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Medically Assisted Procreation (MAP)

Thursday, August 23rd 2012. | Pregnancy

Medically Assisted Procreation Definition

The Assisted Reproductive Technology (ART) combines different techniques that allow infertile couples to achieve pregnancy by promoting the encounter between the male and female gametes (fertilization). As a reminder, fertilization involves the encounter / merger between the male gametes (sperm) and female (oocyte). This fusion takes place in the woman’s uterus after intercourse fertilizing.

Unfortunately, many settings may prevent this union.

There are approximately 20,000 births per year through assisted reproduction techniques that are framed by the bioethics laws of 2004 and a guide to good practice because these practices are not safe or ethical problem.

It describes an infertile couple encounters difficulties when to have children, despite regular reports without contraception for 18 to 24 months. 

Assisted Reproductive Technology

These techniques are reimbursed by AMP insurance if the woman is under 43 years (note that there is no age limit for humans, although most centers are reluctant to- over 60 years …) and should be performed in centers approved AMP in infertile couples living together (married or not) for at least 2 years and after a complete assessment of infertility.

There are several techniques:

  • Intrauterine insemination
  • In vitro fertilization and embryo transfer
  • Intra cytoplasmic sperm injection
  • Ovulation induction (the latter technique is not governed by the laws of bioethics)

That should choose the simplest technique as causes of infertility to limit the risks.

What Assessment Done?

MAP techniques are intended for infertile couples, that is to say that a failure of conception after regular reports without contraception for 18 to 24 months, which shall carry out an assessment to determine the causes of them infertility and choose the most appropriate technique and simple.

We realize that for many budgets for women, men and couples.

For the woman should take a temperature curve for 3 months to determine if the cycles are ovulatory hormone balance sheet including full dosage of FSH, LH, Oestradiol for proper ovarian function, imagery pelvic deformities search and quality of ovarian a hysterosalpingogram to check the integrity of the uterine cavity must accommodate the egg, and finally the classic viral serology (HIV, hepatitis B and hepatitis C, syphilis, rubella and toxoplasmosis)

For the man, we monitor the quality and quantity of his sperm and test the viral serology (HIV, hepatitis B and C, syphilis)

For the couple, it is necessary to pre-ovulatory phase of the woman is the 12 th day of the menstrual cycle, a review where we post coital sperm motility analysis in contact with the mucus secreted by the cervix of the woman, it s ‘also endeavor to look at the quality and quantity of cervical mucus.

Prevention Pre-Conception

After completing the assessment at the couple who has determined the cause of infertility, a fundamental step remains before starting an MPA. Indeed, it is essential to surround every precaution to prepare pregnancy in the best conditions and reduce the risk of complications and miscarriage.

To do this, it should:

  • Update immunizations (rubella, whooping cough, chickenpox if the woman has never contracted),
  • Encourage and help stop the consumption of toxic substances (alcohol, tobacco, cannabis ..)
  • Start vitamin supplementation based folic acid in women  
  • Cons of screening for pregnancy (teratogenic treatment that is to say, against-indicated during pregnancy because it favors malformations, a chronic imbalance may have implications for the proper growth of the fetus …).

What are the different techniques and what are the risks?

After completing the infertility workup (2) and have surrounded pre conceptional care (3), we must choose the most appropriate technique, the simplest and least dangerous. The aim is to promote fertilization that is to say, the meeting between the male and female gametes, which normally occurs in the uterine cavity after the egg has traveled the path between the ovaries to the uterus.

For each of these techniques must take into account the psychological suffering of the couple facing infertility and offer psychological support seems essential.

Here are the different techniques available to clinicians to achieve AMP:

Simple induction of ovulation 

This technique is the more “simple” and which is also not subject to the text of the bioethics laws but requires monitoring demanding.

Is given clomiphene citrate to stimulate the maturation of follicles containing oocytes. Is monitored closely together if there was indeed a ovulation (that is to say, expulsion of an egg) with close monitoring of hormone balance and ultrasounds. That ovulation can be triggered in a drug, once ovulation has occurred, we ask the couple to have sex in the 36 hours after ovulation.

In the absence of pregnancy after 6 cycles of induction simple, it will consider intrauterine insemination.

The risks of this technique are mainly those related to early abortion and pregnancy outside the uterus (ectopic pregnancy). Must inform the couple of the risk of a multiple pregnancy.

Intrauterine insemination 

It involves placing sperm collected in humans directly into the uterine cavity of women with a pipette to promote encounters between gametes.

You realize why again induction of ovulation with clomiphene citrate in detecting ovulation by ultrasound and hormonal monitoring.

Were prepared in parallel with the man’s sperm in the laboratory in selecting the best quality sperm based on mobility and shape.

Then injected with a pipette sperm into the uterus 36 hours after ovulation.

Note that the sperm can come from the partner’s sperm or sperm from an anonymous donor from the sperm bank center study and preservation of eggs and sperm (CECOS).

Must prevent couples risk of multiple pregnancies.

In vitro fertilization (IVF) 

It reproduces in the laboratory 1st stages of embryo development: from fertilization to the first divisions of the embryo. First birth took place in France in 1981 and each year there are 25,000 IVF in France for about 10 000 births.

To do this, after stimulation of the follicles very important and triggering of ovulation drug, should be collected vaginal oocyte under general anesthesia. Sperm are also collected.

Then brought into each oocyte with the presence of many sperm in a test tube and then observed at 24 and 48 hours if fertilization has taken place. If this is the case, we control their healthy development before transferring with a pipette into the uterine cavity.

Now we get a rate of 20% of pregnancy with this technique.

Complications related to ovarian stimulation can cause significant arterial or venous stroke, twists annex or oocyte retrieval may cause vascular wounds, digestive. There is also a risk of ectopic pregnancy and multiple pregnancies.

Note that it is possible to perform IVF with egg donation from a woman donor, voluntary and anonymous.

IVF intra cytoplasmic sperm injection

It involves injecting a single sperm directly into an egg that has been recovered after stimulation. If fertilization is successful and that the embryo develops, we transfer the embryo into the uterine cavity. It gets 25% of pregnancy with this technique.

Complications are similar to IVF even though it was noted that this could increase the risk of malformations and chromosomal abnormalities.

What are the specialties involved?

The obstetrician-gynecologist specializing in AMP is the central actor that support of infertility and the GPA, it will carry to an approved MPA where highly specialized monitoring is essential together a multidisciplinary team including psychologists, midwives, radiologists, laboratory staff and nurses.

Psychological support is very important in these couples experiencing infertility and a lot of them are often depleted of many consultations, the separation between sexual union and procreation, potential failures of previous techniques AMP and the look of their loved society.

The difficulty may be even greater in the case of reproduction by gamete donation for both the couple (sterile suffering partner) for the child in his family and psychological construction.

 

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