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ART-IVF: the Long and Short of it

ART-IVF: the Long and Short of it. Professor Ernest Hung Yu NG Department of Obstetrics & Gynaecology The University of Hong Kong. The Nobel Prize in Physiology or Medicine 2010. Robert G. Edwards for “Development of In Vitro Fertilization”. Louise Brown: First test-tube baby.

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ART-IVF: the Long and Short of it

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  1. ART-IVF:the Long and Short of it Professor Ernest Hung Yu NGDepartment of Obstetrics & Gynaecology The University of Hong Kong

  2. The Nobel Prize in Physiology or Medicine 2010 Robert G. Edwards for “Development of In Vitro Fertilization”

  3. Louise Brown: First test-tube baby 12 July 2008 9 October, 1978

  4. Key developments in assisted reproduction

  5. IVF procedure • Ovarian stimulation • Egg collection • Fertilization • Embryo transfer

  6. IVF Agonist (nasal spray)or Antagonist Egg retrieval Embryo transfer Period Pregnancy test hCG FSH/hMG Stimulation of ovaries Luteal phase support fertilization

  7. 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 10 10 hCG GnRH antagonist protocol rFSH GnRH Antagonist Common protocols hCG GnRH agonist protocol rFSH GnRH Agonist

  8. Ovarian stimulation • Poor ovarian responses • cycle cancellation • poor pregnancy rates • Excessive ovarian responses • risk of ovarian hyperstimulation syndrome • high E2 detrimental to the outcome (Ng et al., 2000)

  9. Strong association between number of eggs and live birth rate • Live birth rate rose with an increasing number of eggs up to 15, plateaued between 15 and 20 eggs and steadily declined beyond 20 eggs

  10. Ultrasound markers Antral follicle count Ovarian volume Ovarian stromal vascularity Hormonal markers Anti-Mullerian hormone FSH Inhibin Tests of ovarian reserve

  11. Aims of ovarian reserve testing • To counsel patients about the likely ovarian response • To individualise stimulation regimes and FSH dose • NOT to advise against treatment in couples with “poor prognosis”

  12. AFC and AMH in prediction of ovarian response and non-pregnancy • Poor ovarian response • Non-pregnancy (Broer et al, F&S 2008)

  13. 1,156 women in the first IVF cycle • Cumulative live birth in the fresh plus all the frozen embryo transfers after the same stimulation cycle • Both AMH and AFC were not significant predictors of cumulative live birth after adjusting for age and number of embryos available for transfer.

  14. Prediction of cumulative live birth

  15. Prediction of cumulative live birth

  16. Risks Bleeding Pelvic infection Injury Abdominal pain Oocyte retrieval under transvaginal ultrasound guidance

  17. Sperm washing Abnormal sperm Semen Culture medium Low density High density Centrifugation Normal sperm with good motility

  18. Fertilization methods Culture medium • Conventional insemination • Intracytoplasmic sperm injection-injecting single sperm into an egg • Severe male factors

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