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Techniques of Assisted Reproduction
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Techniques of Assisted Reproduction

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This term refers to the combination of techniques that used to surpass the obstacles of natural fertilisation, by intervening directly on the spermatozoa, ovules and embryos.  The most frequently used technique are:

Intrauterine Insemination (IUI)
consists in the treatment, in the laboratory, of the seminal liquid in order to select the most mobile spermatozoa and inject them using a plastic tube into the uterus at the time of ovulation, this being spontaneous or stimulated.  Intrauterine insemination is used when there are obstacles in the cervical canal, for unexplained infertility and for andrological causes.  It can give 10% to 15% of pregnancy per attempt

In Vitro Fertilisation and Embryo Transfer (FIVET)
it is the most frequently used  Assisted Reproduction technique.  It consists of strong ovarian stimulation in order to form many follicles in both the ovaries.  During stimulation for FIVET (or ICSI) two protocols exist: in the long protocol the first phase is called “suppression”, in which the ovaries are put to rest for about 2 weeks starting from the 21st day of the preceding cycle with daily injections or a single injection; the second phase is stimulation, comprising daily injections, morning and night, for about 10 days.  In the short protocol stimulation is commenced immediately on the 2nd day of the cycle.  When the follicles are big enough they are pierced with a needle inserted through the vagina and using ultrasound monitoring.  The ovules to be fertilised are isolated from the liquid aspired from inside the follicle in the laboratory. At the same time the seminal liquid is treated for Intrauterine Insemination, and the most mobile spermatozoa are put in contact with the ovules.  Two to three days of development of the ovule outside the body (in an environment that perfectly simulates the bodily environment) the embryos  that are formed are delicately transferred into the uterus using a plastic tube.  This technique is used in cases where the tubes do not function, in cases of unexplained infertility and when there are male problems of  medium seriousness.  The success of FIVET depends mainly on the quality of the embryos that are transferred into the uterus –a characteristic that can largely be evaluated by their aspect under a microscope.  1st grade embryos are the best then there are II, III and finally IV grade, that are the embryos with the smallest possibility of implantation.  It is equally true that a 1st grade embryo has a high probability to start a pregnancy

Intra Cytoplasmic Sperm Injection (ICSI)
It is used in cases of male infertility.  It is practically the same as FIVET up until fertilisation.  If the spermatozoa are very weak, it is not enough to put them in contact with the ovules.  In this case using very sophisticated equipment it is necessary to take the spermatozoa one at a time and insert them directly into the ovules.  After about 40 hours embryos are formed, which, like in FIVET, are transferred in utero

Testicular Sperm Extraction (TESE)
This Assisted Reproduction Technique is used for male infertility in cases of azoospoermia, when there are no spermatozoa in the seminal liquid.  On the same day, or the day before  follicular aspiration, a fragment of  tissue is taken from one or both the testicles:  it is practically a testicular biopsy which is used as a source of spermatozoa for the successive use in ICSI.  In fact, spermatozoa are often present in the testicle, even if in a reduced number.  It can be performed in the doctors rooms under local anaesthetic.  The results depend very much on the presence of spermatozoa in the testicular fragments, which occurs in more than 50% of the cases.  Once the spermatozoa are found, the results in terms of pregnancy are comparable to those of ICSI.  The risks are very few but the effort of the couple is notable.  If after the testicular biopsy 0 spermatozoa are found, the treatment of Assisted Rreproduction cannot continue.  It is possible to freeze the spermatozoa found, for use even after many months.

lunedì 29 giugno 2009

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