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An argument for the past and continued use of pentoxifylline in assisted reproductive technology.

Pentoxifylline was first used within an in-vitro fertilization (IVF) programme before the advent of alternative treatment strategies such as oocyte micromanipulation. Over the years, it has continued to be useful in aiding fertilization in selected IVF cases, with a beneficial effect also being seen in certain cases treated by intrauterine insemination. In both instances, the acrosome reaction to ionophore challenge test appears to have been invaluable in identifying suitable patients. The stimulation of spermatozoa by pentoxifylline should remain a therapeutic option in the treatment of couples with a male factor present. As an adjunct to IVF, it has the advantage of being simpler and less costly to perform compared with micromanipulation. However, its use should be restricted to selected cases, and the merits over and above those of invasive procedures such as intracytoplasmic sperm injection should be discussed with the individual patients. The pretreatment of spermatozoa prior to intrauterine insemination in selected cases gives an alternative therapeutic strategy to those patients not wishing or unable to undertake IVF.

Fertilization↗

Comparison of two methods to obtain hemizonae pellucidae for sperm function tests.

The development of a new generation of diagnostic techniques has provided objective data on the physiological function of the spermatozoon. The hemizona assay has been considered the best predictor for in-vitro fertilization results. Its clinical application has been limited to the availability of human oocytes and the use of a special micromanipulator. Here, the sperm binding capacity of hand-sectioned hemizonae was compared with that of oocytes bisected by a micromanipulator. The results obtained in parallel assays showed no statistical differences between the two methods. Therefore, the bisection of oocytes by hand is useful for hemizona assays even in normal clinical laboratories.

Female↗

Human micro-insemination by injection of single or multiple sperm: ultrastructure.

The process of micro-insemination by single or multiple sperm transfer into the perivitelline space (PVS) or by direct sperm injection into oocytes was examined by transmission electron microscopy. Spermatozoa from normal and oligozoospermic men were injected into oocytes, obtained from consenting IVF patients, mostly by zona-puncture using micromanipulators. Spermatozoa were washed by the Percoll or Ficoll methods and capacitated using Whittingham's T6 or modified Tyrode's medium or incubated in strontium medium before injection. The women were stimulated by three IVF methods and oocytes were recovered by laparoscopy or ultrasonography. Sixty-one oocytes were cultured in T6 or Ham's F-10 media (3-24 h) and were subjected to micromanipulation. Four oocytes were also studied after zona-drilling. Normal 2-pronuclear ova were developed after single-sperm transfer satisfying all morphological criteria of fertilization. Both monospermic and polyspermic fertilization resulted after multiple sperm transfer, indicating that a vitelline block to polyspermy may exist in humans. The majority of oocytes examined were unfertilized. Spermatozoa with intact or reacted acrosomes and those undergoing the acrosome reaction were found in the PVS and in the ooplasm. Abnormal spermatozoa were also seen in these locations. Quantitation of acrosomal status in 16 oocytes after multiple-sperm transfer, revealed that 24% of spermatozoa were acrosome-reacted or reacting in the PVS following Ficoll entrapment, while 76% of spermatozoa were intact (33% of these abnormal). Sperm transfer seemed to be the least invasive, while direct sperm injection was comparatively destructive to oocytes. Drilling with acid made larger breaches in the zona when compared with mechanical perforation and spermatozoa occasionally escaped through breaches. Three 2-pronuclear ova obtained after multiple sperm transfer have resulted in two pregnancies, in cases of severe oligozoospermia, during the course of this study.

Acrosome↗

Immunosuppression by corticosteroid has no effect on the pregnancy rate in routine in-vitro fertilization/embryo transfer patients.

Immunosuppression by exogenous corticosteroids has been used to improve the rates of embryo implantation and pregnancy in in-vitro fertilization (IVF) patients who have micromanipulated embryos replaced. The present study was conducted, in a prospective design, to evaluate effects of corticosteroid on the pregnancy rate in IVF/embryo transfer patients who have non-micromanipulated embryos replaced. Infertile women < 40 years old with tubal factor were included in this study. Patients were grouped according to the different follicle stimulation protocols, and received various doses of 16 beta-methylprednisolone (0, 16 or 60 mg/day) for 4 days from the day of oocyte retrieval. The mean age, duration of infertility, length of folliculogenesis and serum oestradiol concentrations at the time of human chorionic gonadotrophin (HCG) injection were not significantly different between control and corticosteroid-treated groups of patients. Short-term immunosuppression by 16 beta-methylprednisolone administration did not show any effects on the pregnancy and miscarriage rates in IVF/embryo transfer patients. Also, immunosuppression showed no dose effects in any groups. There was no relationship between the types of follicle stimulation protocols and the effect of 16 beta-methylprednisolone. Therefore, we concluded that short-term immunosuppression by exogenous corticosteroids in IVF/embryo transfer patients who have embryos with intact zona pellucida replaced has neither positive nor negative effects on pregnancy rates.

