Description
Assisted Reproductive Technology (ART) plays a crucial role in managing infertility, offering hope to couples struggling to conceive. It includes advanced techniques like in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and gamete donation. ART helps overcome various infertility causes, including ovulatory disorders, blocked fallopian tubes, low sperm count, or unexplained infertility. It involves stimulating ovaries, retrieving eggs, fertilizing them outside the body, and transferring embryos to the uterus. Success rates depend on age, health, and underlying conditions. ART has revolutionized reproductive medicine, enabling many to achieve parenthood while ensuring ethical and medical standards are met.
Résumé
- ART (Assisted Reproductive Techniques) provides artificial aid to infertile couples. The initial step involves identifying the cause of infertility through careful study, investigation, and examination. This is crucial for selecting the most appropriate treatment method. Infertility can stem from hormonal imbalances, affecting both males and females, with key hormones including AMH, LH, FSH, prolactin, and TSH.
- Male and female factors each contribute to about 40% of infertility cases, while unexplained factors account for the remaining 20%. Female factors include endocrine, tubal, and ovarian issues, as well as infections. Male factors often involve abnormal semen parameters, endocrine imbalances, and testicular dysfunction. Unexplained infertility presents a challenge when both partners appear normal.
- Seminalysis is a common initial test for male infertility. Current WHO guidelines define normal sperm parameters, emphasizing that only a small percentage of sperm in a sample need to be morphologically normal. Beyond count and motility, a detailed analysis should consider reactive oxygen species, peroxidase, agglutinations, morphometric analysis, and chromatic studies.
- Female examination includes menstrual history, prior miscarriages, hormone profiling, and tests like hysterosalpingography (HSG) to assess tubal patency. Laparoscopy can be diagnostic or surgical, and ultrasound helps to observe blood flow within the uterus and ovaries. Counseling is an important part of any ART procedure, it is now considered mandatory to have a counselor in an ART setup to help with mental health and understand procedures.
- Available ART treatments include mild induction and monitoring, intrauterine insemination (IUI), and in vitro fertilization (IVF). IVF involves fertilizing eggs outside the body and then transferring the embryos back into the uterus. Intracytoplasmic sperm injection (ICSI) is often preferred, especially in cases of male infertility, as it involves directly injecting a sperm into an egg.
- Advanced techniques include intracytoplasmic morphologically selected sperm injection (IMSI), which uses higher magnification to select sperm, and laser-assisted hatching to aid embryo implantation. Time-lapse monitoring allows continuous observation of embryo development, aiding in the selection of viable embryos.
- Preimplantation genetic diagnosis (PGD) and screening (PGS) are used to assess the genetic health of embryos. Genetic tests include aneuploidy screening, mosaicism testing, and gene sequencing, often performed on blastocyst-stage embryos. Surgical sperm retrieval methods like TESA, PESA, and micro-TESE are options when sperm production is severely compromised.
- Cryopreservation, particularly vitrification, allows for the freezing of eggs and embryos, enabling delayed embryo transfer in a more synchronized environment. Despite advancements in ART, a guaranteed positive outcome isn't possible, making it challenging to manage expectations after negative results. However, there's hope for improved outcomes with future technologies and AI integration.
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