What is Assisted Reproduction Technology?Jessica Guerrero

What is ART?Group of high tech treatment methods to improve infertility.Techniques includeIn Vitro FertilizationArtificial InseminationGamete Intra-Fallopian TransferAnd many more

History of ART1978- first successful birth using In Vitro Fertilization1984- first successful birth using Gamete Intra Fallopian Transfer1986-first successful birth using Zygote Intra Fallopian Transfer

What is Infertility? Inability to conceive a baby after one year of unprotected intercourse.Affects the reproductive organs of both men and women.Infertility affects about 15% of couples in the United States.

Factors Affecting ConceptionProduction of healthy sperm Healthy eggs by the womanUnblocked fallopian tubesThe ability for the sperm to fertilize the eggThe ability for the embryo to implant in the uterus

Causes of Infertility in WomenThe older a woman is the higher her chances of becoming infertile.Ovulation disorderBlocked fallopian tubes caused by a pelvic inflammatory disease or endometriosis (a condition that causes adhesions and cysts).

Causes of Infertility in MenAzoospermia-lack of sperm productionInability to ejaculate normallyVaricocele- veins in the scrotum are enlarged which can heat the inside of the scrotum and can affect sperm production.Teratospermia- increased percentage of abnormal shapes

StatisticsInfertility affects more than 15% of the couples in the United States.About one-third of infertility cases are caused by male factors.In about 20% of infertile couples the cause is unknown.The remaining one-third of infertile cases is caused by a combination of factors in both partners. The chances of becoming pregnant decreases 3-5% per year after the age of 30.

Most Common Choices of TreatmentIn Vitro FertilizationArtificial InseminationFrozen EmbryosGamete Intra Fallopian TransferZygote Intra Fallopian Transfer

Artificial InseminationSperm is collected and placed into a womans vagina, cervical canal or in the uterus.Sperm can come from your partner or an anonymous donor.

In-Vitro FertilizationA womans eggs are removed from the ovary and mixed with sperm in a laboratory. Then once fertilized, the embryos are placed into the womans uterus.

Gamete Intra-Fallopian Transfer(GIFT)A mixture of a womans eggs and sperm are placed into the fallopian tube during a laparoscopy.Once inserted, fertilization is allowed to occur.

Zygote Intra-Fallopian Transfer(ZIFT)Mixture of In Vitro Fertilization and Gamete Intra Fallopian Transfer.Fertilization takes place outside the uterus and placed into the fallopian tubes.

Intra-Cytoplasmic Sperm InjectionSperm is injected directly into the eggs in a laboratory.Used if infertility originates from the male such as:Low numbers of spermSevere Teratospermia

Frozen EmbryosEmbryos may be taken from an individual and stored for later use.Once ready to use, they can be thawed and then placed into the uterus.This allows a higher chance of pregnancy.

Selecting an ART ProgramQualifications and experience of the clinic and its personnel.Support services availableCostSuccess rates of that specific program

How Does this Affect Me? Knowing your body, as well as taking care of your body increases your chances of becoming pregnant. If you are considering having children in the future, the best thing to do is practice safe sex, take care of your body and stay away from harmful contaminants such as smoking and other types of drugs. Fertility affects us all, male or female and attending the doctor regularly can increase your chances of becoming pregnant in the future.

Works CitedAge and Female Fertility.2006. American Fertility Association. 8 March 2006. http://theafa.org/faqs/afa_ageandfemaleinfertility.htmlAssisted Reproductive Techonologies. Society for Assisted Reproductive Technology. 2005. 8 March 2006. Assisted Reproductive Technologies: A guide for Patients. United States Department of Health & Human Services. 2003. American Society for Reproductive Medicine. 8 March 2006. http://asrm.org/Patients/patientechnologybooklets/Art.pdfEmbryo Freezing. IVF-Infertility.com. 15 October 2005. 8 March 2006. http://www.ivf-infertility.com/ivf/frozen.phpInsemination. 1 March 2005, Home ed., InfoTrac. College of the Sequoias Library, Visalia, CA. 1 March 1999.The Reproductive System. Westport, CT: Greenwood Press, c2004Male Infertility. Familydoctor.org. 3 March 2005. American Academy of Family Physicians. 8 March 2006. http://familydoctor.org/766.xmlUnderstanding Fertility and Infertility: The Sourcebook for Reproductive Problems, Treatments and Issues. New York: CheckmarkBooks.c2003What is Infertility? Frequently Asked Questions About Infertility. 2006. American Society for Reproductive Medicine. 8 March 2006.http://www.asrm.org/Patients/faqs.html#Q1:Wisot, Arthur L et. Al. Conceptions & Misconceptions: The Informed Consumers Guide through the Maze of In Vitro Fertilization and other Assisted Reproduction Techniques.Zygote Intrafallopian Transfer. Pregnancyinfo.net. 2005. 8 March 2006. http://www.pregnancy-info.net/infertility_medical_options_zift.html