Adrenal Cortex Hormones↗

Use of lasers in assisted fertilization and hatching.

The erbium-yttrium-aluminium-garnet (Er:YAG) laser has been applied to micromanipulation in humans. It was used in the fertilization process for both subzonal insemination (SUZI) and for partial zona dissection (PZD). Laser-assisted micromanipulation achieved significantly higher fertilization rates (34.8%) when compared to mechanical SUZI (16.1%), but use of the laser did not improve the PZD results (laser 14.8% versus mechanical 14%). The Er:YAG laser was used to assist hatching. In the mouse it significantly improved the hatching rate (80 versus 29.3%) 110 h after administration of human chorionic gonadotrophin. This technique was applied in two different centres to patients with previous in vitro fertilization (IVF) failures. the implantation rate per embryo (14.4% laser-assisted hatching versus 6% control group) and the pregnancy rate per transfer (40 versus 16.2%) were improved.

Adult↗

Adhesive force of chondrocytes to cartilage. Effects of chondroitinase ABC.

Chondrocyte transplantation is a clinical procedure for cartilage repair. Transplanted cells may have difficulty attaching to the surface of chondral lesions because of the anti-adhesive properties of the proteoglycan rich matrix. This study used micromanipulation methods to determine if pretreatment of cartilage with chondroitinase ABC affects chondrocyte adhesion to cartilage and if chondrocytes adhere preferentially to the superficial, middle, or deep layers of cartilage. Bovine chondrocytes were transplanted in vitro on articular cartilage sections cut perpendicular to the articular surface. At various times between 15 and 75 minutes after seeding, a micropipette micromanipulation system was used to measure the adhesion force of individual chondrocytes to cartilage. The chondrocyte adhesion force increased with chondroitinase ABC treatment and seeding time but generally was similar for the different regions of articular cartilage (superficial, middle, deep layer) to which the cells were attached. For normal cartilage, the adhesion force increased from 1.29 +/- 0.24 mdyne after 15 to 30 minutes seeding to 5.29 +/- 0.25 mdyne after 60 to 75 minutes. Treatment with chondroitinase ABC at certain concentrations and durations (1.0 U/mL for 5 minutes or 0.5 or 1 U/mL for 15 minutes) led to an increase in adhesion force, whereas relatively low concentration or treatment time (0.25 U/mL for 15 minutes or 0.5 U/mL for 5 minutes) had little or no detectable effect. The increase in adhesion attributable to chondroitinase ABC treatment appeared most marked (+144% to +292%) for short (15 to 30 minutes) seeding durations but was still significant (+46%) for the longest seeding period (60 to 75 minutes) studied after the 1 U/mL for 15 minute treatment condition. These results provide direct biomechanical evidence that enzymatic treatment of a cartilage surface can enhance chondrocyte adhesion.

Analysis of Variance↗

Single lipopolysaccharide-reactive B cells in the non-immune mouse spleen cell population secrete natural multispecific autoantibodies.

Starting from unimmunized BALB/c splenocytes, B-cell clones were obtained by lipopolysaccharide (LPS) stimulation, and the frequencies of their anti-TNP, anti-BALB/c actin, and anti-BALB/c tubulin secretion were determined. The culture conditions were then chosen so as to have one anti-TNP precursor per positive well. Out of the 41 wells containing one anti-TNP antibody-secreting cell, nine (22%) also reacted either with actin or with tubulin and five (12%) with both actin and tubulin. Using horse red blood cells to which trinitrophenyl (TNP) had been coupled, spleen cell rosettes were prepared, enriched, micromanipulated, and cultured individually. Of the 500 micromanipulated and cultured TNP antigen-binding cells, 28 were found to secrete antibodies directed against TNP. Eight of these 28 clones (28%) also reacted with either actin or tubulin, and five (17%) reacted with both actin and tubulin. The frequency of these multispecific clones is of the same order of magnitude as that obtained with the limiting dilution experiments. The results show that unimmunized BALB/c mouse spleen contains precursor cells that secrete natural multispecific autoantibodies.

