Assisted Reproduction Techniques

Assisted Reproductive Techniques (ART) Overview

• Definition: ART encompasses medical procedures used to treat infertility by handling eggs and sperm to achieve pregnancy.

Lecture Objectives

• Understand the necessity for Assisted Reproductive Techniques.
• Explore the availability of ART on the NHS.
• Discuss both non-embryo culture and embryo culture methods of ART.
• Analyze success rates of ART in the UK.
• Identify common issues associated with ART.
• Look at additional ART options available.

Why ART is Required

• Infertility Statistics:
  • 1 in 7 heterosexual couples face difficulties conceiving.
  • Male subfertility accounts for 37% of issues:
  • Sperm motility, count, morphology, quality, access (vas deferens).
  • Female subfertility accounts for 31%:
  • Egg quality (age), ovulation, sperm access (fallopian tubes), fertilization, and early embryonic development.
  • 32% of cases categorized as ‘unexplained infertility’.

Need for ART in Specific Cases

• Donor Eggs/Sperm: Needed for non-heterosexual couples, individuals with inheritable diseases, and those with reduced ovarian/testicular function.
• Surrogacy: For individuals unable to carry children or undergo childbirth.
• Egg/Sperm Freezing: Important for cancer patients and others at risk due to age or other factors.
• Avoiding Viral Infections: Prevent transmission of infections.

Subfertility Risk Factors

• Common Factors:
  • Smoking, alcohol, drug use (including prescription), BMI extremes.
• Less Common Factors: Tight male underwear, occupational hazards.

Historical Development of ART

• 1700s: Spallanzani noted fertilization without intercourse and Hunter used husband's sperm for impregnation with assistance.
• 1878 onwards: Noted embryonic development from cultured eggs & early sperm retrieval techniques.
• 1934: Initial claims to produce embryos via IVF, later disproven as natural conception.
• 1978: Birth of Louise Brown, the first ‘test tube’ baby.

ART Costs

• Economic Aspects:
  • Typically costs £3000 for one cycle on the NHS; private clinics may charge significantly more.
• NHS Funding: Some treatments available through NHS, but eligibility often varies and resembles a ‘postcode lottery’.

Eligibility for NHS Funded Cycles

• Typically requires:
  • Heterosexual couples attempting to conceive for 2 years (1 year prior to tests included).
  • Criteria: Partner under 40, no living children, healthy BMI (19-30), and no drug use.
• Groups Generally Excluded:
  • Single women using donor sperm, some older males, non-heterosexual couples.

ART Procedures Overview

Primary Assessment of Female Fertility

• Hormonal Testing: Progesterone levels for ovulation; gonadotrophins for ovarian function.
• Ovarian Testing: Ultrasound to assess follicles and AMH levels for egg reserve.
• Fallopian Tube Testing: X-ray/ultrasound/laparoscopy to check for blockages.

Primary Assessment of Male Fertility

• Semen Analysis: Evaluating volume, color, pH, and sperm quality (count, motility, morphology).

Types of ART Methods

Non-Embryo-Culture Techniques

• Intrauterine Insemination (IUI): Direct introduction of sperm into the uterus.
• Gamete Intrafallopian Transfer (GIFT): Non-recommended due to guidelines, involves placing sperm and eggs directly in fallopian tubes.

Embryo Culture Methods

• In Vitro Fertilization (IVF): The foundational procedure where fertilization occurs in petri dishes.
  • Cycle Steps:
  1. Ovarian stimulation via hormonal therapy.
  2. Egg retrieval using ultrasound-guided methods.
  3. Sperm preparation and fertilization methods (traditional IVF, ICSI).
  4. Culturing embryos for development.
  5. Transfer of embryos into the uterus, preferably at 5-6 days post-fertilization.

Success Rates of ART

• Pregnancy Rates: Approximately 20-30% implantation success rate, with birth success rates ranging from 7-30% based on age.
• Factors Affecting Rates: Age and health of eggs, sperm quality.

Common Issues with ART

• Psychological Effects: Stress, reduced libido, need for counselling.
• Procedural Risks: Ectopic pregnancy, multiple pregnancies, ovarian hyperstimulation syndrome (OHSS), and concerns over long-term hormonal intervention effects.

Additional ART Options

• In Vitro Maturation: Culturing immature eggs collected before ovulation.
• Preimplantation Genetic Testing: Screening for inheritable diseases (PGD, PGS).
• Gametes/Embryos Freezing: For those undergoing treatments like cancer.
• Preimplantation Tissue Typing: Finding embryos that can act as stem cell donors for ill siblings.

Conclusion

• ART provides critical options for fertility treatments but comes with financial, ethical, and health considerations. Understanding eligibility, procedural methods, and psychological impacts is essential for those considering ART as an option.