Embryology and assisted conception
• Infertility – inability to conceive after 1-year unprotected intercourse (1 in 6/7 couples need help
conceiving)
• Why treat infertility?
o Medical problems with a health need or lifestyle issue
o Definite illness model
o Health issue
o Social arguments
o Publix opinion
o Effectiveness and cost
• Funding fertility treatments
o Reduce suffering
o Increased amount of medical care
o Decreased economic output
o Poor area
o Post code treatment
o Guidelines
• Effective treatments for infertility – intercourse must occur at least 3 weeks a week for pregnancy
chance
o Tubal – tubal surgery, IVF
o Unexplained – SO/IVI, IVF
o Endometriosis – ablation, IVF
o Male – SO/IVI, IVF, ICSI, DI
o Ovulatory – general health, anti-oestrogens, cabergoline, IVF (obesity, too much fat around
the ovaries, is main cause of women not ovulating)
• Complications during assisted conception
o Bleeding
o Vessel injury
o Multiple pregnancy
o Bowel injury
o Ectopic pregnancy
o Ovarian hyperstimulation syndrome (OHSS)
• Removing inherited diseases
o Pre-implantation genetic diagnosis
▪ 1 cell removed from 8-cell embryo and test by PCR – if abnormality detected,
embryo not used
• Stem cells
o Umbilical cord blood stem cells currently being used to treat over 70 diseases – e.g.,
leukaemia, myelomas, sickle cell anaemia
o Potential therapies being research using cord blood stem cells
▪ Diabetes, Parkinson’s, Alzheimer’s, spinal cord injury, stroke, cerebral palsy
• Genetic engineering
o Genetic modification by inserting genes into living cells, designed gene attached to viral
vector, which has ability to carry gene across cell membrane
o Leads to designer babies
• Sperm collection
o Via masturbation mainly – if low sperm count, surgical sperm retrieval taken from testicle
o 2-7 days of abstinence
▪ Epididymis where sperm ejaculated from cannot completely refill before 2 days
▪ Sperm start to die if over 7 days
o Masturbation in unit so sperm is fresh
• Semen analysis – used to determine insemination technique
, o Macroscopic (see with naked eye)
▪ Volume – low volume = blockage = potential infertility cause
▪ Liquification
▪ Viscosity
▪ Colour
▪ Opacity
• Really clear = no sperm
• Really opaque = lots of sperm
o Microscopic
▪ Count (million/ml)
▪ Motility (%)
▪ Morphology (%) – 4% and above is normal, very few are normal
▪ Cellular debris
▪ Round cells
▪ Agglutination
o Sperm parameters
▪ ‘normal’ reference ranges have changed
▪ Morphology from 80% → 4%
▪ Figures gained from census of men worldwide alongside data of is they have
fathered a child
• Sperm preparation
o Remove semen
▪ Used to protect sperm from acidic vagina
▪ Can damage sperm if left in semen too long
o Remove abnormal/dead sperm and other cellular debris
o Density gradient method
▪ Separate sperm on their specific gravity/density under centrifugal forces
▪ Sperm pellet forms at the bottom
▪ Fertilisation media added to pellet and centrifuged again to further ‘wash’ sperm
then is resuspended in fresh media
▪ Inevitably loss some good sperm
o Sperm wash method
▪ Used if semen sample has low sperm count
▪ No loss of sperm but does concentrate dead sperm and cellular debris
▪ Washed for 5 minutes
• Egg collection
o During normal cycle, hundreds of eggs die and only 1 reaches size suitable for collection
o Previous to collection, take medication which shuts down menstrual cycle and controls
hormones so lots of egg reach suitable size (8-12 follicles)
o Unpredictable how women will respond to treatment – still might not have lots of follicles
are right size
o Transvaginal probe with needle pushes through vaginal wall to get to ovary and drain fluid
o Fluid → hot block warmer → dish to search for egg (microscope) → egg into collection dish
→ incubator
o Eggs are very fragile as cannot be out of body so need to be kept in an incubator
• In vivo fertilisation, IVF
o Eggs move from collection dish to 5-well plate
o Volume of sperm calculated and pipetted into dish – 100,000 spermatozoa
o Relies on sperm finding and penetrating egg - more natural, just shortens distance sperm
has to travel
o Left overnight then eggs cleaned (cumulus cells and sperm removed) - if female and male
pronuclei seen then fertilisation has occurred (16-20 hours)
• Infertility – inability to conceive after 1-year unprotected intercourse (1 in 6/7 couples need help
conceiving)
• Why treat infertility?