Actins↗

Mainly unmutated V(H) genes rearranged in B cells forming germinal centers in a cutaneous pleomorphic T-cell lymphoma.

B cells in skin lesions of a pleomorphic cutaneous T-cell lymphoma with reactive germinal center hyperplasia were analyzed for their immunoglobulin V(H)DJ(H) gene rearrangements by micromanipulation and single cell polymerase chain reaction (PCR) analysis. In B lymphocytes located in germinal center-like structures, we found in 11/16 different V(H)DJ(H) rearrangements completely unmutated VH genes, suggesting that those cells did not undergo antigen-driven selection. Two V(H) genes showed more than 98% germ-line identity. In only three cells V(H) segments were somatically mutated to a higher extent, but two of these rearrangements were non-productive. These results differ markedly from what we have previously detected in B cells present in mycosis fungoides, another entity of cutaneous T-cell lymphomas where the Ig gene repertoire resembles the situation in peripheral blood with a significantly higher proportion of mutated V(H) genes. When investigating the large atypical B cells strongly expressing CD30 which were detected within the T-cell zone outside the germinal centers, we found again, in most cases, that the rearranged VH genes were completely unmutated. The B cells were of polyclonal origin. Due to this comparable Ig gene repertoire and mutational pattern, we suggest that these cells descend from the germinal center centroblasts which migrated into the T-cell zone and obviously became stimulated to express the CD30 marker. The micromanipulation technique and molecular analysis on the single cell level may provide an important input into our understanding of the mechanisms of immune regulation in cutaneous lymphomas.

Amino Acid Sequence↗

Correlation between polyploidy and auxotrophic segregation in the imperfect yeast Candida albicans.

In order to clarify the relationship between polyploidization and the capability of phenotypic switching in the imperfect yeast Candida albicans, two types of variants were isolated as segregants from a fusant, which produced a proportion of the cell population with a higher ploidy than the rest, either in a temperature-dependent or -independent manner, when incubated at low (28 degrees C) and high (37 degrees C) temperatures. In the case of the temperature-dependent type of variants, high-ploidy cells appeared at 37 degrees C but rarely at 28 degrees C. This phenotype was named Pldts (temperature-sensitive polyploidization), and the temperature-independent phenotype was called Pld-. The appearance of high-ploidy cells in the culture of the Pldts strain at 37 degrees C was accompanied by a significant increase in the frequency of auxotrophic variants; these variants probably occur as a result of segregation of auxotrophic markers from the heterozygous to the homozygous state. Both Pldts and Pld- phenotypes were recessive in a fusion with a Pld+ parent. An adenine auxotrophic marker (ade1) was introduced into a Pldts strain in a heterozygous state, and the individual high-ploidy cells of this strain, grown at 37 degrees C, were micromanipulated to form colonies, which consisted of red and white sectors appearing at high frequency on a pink background. When the ade1 auxotrophy was introduced into Pld- strains, frequently sectored colonies were produced. These results suggested an increased level of chromosome missegregation in both types of Pld mutants. Analyses by pulsed-field gel electrophoresis of Ade-segregants, derived from a micromanipulated high-ploidy cell of a Pld(ts) strain, suggested the occurrence of nonreciprocal recombination, some of which includes chromosome loss.

Adenine↗

A versatile argon microsurgical laser.

A laser instrument designed for use in otologic, dermatologic, and cosmetic surgery is evaluated. The argon ion laser produces a visible wavelength in the emerald green range (0.488 to 0.415 micrograms). Its attachments include a handpiece and a micromanipulator. The handpiece is manufactured with a 1- or 2-mm spot size and may be used for treatment of cutaneous lesions such as telangiectasis, hemangiomas, and tatto marks. The micromanipulator is made for attachment to the Zeiss Omni I microscope. The working distance coordinates with that of the operating microscope when used for otologic procedures such as ossicular reconstruction, stapedectomy, tympanoplasty, or soft tissue tumor removal. The technical specifications and medical applications are outlined.

