DR.L.

ANANDA KUMAR
M.D(F.M)
Assisted Reproduction
Assisted Reproductive Technologies
(ART)
• Artificial Inseminations
• In vitro fertilization (IVF)
• Gamete Intra-Fallopian Transfer (GIFT)
• Zygote Intra-Fallopian Transfer(ZIFT)
• Intra cytoplasmic Sperm Injection (ICSI)
• Surrogate Motherhood
 Some Common Reasons for ART
• Infertility
– Male
– Female
• Absence of one or the other partner
– Lesbian, gay
– Death of spouse
• Genetic Engineering
– Hereditary disorders
– Sex selection
 Sorting sperm according to sex
• Sperm are sexually dimorphic: half have an X-
chromosome, half have a Y-chromosome

• The X-chromosome is much bigger, so “female

determining” sperm have more DNA, and are
(hypothetically) slightly heavier

• Try to physically separate sperm based on size or DNA

content

• Mark either the X or Y chromosome in some way and sort

on the basis of the marking.
 Artificial Insemination
Deposition of semen or washed sperm in the
vagina, cervix ,uterus and Fallopian tubes with
help of instrument to bring about pregnancy in a
healthy women who is unable to conceive through
sexual intercourse with her husband.

• Can be from legally recognized partner (husband)

AIH
• from another donor AID
• Artificial Insemination Homologous Donor AIHD
• Fresh or frozen semen samples
 Long History of AI

• Human experience
– John Hunter (1780s) patient with hypospadias
– By 1941 over 10,000 births in the US by AI
– By 1955 over 50,000
– Now, approx 1 percent of all births in US
The Famous Turkey Baster
 Indications
• When the husband is impotent but fertile.

• when the husband is sterile.

• Where there is Rh incompatibility between

husband and wife.

• when the husband is suffering from hereditary

disease.
 Procedure:
• The usual practice is to deposit 1 ml of semen above the
internal os by means of a sterile syringe, at or about the time
of ovulation, i.e. 14th day after menstruation.

• The semen should be collected by masturbation, preferably

after a week's abstinence, and used within about 2 hours.

• The timing of insemination is important as the life span of

the spermatozoa in the female reproductive tract is short.

• The use of frozen semen for AID is becoming increasingly

common.
 Guiding Principles:
• Knowledge and full informed consent of both spouses
are essential. The consent must be in writing.

• The identity of the donor and recipient must not be

revealed to each other nor should the donor know the
result of insemination.

• The donor must be below the age of 40, not related to

either spouse, and should have children of his own.

• There should be parity of race, religion and as much as

possible the morphological appearance between the
donor and the husband of the recipient woman.
• The donor should give a written declaration that he will
not prefer parenthood claim for any child on the ground
of donation of semen.

• The physician who administers the artificial insemination

should avoid delivering the child.

• The wife of the donor must agree for donating the semen
for the purpose of insemination and the semen should be
obtained from an act of masturbation.

• A nurse/female attendant should be present when the

insemination procedure is being carried out.
 The 'code of conduct' for ART as formulated
by ICMR is being furnished:
• The ART clinic is not a commercial party in donor
programme or surrogacy.

• No ART procedure can be done without the spouse's

consent.

• The sperm donor and surrogate should not be a relative

or a friend of the couple.

• Sex selection is not permitted.

• The consent of couples for the use of embryos is a

must.
• Biological parents must adopt a child born through
surrogacy.

• The sale or transfer of human embryos outside the

country is prohibited.

• Donors should be screened for HIV and hepatitis B/C

infections.

• ART clinic has to get approval from the appropriate

accreditation authority.

• The records have to be maintained and regularly

checked to guard against tampering.
 IVF: In vitro fertilization
• Surgically remove “ripe” egg from follicle in ovary
• Obtain sperm sample
• Mix egg and sperm in glass (in vitro) dish
• Allow fertilized egg to develop for several days (in
nutrient solution at body temp)
• Put embryo(s) (blastocyst) into “prepared” uterus
(or Fallopian tube)
• Variation: sperm and egg are put into Fallopian tube
Scientists do it on the lab bench
3 day old human embryo
• Indications

• Absent or nonpatent fallopian tubes.

• Inadequate motile sperm count.

• Hostile cervical mucus.

• Refractory endometriosis.

• Unexplained infertility.
 This allows the following permutations:
• The woman's own ova to be fertilized by her husband's sperm
and reintroduced into her uterus.

• The woman's Own ova to be fertilized by a donor's sperm and

returned to her 0wn uterus.

• The woman's own ova to be fertilized by her husband's sperm

and returned to an other woman's uterus ('surrogate
motherhood').
• The woman's 0wn ova to be fertilized by a donor's sperm and
returned to a surrogate woman's uterus.

• An infertile woman may have another woman's ova implanted

in her, fertilized either by her husband or by a donor.
Gamete Intra-Fallopian Transfer
(GIFT)

A mixture of a woman’s
eggs and sperm are placed
into the fallopian tube
during a laparoscopy.

Once inserted, fertilization

is allowed to occur.
Zygote Intra-Fallopian Transfer
(ZIFT)

• Mixture of In Vitro
Fertilization and Gamete
Intra Fallopian Transfer.
• Fertilization takes place
outside the uterus and
placed into the fallopian
tubes.
 Fertilized egg or “zygote”
[note the two nuclei, egg and sperm]
Intracytoplasmic Sperm Injection
(ICSI)
Direct injection of sperm into egg
 Legal Problems of Artificial
Insemination
• Danger of litigation:
• Adultery:
• Legitimacy:
• Nullity of marriage and divorce:
• Natural birth:
• Incest:
• Posthumous child:
Surrogate Motherhood
 Surrogate Motherhood
• A surrogate mother is one who is hired to bear a child
which she turns over at birth to her employer.

• Surrogacy is an arrangement whereby a woman agrees to

become pregnant for the purpose of gestating and giving
birth to a child for others to raise.

• She may be the child's genitic mother (the more traditional

form of surrogacy), or

• She may be implanted with someone else's fertilized egg

(gestational carrier).
 Who chooses surrogacy?

• Surrogacy is a method of assisted reproduction.

• In some cases it is the only available option for
a couple who wish to have a child that is
biologically related to them, as opposed to
adopting a child.
 Legality

• The legal status of surrogacy arrangements

varies from jurisdiction to jurisdiction.