What is Assisted Reproductive Technology?

Sunday 13 May 2018   Autore: Prof. A. Natali

Topic: Male infertility

It is a field of Reproductive Medicine in which progressively more complex technologies try to achieve pregnancy

According to the World Health Organization (WHO), when in a sexually active couple, with a woman under 35, a year of unprotected regular sexual intercourse has passed and no conception has occurred, we start talking about Infertility of couple. In this context, man can be the cause of the problem in at least 50% of cases. This is due to diseases such as varicocele, criptorchidism,  epididimitis, which reduce the fertilizing capacity of the seminal fluid. In the case of more advanced age of the woman, usually after 35 years, the time frame to consider before contacting a specialist is six months. It is important to know that the human species does not have a high reproductive power, there is talk of a 25% chance of pregnancy in sexual intercourse coinciding with the moment of ovulation of the woman. Approximately one in six fertile couples is affected by infertility (15-17%). To determine the cause of infertility, in addition to an accurate clinical history of the couple and a complete medical examination for both, specific investigations are then necessary. In the case of women, the basic exams are the basal hormonal study, ultrasound and hysterosalpingography. For the man, the fundamental examination is the analysis of the seminal fluid by means of a spermiogram. If naturally a couple does not arrive at a conception, the medicine provides technologies, gradually more complex and invasive to get to the result. In this case it speaks of Assisted Reproductive Technology (ART). It starts from the simplest method (1st level ) that is called Intrauterine Insemination (IUI). It is a technique that consists in placing a sperm sample, previously treated in the laboratory, inside the woman's uterus in order to increase the sperm potential and the possibilities of fertilization of the egg. In this way the distance between the egg and the sperm is shortened and the meeting between both gametes is facilitated. If this technique is not achieved the result can be passed to a 2nd level of technology represented by In Vitro Fertilization with Transfer of the embryo (IVF-ET) .This is a technique that, after taking the oocytes from the woman, allows the approach of the egg to the spermatozoon in the laboratory -in vitro- in order to obtain already fertilized embryos to be transferred into the maternal uterus. The fertilization of the eggs can be performed using conventional IVF-ET technique or with Intra Cytoplasmic Sperm Injection (ICSI) which consists in selecting the best spermatozoon in the laboratory and inserting it directly into the oocyte.In the case that the man does not produce spermatozoa ( azoospermia), these ART techniques on woman are associated with surgical techniques on man to recover sperm from the testes. These procedures can be percutaneous (TEFNA) or open air (TESE, Micro-TESE) depending on the various pathological situations that are at the root of the problem in humans. In Italy, over the years, the legislation in reference to the PMA has changed, currently all the above mentioned techniques are allowed.

 

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