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Advances in Human Assisted Reproductive Technology

Advances in Human Assisted Reproductive Technology. Xu Lan The Dept. of G & O, the First Affiliated Hospital of Shantou University Medical College. Human assisted reproductive technology. Infertility is a frequent medical problem around the world

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Advances in Human Assisted Reproductive Technology

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  1. Advances in Human Assisted Reproductive Technology Xu Lan The Dept. of G & O, the First Affiliated Hospital of Shantou University Medical College

  2. Human assisted reproductive technology • Infertility is a frequent medical problem around the world • Infertility affects about 15% of all couples attempting pregnancy

  3. Human Assisted Reproductive Techniques • Artificial Insemination • In vitro Fertilization-Embryo Transfer(IVF-ET) • Intracytoplasmic Sperm Injection(ICSI) • Pre-implantation Genetic Diagnosis(PGD)

  4. Artificial Insemination • Definition：Place sperm into female reproductive tract by artificial method, but not sexual intercourse • AIH(Artificial Insemination by Husband) • 夫精人工受精, 1790 • AID(Artificial Insemination by Donor) • 供精人工授精, 1884

  5. Artificial Insemination Indications • Abnormal Semen Parameters • Cervical Factors • Abnormal Post-coital Test • Difficulties in Sexual Intercourse

  6. Artificial Insemination Semen preparation • Swim-up separation • Percoll continuous gradient separation • Wang’s Tubal separation • Double-washing separation

  7. Artificial Insemination Real-time sperm separation(Wang’s tube)

  8. Artificial Insemination

  9. Artificial Insemination Features of Artificial Insemination • Only involving in semen samples preparation in vitro • There is no changes for the process of fertilization of sperm and oocyte compared with normal pregnancy • The pregnancy rate is about 20% • Easy, economic

  10. In Vitro Fertilization and Embryo Transfer • In Vitro Fertilization (IVF,体外受精) • Matured oocyte retrieved from female ovaries and fertilized with sperm in lab • Embryo Transfer (ET,胚胎移植) • The earlyembryo fertilized in vitro was transferred back to uterus

  11. IVF-ET IVF－ET

  12. In Vitro Fertilization & Embryo Transfer Who needs IVF-ET It is effective to overcome a variety of infertility problems, particularly tubal or marked sperm deficiencies. • Tubal problems • Immunologic infertility • Ovulatory problems(oocyte donor) • Sperm problems • Uterus dysformation(surrogate) • Other problems

  13. Collect husband semen sample Induction of superovulation in wife Liquefaction of semen Monitoring Ovarian Stimulation Swimming up of motile spermatozoa Capacitation of spermatozoa Retrieval of oocytes In vitro fertilization Post-insemination culture Embryo transfer Follow up In Vitro Fertilization & Embryo Transfer

  14. In Vitro Fertilization & Embryo Transfer Trans-vaginal ultrasound B follicle monitor

  15. In Vitro Fertilization & Embryo Transfer/ICSI Embryo Transfer

  16. In Vitro Fertilization & EmbryoTransfer Demands for embryo transfer • Condition：the development of endometrium should be coordinated simutaneously with that of embryo • Corpus lutem support

  17. In Vitro Fertilization & Embryo Transfer Significance： _Get rid of the traditional mode of marriage-sex-fertility, making it possible to control the process of human reproduction in vitro _possible for women who have ovary failure to get oocytes from donor or implanting the embryos in other’s uterus

  18. In Vitro Fertilization & Embryo Transfer R.G. EdwardsThe pioneerof human IVF-ET

  19. In Vitro Fertilization & Embryo Transfer Steptoe & Edwards

  20. In Vitro Fertilization & Embryo Transfer • More than a million healthy babies through IVF since the birth of Louise Brown 28 years ago. • Accounting for 1 in 200 births in the U.S. and more than 1 in 50 births in the U.K., France, Scandinavia, and Israel.