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Understanding Fertility and Infertility: The Sourcebook for Reproductive Problems, Treatments and Issues. New York: CheckmarkBooks.c2003ART includes a group of high tech treatment methods used to improve fertility which involves collecting the eggs and putting them in direct contact with sperm. Together they form an alphabet soup of techniques including IVF (In Vitro Fertilization), GIFT (Gamete Intra-Fallopian Transfer), ZIFT (zygote Intra-Fallopian Transfer).

http://www.sart.org/Guide_AssistedReproductiveTechnologies.htmlAssisted Reproductive TechnologiesAssisted Reproductive Technology (ART) includes in vitro fertilization-embryo transfer (IVF-ET), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), tubal embryo transfer (TET), and frozen embryo transfer (FET). These are relatively new procedures for couples who are unable to conceive by other methods. Although ART has helped many people overcome their infertility, they are not the answer for every infertile couple. Most of the time we use ART only when less complex and less expensive methods of treatment have failed. However, in certain circumstances (such as advanced age or severe male factor) we may recommend ART as first-line therapy. *Wisot, Arthur L et. Al. Conceptions & Misconceptions: The Informed Consumers Guide through the Maze of In Vitro Fertilization and other Assisted Reproduction Techniques.

First successful birth- July 25, 1978 in England- Louise Brown- In Vitro Fertilization1984- first pregnancy as the result of Gamete Intra Fallopian Transfer was reported in Texas1986- first successful pregnancy from zygote intrafallopian transfer.*

Wisot, Arthur L et. Al. Conceptions & Misconceptions: The Informed Consumers Guide through the Maze of In Vitro Fertilization and other Assisted Reproduction Techniques. Infertility is defined as the inability to conceive a baby after one year of fairly unprotected intercourse. Thats not the same as trying to have a baby for a year. The Reproductive System. Westport, CT: Greenwood Press, c2004An inability to conceive a child after one year of unprotected intercourse. Primary infertility is the inability to conceive a first child: secondary infertility is the inability to conceive again after one or more successful pregnancies.

http://www.theafa.org/faqs/afa_ageandfemaleinfertility.html

More than 15% of couples in this country have difficulty conceiving a child.

*What is Infertility? Frequently Asked Questions About Infertility. 2006. American Society for Reproductive Medicine. 8 March 2006.

Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children. Conception is a complicated process that depends upon many factors: on the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg; the sperm's ability to fertilize the egg when they meet; the ability of the fertilized egg (embryo) to become implanted in the woman's uterus; and sufficient embryo quality. Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.

*http://www.theafa.org/faqs/afa_ageandfemaleinfertility.html

Age and Female Fertility Delayed childbearing has resulted in more women in their late 30s and early 40s attempting conception than ever before. In fact, 20% of women in the United States now have their first child after age. For those who do, however, prompt and thorough evaluation and aggressive treatment are crucial. Unfortunately, as women age they also have a higher chance of miscarrying. At birth, a woman has all the eggs she will ever have. As an egg ages, it is more likely to develop a chromosomal abnormality. A fertilized egg with abnormal chromosomes is the single most common cause of miscarriage: at least half of all miscarriages are due to abnormal chromosomes. Fertility declines significantly after age 40.

Miscarriage rates are higher for older women. A decreased ovarian reserve suggests a poor prognosis for fertility. In women over 35, a fertility evaluation should be given after 6 months of unprotected intercourse. Aggressive treatment may be indicated to capitalize on the "window" of fertility. Oocyte donation is most likely the best option for the woman over 40 who has an elevated basal FSH level. Prepared by:David Barad, M.D., Director The Fertility & Hormone Center at Dobbs Ferry Dobbs Ferry, NY

Causes of Infertility? Frequently Asked Questions About Infertility. 2006. American Society for Reproductive Medicine. 8 March 2006. The most common female infertility factor is an ovulation disorder. Other causes of female infertility include 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 are associated with repeated miscarriages. *The Reproductive System. Westport, CT: Greenwood Press, c2004

Infertility in males is most often due to olgiospermia or azoospermia which means poor or absent sperm production. Other causes are related to impotence or an inability to ejaculate normally.Some estimates state that 10 percent to 25 percent of the cases of male infertility arise from deletions on the Y chromosome in overlapping areas known as the AZF (for the azoospermia factor) regions, which have to do with sperm production. Other genetic causes are related to chromosomal abnormatlies, which appear more often in azoozpermic/oligospermic men. It is for this reason that many fertility clinics conduct genetic screening in such men to determine if there are mutations that could be passed on via fertilization.

