ASSISTED ASSISTED CONCEPTION CONCEPTION TECHNIQUESTECHNIQUES

In vitro In vitro fertilization and embryo transfer fertilization and embryo transfer (IVF(IVF--ET) ET) involves the fertilization of involves the fertilization of gametes in the laboratory and transfer of gametes in the laboratory and transfer of embryos to the uterus. There are a embryos to the uterus. There are a number of related techniques that are number of related techniques that are carried out to overcome barriers to carried out to overcome barriers to enhance fertilization. enhance fertilization.

IVF IVF in in vitro vitro fertilization fertilization DI donor inseminationDI donor inseminationGIFT GIFT gamete intrafallopian transfergamete intrafallopian transferZIFTZIFT zygote intrafallopian transferzygote intrafallopian transferICSIICSI intracytoplasmic sperm injectionintracytoplasmic sperm injectionTESATESA testicular sperm aspirationtesticular sperm aspirationPESAPESA percutaneous sperm aspirationpercutaneous sperm aspirationMESAMESA micromicro--epididymal sperm aspirationepididymal sperm aspiration

Indications of IVF include:Indications of IVF include:TubalTubal damagedamageUnexplained infertilityUnexplained infertilitySevere endometriosisSevere endometriosisPCOSPCOSModerate & severe male factor:Moderate & severe male factor:

nonnon--obstructiveobstructive azoospermiaazoospermiaobstructive obstructive azoospermiaazoospermia

Unsuccessful IUIUnsuccessful IUI

Typical IVFTypical IVF--ET cycle:ET cycle:

Initial consultation and tests:Pituitary down regulation : To prevent the risk of spontaneous LH surge necessitating unplanned oocyte collection gonadotrophin-releasing hormone analogues (GnRH analogues) long protocol – Agonist cycleshort protocol – Antagonist cycle

Ovarian stimulation: FSH (either Ovarian stimulation: FSH (either recombinant or urinary) or MG injections :recombinant or urinary) or MG injections :

try to get about 8try to get about 8--15 eggs (18 mm) at the 15 eggs (18 mm) at the egg egg retrieval procedureretrieval procedure. .

Ovulation trigger with hCGOvulation trigger with hCG

OocyteOocyte collectioncollection

Egg retrieval Egg retrieval

Semen preparationSperm aspiration techniquesInsemination :Conventional IVFICSI

Fertilization and Fertilization and embryo cleavageembryo cleavage

Embryo transferEmbryo transfer

Embryo cryopreservation

Luteal support and establishment of pregnancy

Complications of IVF treatment Complications of IVF treatment

Ovarian Ovarian hyperstimulationhyperstimulation syndrome syndrome multiple pregnancy multiple pregnancy