Chapter 14 - TECHNOLOGIES ARE AVAILABLE TO ASSIST IN REPRODUCTION

For sperm to be able to fertilise an egg, it must be:

• produced in sufficient quantities

• able to move in a forward direction

• able to penetrate the corona radiata and zona pellucida.

Infertility

Infertility is the inability to conceive despite frequent unprotected sex over the period of at least a year.

Other factors affecting male fertility

• Semen, and the sperm it contains, may flow into the bladder, rather than out the urethra.

• The male’s immune system may develop antibodies for their own sperm, altering them and

reducing their effectiveness.

• Blockages may occur in the male’s reproductive tract, especially in the vas deferens, which may

stop the sperm leaving the testes.

• Hormonal imbalances can affect sex drive and the production of sperm.

The information that can be gained from ultrasounds includes:

• confirming pregnancy

• estimating the stage of pregnancy

• determining the number of foetuses

• identifying abnormalities of the cervix or uterus

• monitoring the growth of the foetus

• determining the gender of the foetus

• evaluating the anatomy of the foetus

• genetic screening

• studying the placenta and amniotic fluid

• identifying birth defects

• determining the position of the foetus.

Amniocentesis

A technique in which a small amount of the amniotic fluid surrounding a foetus is removed and examined for indications of possible defects in the foetus

Artificial insemination

Introducing semen from a donor into the vagina using a syringe, to bring about fertilisation

Assisted reproductive technology (ART)

Methods developed to assist couples to have a child, including in vitro fertilisation and intrafallopian transfer

Chorionic villus sampling (CVS)

A technique in which foetal cells are removed from the chorion and examined for indications of possible defects in the foetus

Endometriosis

A condition where tissue similar to the lining of the uterus grows outside the uterus

Polycystic ovarian syndrome (PCOS)

A hormonal condition that causes changes to the menstrual cycle as well as cysts on the ovaries

Foetal blood may be sampled to:

• diagnose chromosomal abnormalities

• diagnose foetal anaemia

• check foetal oxygenation

• identify infections

• give medications.

The blood may be taken from:

• the umbilical cord via percutaneous

umbilical cord blood sampling (PUBS),

where a needle is inserted through the

abdominal wall and uterus into the

umbilical vein

• a foetal blood vessel, usually the liver or

heart, via a fetoscope.

Male and females causes why for infertility

 Microsurgery

 Microsurgery

 Passages are cleared of inflammation, scar tissue

 

 Appropriate when:

§Sperm ducts or vas deferens are blocked in the male

§Uterine tubes blocked in the female.

Assisted reproductive technology (ART)

 In-Vitro Fertilisation

§Uterine tubes blocked

§Male unable to ejaculate normally

§Cervical mucous hostile to sperm

Eggs harvested after hormonal stimulation.

Fertilisation oxccurs outside the body

Embryo implanted into the uterus

Assisted reproductive technologies

 Gamete Intrafallopian Transfer (GIFT)

 Eggs are harvested, immediately mixed with sperm and injected into the uterine tubes of the female.

 Natural implantation takes place.

 Appropriate when:

§Uterine tubes are clear

§High sperm count

 Intracytoplasmic sperm injection (ICSI)

 Intracytoplasmic sperm injection (ICSI)

 Single sperm injected into single egg

 Embryo implanted into the uterus

 Appropriate when

§Low sperm count

§Poor quality sperm

§

Risk: may increase incidents of birth defects

 Donor Egg/Embryo

 Donor Egg/Embryo

 Appropriate when female cannot use own eggs (e.g. cancer treatment, mitochondrial disease)

 Embryo formed in vitro from donor egg and partner’s sperm

 Embryo implanted into the uterus of the female.

 Alternatively, donated embryo implanted into uterus of the female.

 Surrogacy

 Surrogacy

 Appropriate when the female cannot carry a child (e.g. uterine cancer)

 Either

 Male partner provides semen and another woman bears the child

 ART is used to provide an embryo using eggs and sperm from the couple and embryo is inserted into the surrogate.