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Assisted human reproduction

Background

Overview

Definition
Assisted human reproduction or ART refers to any procedure that involves handling eggs, sperm, or both outside the human body (in vitro) including IVF and intrauterine insemination, and ovarian stimulation with gonadotropin or medications.
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Pathophysiology
Assisted human reproduction is used to address primary or secondary infertility, fertility preservation after gonadotoxic treatments in reproductive-age patients, to enable same-sex couples and single women and men to conceive and have biological children, and to facilitate the services of surrogate gestational carriers.
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Disease course
Reproductive problems or infertility is addressed through assisted human reproduction, which includes IVF (IVF), intratubal transfer of gametes (GIFT), intratubal transfer of zygotes (ZIFT), tubal transfer of preimplantation embryos (TET), gamete or embryo donation, cryopreservation, and micromanipulation.
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Prognosis and risk of recurrence
In assisted human reproduction, early mortality increases multiple pregnancies with each additional fetus corresponding to a relative risk of 2.4 for triplets, 3.3 for quadruplets, and 10.3 for quintuplets.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of assisted human reproduction are prepared by our editorial team based on guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC 2014)....
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Diagnostic investigations

Genetic testing: as per SOGC 2014 guidelines, Offer genetic/clinical counseling, karyotype assessment for chromosomal abnormalities, and Y-chromosome microdeletion testing to all men with severe oligozoospermia or azoospermia (sperm count < 5 million/hpf) prior to IVF with intracytoplasmic sperm injection.
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Surgical interventions

Elective single embryo transfer: as per SOGC 2014 guidelines, Provide elective single embryo transfer in couples with good prognosis for success.
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More topics in this section

  • Cryopreserved embryos fertilized in vitro

  • Intracytoplasmic sperm injection

Patient education

Genetic counseling: as per SOGC 2014 guidelines, Counsel couples thoroughly about the significant risks of multiple pregnancies associated with all assisted human reproductive treatments.
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Follow-up and surveillance

Serial imaging assessment: as per SOGC 2014 guidelines, Counsel patients being evaluated for any ART procedure on the slightly increased risk fo congenital structural abnormalities, with emphasis on known confounding factors such as infertility and BMI.
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