Causes of Infertility? Frequently Asked Questions About Infertility. 2006. American Society for Reproductive Medicine. 8 March 2006.The most common male infertility factors include azoospermia (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. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality.

http://familydoctor.org/766.xmlWhat causes male infertility?The most common cause of male infertility is a varicocele (say: "var-ee-koh-seal"). This is when the veins in the scrotum (the skin "sack" that hangs beneath the penis) are dilated (enlarged) on 1 or both sides. This heats the inside of the scrotum and may affect sperm production. A blockage in a man's reproductive system may cause male infertility. Some medicines can also cause infertility.Sometimes the cause of male infertility cannot be identified. In these cases, there may be an underlying genetic problem.http://www.asrm.org/Patients/FactSheets/ICSI-Fact.pdf

A variety of abnormalities can cause male infertility. Sperm can be completely absent from the ejaculate(azoospermia) or present in low concentrations (oligospermia). Sperm may have poor motility (asthenospermia)or have an increased percentage of abnormal shapes (teratospermia). There may also be functional abnormalitieswhich prevent the sperm from binding to and/or fertilizing the egg.

*Causes of Infertility? Frequently Asked Questions About Infertility. 2006. American Society for Reproductive Medicine. 8 March 2006.No one can be blamed for infertility any more than anyone is to blame for diabetes or leukemia. In rough terms, about one-third of infertility cases can be attributed to male factors, and about one-third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or, in about 20 percent of cases, is unexplained.

http://www.theafa.org/faqs/afa_ageandfemaleinfertility.html

More than 15% of couples in this country have difficulty conceiving a child.

The probability of having a baby decreases 3-5 % per year after the age of 30, and at a faster rate after 40.

A woman in her 20s has only a 12-15% chance of having a miscarriage each time she becomes pregnant. On the other hand, a woman in her 40s faces a 50% risk of miscarriage.*Assisted Reproductive Technologieshttp://www.sart.org/Guide_AssistedReproductiveTechnologies.html

Assisted Reproductive Technology (ART) includes in vitro fertilization-embryo transfer (IVF-ET), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), tubal embryo transfer (TET), and frozen embryo transfer (FET). These techniques also apply to oocyte donation and gestational carriers. These are relatively new procedures for couples who are unable to conceive by other methods. Although ART has helped many people overcome their infertility, they are not the answer for every infertile couple. Most of the time we use ART only when less complex and less expensive methods of treatment have failed. However, in certain circumstances (such as advanced age or severe male factor) we may recommend ART as first-line therapy. IVF, GIFT, ZIFT, and TET are very similar procedures although there are a few significant differences. During IVF-ET, ZIFT, and TET, the oocytes and sperm are combined in a culture dish in the laboratory. Fertilization and very early embryo development occur outside the body, rather than in the fallopian tube. Once early embryo development is recognized, the embryos are transferred either into the uterus (IVF-ET) or the fallopian tube (ZIFT, TET). Since most programs have seen no significant difference in success rates, they usually perform IVF-ET because it is less expensive and doesn't require laparoscopy and general anesthesia. In addition, IVF-ET is the only procedure available for women with damaged fallopian tubes. *Insemination. 1 March 2005, Home ed., InfoTrac. College of the Sequoias Library, Visalia, CA. 1 March 1999.

Insemination is when sperm is collected and processed. The sperm is then placed into a womans vagina, cervical canal or directly into the uterus.Artificial Insemination is when the sperm used comes from your partner. Insemination may be used if the mucus around your cervix is not compatible with your partners sperm, or you may have problems with your immune system. This can cause sperm to be killed before your egg is fertilized

*http://www.asrm.org/Patients/faqs.html#Q4:In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a Petri dish ("in vitro" is Latin for "in glass"). After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the women's uterus, thus bypassing the fallopian tubes. IVF has received a great deal of media attention since it was first introduced in 1978, but it actually accounts for less than five percent of all infertility treatment in the United States.

