(' 'DR ;

9. Establis-ing t-erapy ) depending on A!, A"#


14/51

8. (ntrauterine insemination• T-e sample is processed to ma7e mobile

sperm selection morp-ologically normal 2ertiliKers potential . T-is 5ay some

pat-ogenic agents are getting eliminated• (2 stored sperm cryopreservation li1uid

nitrogen )8JH L# ; and subse1uentlyt-a5ed

• Sperm 2res- / t-a5ed ; is inserted intot-e uterine cavity


15/51

Sperm preparation


16/51

8. (ntrauterine insemination• %varian stimulation : etroKole M/)

*onadotropins$ #lomip-ene citrate• !onitoring

–

Ultrasound 6 Day 9 A"#; day J D";• %varian triggering6 r,#*• T-e actual insemination )


17/51


18/51

8. (ntrauterine insemination


19/51


20/51

8. (ntrauterine insemination

•

Disadvantages:8. o5 success rate 8 )9NO;9. !ultiple pregnancy ris7


21/51

=/9G/8H 98

(U( versus('"

IUI baby

IUI baby

IUI baby

10,000 $

5,000 $

9,500 $

IVF baby

IVF baby

IVF baby

43,000 $

13,000 $

16,000 $

Van Voorhis et al. Fert. Steril 1998

Gover e et al. !an"et #000

hili%s et al. &'( )e%ro #000


22/51

9. (n 'itro "ertiliKation


23/51

(n 'itro "ertilisaiton• (ndications:

– "ailure intercourse – (diopat-ic in2ertility – !oderate damage sperm analysis – Endometriosis / S%P# – Tubal de2ects unilateral or bilateral absent 2allopian

tubes ; – Anovulation / S%P# – Erectile dys2unction -ypospadias vaginismus – Advanced age o2 t-e patient – P*S / P*D Preimplantational genetic diagnosis o2

c-ildren resulting 2rom t-e partners-ip or gametes o2one or bot- partners;


24/51

(n 'itro "ertiliKation )STEPS8. #-ec7ing t-e uterine cavity -ysteroscopy ; and sperm

parameters .9. Screening virus ,3' ,#' ,(' 'DR ;


25/51

%varian stimulation• (t aims to ac-ieve a -ig-er number o2 oocytes to be

transvaginal e tracted 2rom t-e patientQs ovaries• (t is important to suppress normal ovulation

because once t-ey leave t-e ovary oocytes can notbe recovered

• Ultrasound monitoring ovaries and endometrium;and serologic Estradiol / Progesterone ;

• #omposed o2 9 p-ases: – Do5n)regulation pituitary; 6 s5itc-ing oC t-e pituitary

gland – %varian stimulation 8N)89 days;


26/51

Principles o2 ovarianstimulation

• %varian stimulation: – ,!* – "S, M/) ,; – ,#* Trigger)s-ot


27/51


28/51

,yper stimulation 's aturalovulation


29/51

Under generalanest-esia- Transvaginal or

laparoscopically$- 9N)


30/51


31/51


32/51

Stages o2 embryonic development

#-ec7ing 2ertiliKation8H)8G -ours a2terinsemination / (#S(


33/51

@ygote


34/51

,o5 big are t-ey


35/51

Ris7s o2 ('"• !ultiple pregnancy• %varian -yper)stimulation• Emotional stress• ac7 o2 pregnancy

Uni1ue pregnancy post ('" 6 cost to Englis- *overnmentappro .


36/51

Embryo)trans2er


37/51

!ultiple pregnancy6 "(' ma>or ris7


38/51

8=) ('" 8)8)9)9)G• adya Suleman

5-o gave birt- tooctuplets in anuary9NNJ -ence itsnic7name%ctomom . using invitro 2ertiliKation aprocedure t-at -adused success2ullybe2ore giving birt-to ot-er H c-ildren


39/51

• 9NNI reality)s-o5 Jon & Kate Plus 8 - ate

se tuplet birt- t-ree boys Aaden #ollinand oel and t-ree daug-ters ea- Ale is and ,anna-


40/51

anuary 9NN

Romania Adriana(liescu HH ears

9NNH SpainHHyears.!aria del #armen3ousada de araDied o2 stomac-cancer 5-en -er

9N8N triplets 6(ndia3-ateri Devi HHyears


41/51

#ryopreservation o2 embryos

• W-en maternal uterus preventsimplantation too t-in post)progestin increased ovarianstimulation ;

• E cess embryos remaining a2terembryo trans2er ;

• T-e uterus is not 2unctional• T-e 5oman 5ill 2ollo5 in t-e near

2uture anticancer treatments


42/51

3an7 o2 embryos


43/51

(n vitro 2ertiliKation ) 5it-donor oocytes

8. Sterile partner9. ac7 o2 partner


44/51

• 3ot- partners are sterile but t-e uterus is intact• *enetic diseases o2 bot- partners• #ountries 5-ere adoption processes are cumbersome• (t is t-e legal mot-er 5-o gives birt- . egal 2at-er is

-er -usband t-e legal presumption ; or -er partner t-e recognition ;

(n vitro 2ertiliKation ) 5it- donatedembryos


45/51

*estational carrier 'S Surrogatemot-er

• *estational carrier 6 carryingt-e c-ild o2 t-e couple spermrecipient M oocyte recipient;*estational carrier is notgenetically related to t-e c-ild.

• Surrogate mot-er6 t-e c-ild

bearing sperm recipient M-er ovocyte;. (t is geneticallyrelated to t-e c-ild . #anresort to (U(


46/51

• egal mot-er is t-e one5-o gives birt- to t-ebaby. T-e -usband is t-elegal 2at-er o2 t-e babyi2 s-e is not married t-ebaby can be recogniKedby a benefciary 2at-er."or t-e benefciarymot-er to become alegal mot-er adoptionprocedures must be2ollo5ed.


47/51

('" 5it- (#S(• (#S( 6(ntracytoplasmic Sperm (n>ection• (ndications:

– Severely impaired sperm parameters – "ertiliKation 2ailures in t-e -istory o2 t-e

couple – !a7ing !A,R 5it- testicular tissue biopsy :

• TESE 6 Testicular Sperm E traction;• !ESA !icroscopic Epididymis Sperm Aspiration;• PESA Percutaneous Epididymis Sperm Aspiration;• !)TESE !icro)TESE;


48/51

(n>ection


49/51

,o5 itQs actually done4


50/51


51/51

curs3-tradus_engleza.pptx

Documents

Transcript of curs3-tradus_engleza.pptx