Argon↗

Kinetic analysis of the intestinal iron absorption process in situ. The potential of vascularly autoperfused intestinal loops.

1 Blood sampling from mesenteric venules during absorption in situ is a useful tool to analyse intestinal absorption kinetics and prehepatic metabolism in different sections of the rat small intestine. By use of a micromanipulator, the method can be applied to the duodenum. This part of the small intestine shows the strongest adaptation of non-haem iron absorption to the demand for iron. 2 Iron absorption kinetics was linear in duodenal and jejunal segments. In iron-deficient animals, intestinal iron absorption capacity was increased in the duodenum, while simultaneously determined galactose absorption showed no change. 3 In situ perfusion and cannulation of mesenteric venules in duodenal segments are described. The use of a micromanipulator permits varying the blood volume collected by changing the vertical angle between the cannula and the mesenteric vessel. 4 Intestinal iron absorption rates remained close to constant when blood flow rates were varied by a factor of about ten. Plasma concentrations of absorbed iron vs mesenteric blood flow rates followed a hyperbolic function, as the plasma concentration of absorbed iron in mesenteric venules increased to the same extent as the blood flow decreased. 5 As the plasma transferrin concentration did not change over the experimental period, the concentration of absorbed iron in the mesenteric plasma exceeded the iron-binding capacity of plasma transferrin at low blood flow rates. This observation shows that enhancement of intestinal iron absorption does not require a corresponding increase in plasma iron-binding capacity in the intestinal tissue. 6 Vascularly perfused gut loops were also used to measure prehepatic metabolism, which may influence organotropism of carcinogenic metabolites. Therefore, this type of preparation is likely to find a variety of toxicological applications.

Animals↗

Odd chromosome movement and inaccurate chromosome distribution in mitosis and meiosis after treatment with protein kinase inhibitors.

Errors in chromosome orientation in mitosis and meiosis are inevitable, but normally they are quickly corrected. We find that such errors usually are not corrected in cells treated with protein kinase inhibitors. Highly inaccurate chromosome distribution is the result. When grasshopper spermatocytes were treated with the kinase inhibitor 6-dimethylaminopurine (DMAP), 84% of maloriented chromosomes failed to reorient; in anaphase, both partner chromosomes were distributed to the same daughter cell. These chromosomes were observed for a total of over 60 h, and not a single reorientation was seen. In contrast, in untreated cells, maloriented chromosomes invariably reoriented, and quickly: in 10 min, on average. A second protein kinase inhibitor, genistein, had exactly the same effect as DMAP. DMAP affected PtK1 cells in mitosis as it did spermatocytes in meiosis: improper chromosome orientations persisted, leading to frequent errors in distribution. We micromanipulated chromosomes in spermatocytes treated with DMAP to learn why maloriented chromosomes often fail to reorient. Reorientation requires the loss of improper microtubule attachments and the acquisition of new, properly directed kinetochore microtubules. Micromanipulation experiments disclose that neither the loss of old nor the acquisition of new microtubules is sufficiently affected by DMAP to account for the indefinite persistence of malorientations. Drug treatment causes a novel form of chromosome movement in which one kinetochore moves toward another kinetochore. Two kinetochores in the same chromosome or in different chromosomes can participate, producing varied, dance-like movements executed by one or two chromosomes. These kinetochore-kinetochore interactions evidently are at the expense of kinetochore-spindle interactions. We propose that malorientations persist in treated cells because the kinetochores have numerous, short microtubules with a free end that can be captured by a second kinetochore. Kinetochores capture each other's kinetochore microtubules, leaving too few sites available for the efficient capture of spindle microtubules. Since the efficient capture of spindle microtubules is essential for the correction of errors, failure of capture allows malorientations to persist. Whether the effects of DMAP actually are due to protein kinase inhibition remains to be seen. In any case, DMAP reveals interactions of one kinetochore with another, which, though ordinarily suppressed, have implications for normal mitosis.

Adenine↗

Tension-sensitive kinetochore phosphorylation and the chromosome distribution checkpoint in praying mantid spermatocytes.

