Assisted Reproductive Technology (ART) Rajeev Sharma, Randhir Puri, Narendra Malhotra, Jaideep Malhotra
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Overview of ARTChapter 1

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Infertility is not only a common health problem in young couples but a formidable cause for social, psychological and financial suffering. It is important to understand the terms before proceeding.
 
 
Terms and Definitions
Infertility is defined as inability to achieve pregnancy in spite of regular unprotected intercourse for at least one year.
Subfertility infertile patients who achieve pregnancy after 1–2 years without any aid or assistance.
Sterility-inability to achieve pregnancy in spite of continued efforts until some assistance is extended.
Infertility can be treated by medications, surgery or both. Couples in whom the above said measures fail are candidates for assisted reproductive procedures.
 
Assisted Reproductive Procedures
  1. Intrauterine insemination (IUI)
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    Fig. 1.1: Steps of IVF (Conventional)
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  2. In vitro fertilization-embryo transfer (IVF-ET)
  3. Intratubal transfer techniques
  4. Sperm retrieval techniques
  5. Intracytoplasmic sperm injection (ICSI)
  6. Other microassisted fertilization techniques for male factor infertility.
 
Steps Involved in these Procedures
  1. Intrauterine insemination – case selection
    • Ovarian stimulation
    • Follicle and endometrial monitoring
    • hCG trigger and timing of IUI
    • Semen preparation
    • IUI procedure
    • Luteal phase support
  2. In vitro fertilization-embryo transfer (IVF-ET)
    • Down regulation
    • Ovarian stumulation + follicle monitoring
    • Oocyte collection
    • Sperm collection
    • Insemination
    • Fertilization + Culture of embryos
    • Embryo transfer
  3. Intratubal transfer techniques
    • GIFT-Gamete intrafallopian transfer
    • ZIFT-Zygote intrafallopian transfer
  4. Sperm retrieval techniques
    • MESA—microepididymal sperm aspiration
    • PESA—Percutaneous epididymal sperm aspiration
    • TESE—Testicular sperm extraction4
    • TESA—Testicular sperm aspiration
    • Others—Vas deferens sperm aspiration
      • Rete testis sperm aspiration
  5. Intracytoplasmic sperm injection (ICSI)
    • Ovarian stimulation and monitoring
    • Oocyte retrieval
    • Sperm preparation
    • Denuding of oocytes
    • Preparation of dish for ICSI
    • Sperm injection
    • Embryo culture
    • Embryo transfer
  6. Other microassisted fertilization techniques for male factor infertility
    • Zona drilling
    • Partial zona dissection
    • Subzonal insemination (SUZI)
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Fig. 1.2: Pioneer IVF team and world's first IVF baby and her family