What is Assisted reproductive technology?
The frequency of infertile marriages in the world exceeds 15%, which, according to WHO, is considered a critical level. According to expert estimates, the rate of only female infertility has increased by 14% in the last 5 years. One of the forms of help in the treatment of infertility is ART.
Main types of ART services
- Intrauterine or artificial insemination. Divided into two procedures: AIH - artificial insemination with sperm of the husband, AID - artificial insemination with donor sperm.
- IVF - in vitro fertilization
- ICSI - in vitro fertilization with intracytoplasmic sperm injection into the egg.
In all IVF methods donor sperm may be used.
What really is assisted reproductive technology? For the Assisted reproductive technology definition, people take "ART - are methods of infertility treatment, in which some or all of the stages of conception and early embryo development are done outside of the body." The list of technologies that can be associated with ART is not settled. But more often than in the ART include:
- artificial insemination with the sperm of the husband (donor)
- in vitro fertilization and embryo transfer into the uterus
- injection of the sperm into the cytoplasm of the egg
- sperm donation
- egg donation
- preimplantation diagnosis of hereditary diseases
Actually it was the classic method of in vitro fertilization (IVF) in the uterus that became the basis for the development of a number of approaches that are now united by a common term assisted reproductive technology. In this case eggs after being cultivated in a special growth environment are fertilized with the sperm which had been previously treated and centrifuged in the nutritional environment.
Regarding the patients of the IVF program it is necessary for both in the couple to be infertile. This fundamentally changes the approach to the selection of the patients and their preparation for the program, that is, it makes mandatory, the preliminary assessment of the state of the reproductive system of both, the woman and the man separately.
According to the literature, about 40% of the cases of infertility among couples is due to male infertility. ART methods allow men to have offspring even with severe infertility (oligo, severe asteno-Teratozoospermia), and sometimes with only a single sperm cells, including testicular biopsy in punctate. IVF using donor eggs is used to overcome infertility in cases where a woman's own egg cells cannot be obtained, or poor quality eggs are obtained which are not able to be fertilized and develop into a full pregnancy.
The "surrogate" motherhood -is the only method of obtaining genetically personal baby for women with absence of a uterus or severe extra genital pathology during which the bearing of child is impossible or contraindicated.
Preimplantation diagnosis is also based on the method of IVF. The purpose of it is - getting the embryo in the early stages of preimplantation development and screening it for genetic abnormalities. Reduction operation is performed if there are more than three embryos. This procedure/decision is forced, but necessary for the successful flow of a multiple pregnancy. Rational and scientifically justified use of reduction, as well as improving the performance of its technology in multiple pregnancy allows to optimize the clinical course of the pregnancy, the birth of healthy offspring to predict and reduce the incidence of perinatal losses.
The purpose of ART
Assistance during infertility, getting healthy offspring infertile couples.
TIndications for assisted reproductive technologies:
- absolute tubal infertility in the absence of fallopian tubes or their obstruction
- unexplained infertility
- infertility not treatable by therapy, or infertility, the chance of overcoming which is higher with the help of IVF rather than when using other methods
- immunological forms of infertility (presence of sperm antibodies by MAP test ≥50%)
- various forms of male infertility (oligo, astheno or teratozoospermia) requiring the use of the ICSI method
Contraindications against ART
- congenital malformations or acquired deformities of the uterus, which prevent embryo implantation or child bearing
- benign uterine tumors requiring timely treatment
- malignant tumors of any localization (including history)
- ovarian tumor
- acute inflammatory diseases of any localization
- somatic and mental illnesses that are contraindicated for carrying a pregnancy and childbirth
Assisted Reproductive Technologies (IVF) success rate
According to the European Association of Human Reproduction in Europe today more than 290 000 ART cycles are being done per year, of which 25.5% end in birth; in the US - more than 110 000 cycles per year pregnancy rate is 32.5% on average. This success rate is averaged. Each pair - have their own story, their victories and failures. It should also be kept in mind and worth considering that the performance of PGD within the IVF program significantly increases the success rate - to about 65%.
Factors that affect the effectiveness of ART
The development of the pharmaceutical industry has led to the development of new medicaments to stimulate folliculogenesis, new disposable puncture needles for collection of eggs as well as modern noninvasive PE catheters which go into the uterus. This allowed a greater number of eggs of good quality to be extracted, reduce the risk of complications during the RTA and therefore improve the IVF program success rate to 36-39% at the rate of one PE in the uterine cavity.
In the IVF and PE program the most effective is the stimulation of superovulation scheme with the use of recombinant gonadotropins medications with the background of GnRH desensitization of the reproductive system. From our point of view, the use of superovulation stimulation scheme using recombinant gonadotropins medications and GnRH antagonists is less effective, however, it can reduce the incidence of ovarian hyperstimulation syndrome by almost 2 times.
The use of ICSI by couples with two or more unsuccessful attempts at IVF in their history, at normal rates of spermatogenesis and the reproductive functions of the woman allows to achieve pregnancy in 52% of the cases.
Biopsy of the testis and / or epididymis with the subsequent histological examination, in combination with the hormonal and genetic screening in patients with azoospermia, allows to establish the diagnosis and determine the further tactics of treatment of infertility of the couple. The group of patients with non-obstructive azoospermia form, prognostically are the most unfavorable in terms of obtaining sperm and pregnancy rates in IVF / ICSI. Pregnancy rates in this group of patients is 14.3%.
Cryopreservation of ART are used today for almost all kinds of biological materials. This method allows to store sperm, testicular tissue, oocytes and embryos for a long time. After thawing the percentage of viable material is 95% of spermatozoa, 80% of the embryos. If PE procedures are cancelled in the stimulated cycle because of the high risk of OHSS and cryopreservation of embryos "good" quality, the pregnancy rate in patients is 37.1% based on the stimulation cycle. The effectiveness of using the blastocysts thawed after cryopreservation in ART programs by women with an unsuccessful attempt is 29.5%.
Prenatal diagnosis in IVF and PE programs has reduced the incidence of spontaneous abortions up to 13% in couples where one of the parents - is the carrier of chromosomal aberrations, compared to the frequency of spontaneous abortions in patients with similar problems, that haven’t used the prenatal diagnosis services. Detection of chromosomal aberrations in the embryos and transferring of only genetically normal embryos increases the percentage of implantation, reduces the risk of spontaneous abortion and prevents the birth of a child with a genetic disease in the patients of the IVF program. With prenatal diagnosis one can avoid chromosomal diseases linked with fetal sex (haemophilia A and B, myopathy, dystrophy syndrome Martin-Bell et al.), Trisomy on the 21st chromosome (Down's syndrome), 13th chromosome (Patau syndrome), 18th chromosome (Edwards syndrome), monosomy (Turner), and others.
Prenatal diagnosis is indicated in the case of the birth of children with hereditary and congenital pathology, presence in the karyotype of balanced chromosomal aberrations, two or more failed IVF attempts, hydatidiform mole in the history, a high percent of spermatozoa with aneuploidy of different chromosomes (the X, Y chromosomes> 0.25%) in the ejaculate of the spouse, at the age of the woman higher than 35 years, for the determination of the sex of the fetus. The accuracy of determining the sex of the fetus by this method is 95-97%.