o Medical problems with a health need or lifestyle issue
o Definite illness model
o Health issue
o Social arguments
o Publix opinion
o Effectiveness and cost
• Funding fertility treatments
o Reduce suffering
o Increased amount of medical care
o Decreased economic output
o Poor area
o Post code treatment
o Guidelines
• Effective treatments for infertility – intercourse must occur at least 3 weeks a week for pregnancy
chance
o Tubal – tubal surgery, IVF
o Unexplained – SO/IVI, IVF
o Endometriosis – ablation, IVF
o Male – SO/IVI, IVF, ICSI, DI
o Ovulatory – general health, anti-oestrogens, cabergoline, IVF (obesity, too much fat around
the ovaries, is main cause of women not ovulating)
• Complications during assisted conception
o Bleeding
o Vessel injury
o Multiple pregnancy
o Bowel injury
o Ectopic pregnancy
o Ovarian hyperstimulation syndrome (OHSS)
• Removing inherited diseases
o Pre-implantation genetic diagnosis
▪ 1 cell removed from 8-cell embryo and test by PCR – if abnormality detected,
embryo not used
• Stem cells
o Umbilical cord blood stem cells currently being used to treat over 70 diseases – e.g.,
leukaemia, myelomas, sickle cell anaemia
o Potential therapies being research using cord blood stem cells
▪ Diabetes, Parkinson’s, Alzheimer’s, spinal cord injury, stroke, cerebral palsy
• Genetic engineering
o Genetic modification by inserting genes into living cells, designed gene attached to viral
vector, which has ability to carry gene across cell membrane
o Leads to designer babies
• Sperm collection
o Via masturbation mainly – if low sperm count, surgical sperm retrieval taken from testicle
o 2-7 days of abstinence
▪ Epididymis where sperm ejaculated from cannot completely refill before 2 days
▪ Sperm start to die if over 7 days
o Masturbation in unit so sperm is fresh
• Semen analysis – used to determine insemination technique
, o Macroscopic (see with naked eye)
▪ Volume – low volume = blockage = potential infertility cause
▪ Liquification
▪ Viscosity
▪ Colour
▪ Opacity
• Really clear = no sperm
• Really opaque = lots of sperm
o Microscopic
▪ Count (million/ml)
▪ Motility (%)
▪ Morphology (%) – 4% and above is normal, very few are normal
▪ Cellular debris
▪ Round cells
▪ Agglutination
o Sperm parameters
▪ ‘normal’ reference ranges have changed
▪ Morphology from 80% → 4%
▪ Figures gained from census of men worldwide alongside data of is they have
fathered a child
• Sperm preparation
o Remove semen
▪ Used to protect sperm from acidic vagina
▪ Can damage sperm if left in semen too long
o Remove abnormal/dead sperm and other cellular debris
o Density gradient method
▪ Separate sperm on their specific gravity/density under centrifugal forces
▪ Sperm pellet forms at the bottom
▪ Fertilisation media added to pellet and centrifuged again to further ‘wash’ sperm
then is resuspended in fresh media
▪ Inevitably loss some good sperm
o Sperm wash method
▪ Used if semen sample has low sperm count
▪ No loss of sperm but does concentrate dead sperm and cellular debris
▪ Washed for 5 minutes
• Egg collection
o During normal cycle, hundreds of eggs die and only 1 reaches size suitable for collection
o Previous to collection, take medication which shuts down menstrual cycle and controls
hormones so lots of egg reach suitable size (8-12 follicles)
o Unpredictable how women will respond to treatment – still might not have lots of follicles
are right size
o Transvaginal probe with needle pushes through vaginal wall to get to ovary and drain fluid
o Fluid → hot block warmer → dish to search for egg (microscope) → egg into collection dish
→ incubator
o Eggs are very fragile as cannot be out of body so need to be kept in an incubator
• In vivo fertilisation, IVF
o Eggs move from collection dish to 5-well plate
o Volume of sperm calculated and pipetted into dish – 100,000 spermatozoa
o Relies on sperm finding and penetrating egg - more natural, just shortens distance sperm
has to travel
o Left overnight then eggs cleaned (cumulus cells and sperm removed) - if female and male
pronuclei seen then fertilisation has occurred (16-20 hours)