Does In Vitro Fertilization Work? A: Yes. IVF was introduced in the United States in 1981 and from 1985 through 2000 ASRM and its affiliate, the Society for Assisted Reproductive Technology (SART), have counted more than 139,000 births of babies conceived through IVF. Through the end of 2002, almost 300,000 babies have been born in the US as a result of reported Assisted Reproductive Technology procedures (IVF, GIFT, ZIFT, and combination procedures). IVF currently accounts for about 99% of ART procedures with GIFT, ZIFT and combination procedures making up the remainder. The average live delivery rate for IVF in 2000 was 29.9 per cent per retrieval--a little better than the 20 per cent chance in any given month that a reproductively healthy couple has of achieving a pregnancy and carrying it to term. In 2002, approximately one in every hundred babies born in the United States was conceived using ART*http://www.sart.org/Guide_AssistedReproductiveTechnologies.html

GIFT differs from the other procedures in that sperm and oocytes are transferred into the fallopian tubes immediately after oocyte retrieval. Fertilization thus occurs in the body, rather than in the laboratory. GIFT originally was thought to represent a breakthrough in infertility therapy. National ART statistics suggest that success rates are higher with GIFT than IVF-ET. However, many investigators have concluded that GIFT does not increase the likelihood of conception compared to other ART procedures, and that the statistics may reflect differences in laboratory expertise or in the kinds of patients treated with GIFT versus IVF-ET. In addition, GIFT does not allow for confirmation of successful fertilization if the procedure does not produce a pregnancy. Because of these disadvantages, most programs do not perform GIFT. Your physician will discuss each of these procedures with you so that the most appropriate procedure for your individual situation will be used. *

Wisot, Arthur L et. Al. Conceptions & Misconceptions: The Informed Consumers Guide through the Maze of In Vitro Fertilization and other Assisted Reproduction Techniques.

With this method, which is a mixture of IVF and GIFT, fertilization takes place in vitro, but the resulting fertilized eggs (zygotes) are placed into the fallopian tubes.

http://www.pregnancy-info.net/infertility_medical_options_zift.htmlHow Its Done Starting off like IVF, you will begin by receiving medications that will help your egg follicles mature. Before your body spontaneously releases the eggs, a doctor will retrieve them while you are placed under anesthesia. These eggs will then be taken to a laboratory where they will be combined with your partners sperm and left overnight to fertilize. About a day later, the eggs which have been fertilized will be transferred back to you through laparoscopy. This is a type of surgery that involves a small incision being made just below your navel into which a tiny tube is inserted. Through this tube, the fertilized eggs will be deposited into your fallopian tubes. Between one and four embryos are usually transferred. The embryos will then be left to travel on their own down through your fallopian tubes and into your uterus.Pregnancy Success With ZIFT On average, 36% of women are able to get pregnant using ZIFT, while 29% of women have a live birth. However, because several eggs are transferred back to the woman, 35% of the pregnancies that result from ZIFT are multiples with the majority of them being triplets or more. Additionally, there is an increased risk of ectopic pregnancy with this method. *

This is a variation of a single sperm into the egg. It is utilized when the male partner has a significant problem with his sperm or when IVF is planned and there is a significant concern regarding fertilization. http://www.asrm.org/Patients/FactSheets/ICSI-Fact.pdfICSI, a form of micromanipulation, involves theinjection of a single sperm directly into the cytoplasm of a mature egg (oocyte) using a glass needle (pipette).This process increases the likelihood of fertilization when there are abnormalities in the number, quality, orfunction of the sperm. ICSI is generally unsuccessful when used to treat fertilization failures that are primarilydue to poor egg quality.Indications for Intracytoplasmic Sperm Injection Very low numbers of motile sperm. Severe teratospermia. Problems with sperm binding to and penetrating the egg. Antisperm antibodies thought to be the cause of infertility. Prior or repeated fertilization failure with standard IVF methods. Frozen sperm limited in number and quality.Approximately 30% of all ICSI cycles performed in the United States in 1998 resulted in a live birth, which is comparableto rates seen with traditional IVF. Younger patients may achieve even more favorable results. Factorssuch as poor egg quality and advanced maternal age may result in lower rates of success.ICSI does not increase the incidence of multiple gestation as compared to standard IVF. Because ICSI is a relativelynew technique, first performed in 1992, long-term data concerning future health and fertility of childrenconceived with ICSI is not available. Some studies report that the incidence of a congenital malformationcalled hypospadias (urethra opening on underside of penis) is increased in babies conceived through ICSI.This is an area of ongoing investigation. Because some causes of male infertility are familial and are related togenetic problems, male offspring might have reproductive problems as adults. Despite these concerns, ICSI isa major advance in the treatment of severe infertility.