  21. In Vitro Fertilization & Embryo Transfer Intracytoplasmic Sperm Injection (ICSI)

  22. ART and ICSI Indications • Severe oligozoospermia or obstructive-azoospermia • Asthenospermia • Aged women • Harden zona pellucida

  23. ART and ICSI Problem • The potential risk of transmission of the parental genetic defects to the offspring Demands prior to ICSI • Strictly genetic screening: including chromosome karyotype and AZF microdeletion

  24. In Vitro Fertilization & Embryo Transfer/ICSI

  25. In Vitro Fertilization & Embryo Transfer/ICSI

  26. In Vitro Fertilization & Embryo Transfer/ICSI

  27. In Vitro Fertilization & Embryo Transfer/ICSI Micromanupulation

  28. In Vitro Fertilization & Embryo Transfer/ICSI With Dr. Gianpiero D. Palermo

  29. Preimplatation GeneticDiagnosis (PGD)

  30. 体外受精与胚胎移孕/PGD Preimplantation Genetic Diagnosis（PGD,胚胎着床前诊断）

  31. IVF-ET/PGD Embryo biopsy (胚胎活检)

  32. Preimplatation Genetic Diagnosis

  33. IVF-ET/PGD Procedure I. Biopsy Polar body removal Embryo biopsy II. Isolation and Fixation of single cell III. PCR and FISH analysis

  34. Preimplatation Genetic Diagnosis PGD for Reciprocal Translocation • 46, XX, t(4;11)(q21;q13) • The first success in the world

  35. Preimplatation Genetic Diagnosis 46, XX, t(4;11)(q21;q13)from lymphocyte

  36. Preimplatation Genetic Diagnosis PGD For 46, XX, t(4;11) (q21;q13)

  37. Preimplatation Genetic Diagnosis PGD For 46, XX, t(4;11) (q21;q13)

  38. Preimplatation Genetic Diagnosis PGD For 46, XX, t(4;11) (q21;q13)

  39. Preimplatation Genetic Diagnosis FISH analysis

  40. Preimplatation Genetic Diagnosis Benefits of PGD • Elimination of the risk associated with • 1. Chorionic villus sampling • 2. Amniocentesis • Elimination of the unfortunate circumstance of having to terminate an established but affected pregnancy

  41. Maturation in vitro of immature human oocyte

  42. From GV to first cleavage

  43. Oocytes fromstimulated and unstimulated ovaries 1. Live birth (Paulson, 1994) 2. Average 11 oocytes per patient (Russell, 1997) 3. Replace the standard stimulated IVF cycle

  44. Cryopreservation of immature oocytes • Widen the possibility of establishing an ovum bank. • Store oocytes from patients who risk the loss of ovarian functions. • Prevent from aneuploidy (freezing before spindle formation). • Overcome many of the legal and ethical problems.

  45. Cryopreservation of sperm and embryo

  46. 卵胞浆移植Ooplasm transfer, OT 将品质较佳的卵子吸取一小段细胞质, 藉显微注射技术注入品质较差的卵子细胞质内以改善其品质。 The transfer of small amounts ofdonor ooplasm (5–15%) probably includes mRNAs, proteins,mitochondria, as well as other factors and organelles.

  47. 人工辅助孵化术（AHA） 取出的精子卵子在体外授精培养成胚胎后,利用显微注射技术，在胚胎透明带上打个小洞,以利胚胎植入母体后顺利孵化提高着床率。

  48. Artificial womb人造子宫的研究 Bye Womb! Bye Mam! Bye Lady! Be the process by which a fetus gestates in an environment external to the mother. 人类胚胎发育的全过程都在母体外进行

  49. Artificial womb 人造子宫 A plastic box • filled with amniotic fluid • attached to a number of devices that monitor vital functions. • A pump replaces the placenta by supplying oxygen and food that goes directly into the fetus's blood. • The fetus lies submerged in the fluid, and its blood supply is cleaned and oxygenated by a dialysis machine through the umbilical cord.

  50. Artificial womb 人造子宫 • 可直接观察胎儿的生长发育情况 • 避免孕期感染或母体健康不佳引起胎儿体格及脑功能发育不全等缺陷 • 减轻妇女痛苦

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