Assisted reproductive technologies




A Assisted reproductive technologies




1. Introduction
a) Procedure overview

    Assisted reproductive technologies (ARTs) refers to all techniques used to retrieve and fertilize human oocytes. In vitro fertilization (IVF) is the most common technique used to artificially fertilize human oocytes.

    The procedure is performed by initially stimulating maturation of the follicle with a gonadotropin-releasing hormone agonist that induces pituitary gland suppression and creates quiescent ovaries to prevent the production of a single dominant follicle. Follicle-stimulating hormone (FSH) and human menopausal gonadotropin are then administered, which induces 10 to 15 ovarian follicles. The patient is then given human chorionic gonadotropin (hCG), which induces the follicle to then mature and move into the follicular fluid. The oocyte is retrieved transvaginally, transabdominally, or via laparoscopy with an ultrasonically guided probe 34 to 36 hours after hCG administration. All visible follicles are collected, washed, incubated for 4 to 6 hours in a culture medium, and examined microscopically. Most follicles contain only one oocyte. Fertilization occurs in the IVF laboratory. The oocyte is identified and has minimal exposure to ambient room temperature, room air, and especially any chemical odors. Sperm are washed and centrifuged. Fresh media is added next to the centrifuged sperm, and those sperm that swim to the media, which can number 50,000, are placed with the oocyte. Timing must be coordinated with proper maturation of the uterine endometrium. ART is found to increase the risk of multiple gestations. Also, it has been reported that atypical implantations of the fertilized ovum or zygote, such as abdominal, cervical, ovarian, or tubal pregnancy, occur more frequently with ART. Common ART techniques are listed in the table on pg. 413.


Common Assisted Reproductive Technology Techniques






























In vitro fertilization (IVF) Oocytes are removed, fertilization occurs in the laboratory, and the embryo is placed transcervically into the uterus or into the distal portion of the fallopian tube(s).
Gamete intrafallopian transfer (GIFT) Oocytes and sperm are transferred into one or both fallopian tubes for fertilization.
  Advantage: oocyte retrieval and gamete transfer occur with a single procedure.
  Disadvantages: Requires at least one patent fallopian tube and laparoscopic surgery. Fertilization cannot be confirmed.
Zygote intrafallopian transfer (ZIFT) Fertilized embryos are placed into the fallopian tube.
  Advantages: Fertilization is confirmed. Laparoscopic surgery can be avoided if fertilization has not occurred. The embryos can be transferred at an appropriate developmental stage.
  Disadvantage: Requires a two-stage procedure, with added risks and costs. Requires at least one patent fallopian tube.
Tubal embryo transfer (TET) Cleaving embryos are placed into the fallopian tube.
Peritoneal oocyte and sperm transfer (POST) Oocytes and sperm are placed into the pelvic cavity.

Modified from Speroff L. Clinical gynecologic endocrinology and infertility. 6th ed. Baltimore: Lippincott Williams & Wilkins; 1999: 1133-1148; Tsen LC. Anesthesia for assisted reproductive technologies. Int Anesthesiol Clin 2007;45:99-113.

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Dec 2, 2016 | Posted by in ANESTHESIA | Comments Off on Assisted reproductive technologies

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