*http://www.ivf-infertility.com/ivf/frozen4.phpEmbryo freezing(Embryo cryopreservation)Embryo freezing is a well-established form of assisted conception treatment. An increasing number of IVF clinics worldwide are now able to freeze spare embryos for later transfer. The first frozen embryo baby was born in 1984. Embryo cryopreservation allows multiple embryo transfers from a single egg collection and improves the chances of livebirth.Advantages of embryo cryopreservationAllow maximizing the potential for conception for IVF and prevent wastage of viable normal spare embryos. Perhaps this is the most important advantage of cryopreservation. Approximately 50% of women may have spare embryos available for freezing. In some clinics, the pregnancy and live birth rates with frozen-thawed embryo transfer is as high as those achieved with fresh embryo transfer. Freezing all embryos for subsequent transfer may be advised for women who are at a high risk of developing severe ovarian hyperstimulation syndrome following ovarian stimulation for in-vitro fertilization (IVF). When embryo implantation may be compromised in cases such as the presence of endometrial polyps, poor endometrial development, break through bleeding near the time of embryo transfer or illness. Difficulty encountered at fresh embryo transfer e.g. cervical stenosis (inability to pass through the cervical canal because the cervix is narrowed or scarred, etc). Cryopreservation of embryos is very important to be incorporated in the egg donation programs. It is not always possible to synchronize the recipients cycle with that of the egg donor. In some countries, it is mandatory to freeze all embryos created from donated eggs, quarantined for a period of six months and until the donor have a repeat negative screening tests. As a result of successful cryopreservation programs, frozen embryos have also become available for donation to infertile couples. Before cancer chemotherapy or radiotherapyThawing of embryo involves removing the embryos from the liquid nitrogen, thaw at room temperature, remove the cryoprotectant fluid and mix the embryo in a special culture media. The mixture is then kept in the incubator ready for transfer.If the embryos were frozen at cleaved stage or blastocyst, they can be thawed and replaced in the same day. However, if they were frozen at the two-pronucleate stage, then they are thawed on the day before and cultured overnight to allow them to divide and are replaced when they become 2-4 cell embryo (s).*

http://www.asrm.org/Patients/select.htmlSelecting an ART Program When selecting an ART program, information is crucial. Important points for consideration include the qualifications and experience of personnel, types of patients being treated, support services available, cost, convenience, live birth rates per ART cycle started, and multiple pregnancy rates. Older programs have established live birth rates based on years of experience. Small and new programs may still be determining their live birth rates, although their personnel may be equally well qualified.Every couple wants to use the most successful ART program, but many factors contribute to the overall success of a program. For example, some clinics may be willing to accept patients with a low chance of success. A clinic may specialize in certain types of infertility treatment. Costs may vary between programs. A couple may prefer a program based upon interpersonal interactions with the ART team or may feel more confident in the recommended treatment plan. Consequently, it may not always be appropriate to compare programs based only on the published pregnancy rates.Credibility is important too. Does the program adhere to the guidelines set forth by the American Society for Reproductive Medicine (ASRM)? Is the program a member of the Society for Assisted Reproductive Technology (SART), a society affiliated with the ASRM? Is the IVF lab accredited by the College of American Pathologists and SART or by the Joint Commission on Accreditation of Healthcare Organizations? These organizations require ART programs to have personnel on their staff who have been trained in reproductive endocrinology, laparoscopic surgery, sonography, hormone measurement, tissue culture technique, and sperm/ egg interaction. Are the physicians board certified in reproductive endocrinology and infertility? Does the program report its results to the SART Registry and the Centers for Disease Control and Prevention? The compiled results from the registry are published annually in Fertility and Sterility, the ASRM journal, and results are available on the CDCs Web site at www.cdc.gov/nccdphp/drh/art.htm.The above considerations and answers to the following questions, which may be asked of the program, will help you make an informed decision when choosing an IVF/GIFT program. Details about the Program Does the program meet and follow ASRM guidelines? Does the program report its results to the SART Registry and the CDC? Is the program a member of the Society for Assisted Reproductive Technology? How many physicians will be involved in my care? Are one or more physicians board certified in reproductive endocrinology? To what degree can my own physician participate in my care? What types of counseling and support services are available? Whom do I call day or night if I have a problem? Do you freeze embryos (cryopreservation)? Is donor sperm available in your program? Donor eggs? Donor embryos? Do you have an age or basal FSH limit? Do you do ICSI? If so,when? Cost? Do you do assisted hatching? If so,when? Cost? How many eggs/embryos are transferred?

http://www.sart.org/Guide_AssistedReproductiveTechnologies.html

Couples who are considering ART should realize that it is an intensely emotional, physically arduous, and expensive procedure. Most couples find it difficult to consider the chances for success realistically without dampening the drive that allows them to undertake these procedures. Above all, couples should explore plans for the future, whether or not their attempts at ART are successful.

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