Assisted Reproductive

Technology
 Assisted reproductive technology is the
handling of gametes (ova, sperm), or
embryo (conception) in an attempt to
achieve a pregnancy outside the natural
way, not including measures of human
cloning or duplication.
 Requirement
Complete management has done invert
There is a very clear indication
Understanding the ins and outs of the procedure
Able to give permission on the basis of
understanding
able to fund
Prepared psychologically
Understanding the religious law
 History
Robert Edward and Patrick Steptoe (1978)
USA (1981).
Indonesia 2 Mei 1988 RSAB Harapan Kita
(Program Melati)
TRB is divided into two major groups :
Intra-Corporeal
Extra-Corporeal.
Intra-Corporeal

IUI
GIFT
 Intrauterine Insemination (IUI)
Intrauterine Insemination (IUI) is a way to enter the
sperm cells that have been prepared (to be more active
sperm washing) directly into the uterine cavity with a
catheter at the moment of ovulation (fertile period).
IUI success rate is only about 10%. If it fails better not be
repeated more than one time again (so IUI should only
be done 2 times). It is based on the results of research
that IUI is done 3 times or more will still provide a failure
on subsequent implementation. It is therefore advisable
to conduct other programs such as IVF.
Indications does IUI is:
a. Disruption of delivery of sperm cells in the vagina due to damage to
the anatomy of the penis or vagina, sexual dysfunction in men /
women, or retrograde ejaculation (restrained).
b. Post-coital test results were bad: the ability of sperm cells to live and
swim in the woman's uterus fluid unfavorable.
c. Disturbance factors and cervical mucus. With IUI, sperm delivered
directly into the womb without touching the vagina.
d. Decreasing the number, form, and movement of cells seperma
(oligoasthenozoospermia) medium level. With IUI, sperm cells travel
past the woman's reproductive organs will be helped. But the
success of IUI is still largely determined by the number of sperm
(ideally remains above 20 million sperm / ml).
e. Hormonal disorders such as luteal phase disorder or syndrome LUF
and after trying the treatment for several months remained
unsuccessful.
f. Endometriosis is minimal.
g. Infertility is not yet known why.
Terms does IUI is:
a. Legitimate married couples with wives aged not more
than 45 years. But ideally should be below the age of
wife of 35 years so the chances of success are higher.
b. There is no contraindication to pregnancy.
c. Reproduction wife may respond to the drug triggers
ovulation.
d. Both normal Fallopian tube.
e. Free of TORSH-KM infection, hepatitis, syphilis and
HIV / AIDS
Details of the implementation phase are as follows:

Patient lying on his back on a special examination table

(table for obstetric examinations in pregnant women).
Patients sleep with a higher waist position from the body and
head. Feet in the open position and depending on the left
and the right buffer.
The doctor inserts a speculum into the vagina to the cervix
appears.
Sperm is inserted through the catheter, the tip of the catheter
is inserted through the cervix, cervikalis canal, up to the
uterine cavity carefully to avoid injury to the lining of the
uterine cavity.
Once the catheter tip is the most extensive in the uterine
cavity, sperm sprayed from the catheter. Then a catheter that
has been vacant withdrawn.
Patients lay the same position for approximately one hour.
Then the patient was discharged (should still be done
bedrest)
 Gamete Intra Fallopian Transfer
(GIFT)
1. Female ovaries are stimulated in order to produce more ova than
the number normally through the consumption of certain drugs, such
as Clomifene and gonadotropin.
2. If there has been a mature follicle, the woman would be injected
Hcg and ovulation will occur 36 hours thereafter.
3. Ovum successfully produced then removed from the ovaries by
inserting a needle through the vaginal wall (using ultrasound as a
guide).
4. The ovum ( 3-4 ovum) is mixed with the sperm of her partner (
200,000 motile sperm) in a petri dish.
5. Ovum and the sperm that has been mixed immediately transferred
to the woman's Fallopian tube with laparoscopy, so that fertilization
occurs in the woman's body.
6. Fertilization the zygote results can thrive in their natural environment
right from the earliest stages.
Extra-Corporeal

ZIFT
TET
IVF
ISCI
 Zygote Intrafallopian Transfer
(ZIFT)
ZIFT technique has the same procedure as GIFT.
However, the ZIFT, which is inserted into the
Fallopian tubes is not a mixture of ovum and
sperm, but rather the result of fertilization
between the two, ie the zygote that is inserted
into the tube one day after fertilization.
The advantage: the doctor can ascertain directly
whether or not fertilization occurs.
The disadvantage: a more invasive procedure
than IVF or GIFT. the risk of multiple pregnancy
in ZIFT is also greater.
 Tubal Embryo Transfer (TET)
TET procedure is the same as GIFT and
ZIFT procedures, but that is inserted into
the Fallopian tube embryo is inserted into
the fallopian 2 days after fertilization. TET
can be done on women who have at least
one healthy Fallopian tube but does not
match the GIFT method / technique of
embryo transfer through the vagina.
 In Vitro Fertilization (IVF)
IVF difference with other methods of fertilization embryos
is not inserted into the Fallopian tubes, but into the
uterus. 1-2 embryos entry process is conducted 6 days
after fertilization, using a thin catheter through the cervix
into the uterus (usually using ultrasound as a guide).
Before the entry process of the embryo into the uterus,
the woman should be given progesterone, so
endometriumnya thickened and ready to accept
implantation.
The advantage: less invasive and quality of the resulting
embryo is more controllable.
The disadvantage: higher risk of multiple pregnancy.
 Intra cytoplasmic Sperm
Injection (ICSI)
ICSI is one that can overcome the problem of male
infertility, such as the number or the ability of low sperm
motility, vas deferens were damaged, as well as men
who have a vasectomy. Female ovum retrieval
procedure at the same ICSI procedure GIFT, ZIFT, and
other ART. But at ICSI sperm is injected into the
cytoplasm of the ovum. The resulting embryo is then
inserted into the woman's uterus.
Because ICSI method enables an abnormal sperm to
fertilize an ovum, there are concerns that a child is
generated through ICSI method will have impaired health
or development, such as low birth weight, abnormalities
in the Y chromosome, and the risk of mental retardation.