Improper chromosome attachment to the spindle can lead to daughter cells with missing or extra chromosomes. Such mishaps are avoided in many cells by a checkpoint that detects even a single improperly attached chromosome. What is detected? A misattached chromosome is not under tension from opposed mitotic forces, and in praying mantid spermatocytes, direct experiments show that the absence of tension is what the checkpoint detects. How is the absence of tension detected? Tension-sensitive kinetochore protein phosphorylation is the most likely possibility. We combined micromanipulation with immunostaining for phosphoproteins in order to study the effect of tension on kinetochore phosphorylation in mantid spermatocytes. We confirm earlier observations on mammalian cells and grasshopper spermatocytes that misattached chromosomes have phosphorylated kinetochore proteins. We also confirm experiments in grasshopper spermatocytes showing that tension alters kinetochore chemistry: tension from a micromanipulation needle causes kinetochore protein dephosphorylation, and relaxation of tension causes kinetochore protein rephosphorylation. Beyond confirmation, our results provide fresh evidence for phosphorylation as the signal to the checkpoint. First, mantid cells are the only ones in which an effect of tension on the checkpoint has been directly demonstrated; by equally direct experiments, we now show that tension affects kinetochore phosphorylation in these same cells. Second, sex chromosome behavior in mantids provides a natural experiment to test the relationship between phosphorylation and the checkpoint. In grasshoppers, an unpaired sex chromosome is normal, its kinetochore is under-phosphorylated, and the checkpoint is not activated. In mantids, exactly the opposite is true: an unpaired sex chromosome is abnormal, its kinetochore is phosphorylated and, as predicted, the checkpoint is activated. We conclude that tension-sensitive kinetochore protein phosphorylation very likely is the essential link between proper chromosome attachment and the check-point, the link that permits potential errors in chromosome distribution to be detected and avoided.

Animals↗

A simplified biopsy method for precompacted mouse embryos: a technical report.

This article presents a new, simple and rapid embryo biopsy method. The blastomere for genetic analysis can be separated from a precompacted mouse embryo after a partial zona digestion with the use of a holding pipette. For the micromanipulation only two microcapillaries and micromanipulators are needed. The development of the biopsied embryos was studied during in vitro culture and in utero following embryo transfer. There was no significant difference between the treated and the control groups in the ratio of embryos that developed to the blastocyst stage, although the biopsied embryos were delayed in their development because they contained significantly fewer cells compared to the control ones at the same stage. Although there was no difference in the ratio of implantation, the development of the biopsied embryos in utero was also delayed 12-24 hours on the 9th day of pregnancy. No difference in development was visible from the 13th day of pregnancy. Statistically, no differences were found in the developmental ratio (number of developed fetuses/transferred embryos) of the control and treated embryos during gastrulation (9th day of pregnancy), at the beginning of organogenesis (13th day of pregnancy) and before birth (19th day of pregnancy). The embryo biopsy method presented here can be a new and useful tool for preimplantation genetic diagnosis.

Animals↗

Description of filamentous bacteria present in industrial activated sludge WWTPs by conventional and molecular methods.

Conventional cultivation methods and molecular approaches were utilised to describe the filamentous bacterial population of industrial activated sludge WWTPs. In total 43 strains were isolated by micromanipulation and were affiliated with 12 different species, comprising two new species and a new genus. In particular, a new species of Microthrix, a new genus of a filamentous Alphaproteobacteria morphologically similar to Nostocoida limicola, and a new filamentous species closely related to the opportunistic pathogen Propionibacterium propionicum were obtained. Despite the high number of isolates, the cultivation approach was unable to describe the filamentous bacteria most common in industrial WWTP. A culture-independent approach, termed the cell sorting/RT-PCR method, was therefore applied to identify fastidious or non-culturable filamentous microrganisms from different industrial plants. By this method the relevant filaments were micromanipulated and their 16S rDNA genes were amplified by RT-PCR. This approach was highly efficient. In total 31 16S rRNA sequences were obtained and 16 of them were used for the design of new specific oligonucleotide probes that highlighted dominant filaments in industrial activated sludge plants.

Bacteria↗

Microinjection of human sperm into perivitelline space of hamster eggs: comparison with zona-free hamster egg penetration of human sperm.

Micromanipulation of human sperm and oocyte has been utilized to facilitate fertilization of those patients with male factor due to oligoasthenospermia or those patients with repeated fertilization failure in an in vitro fertilization (IVF) program. Before manipulating human gametes, one needs experience with animal models. Our objective was to perform subzonal insertion of human sperm into hamster eggs and to compare the result with that of sperm penetration assay (SPA) using zona-free hamster eggs. Semen samples were obtained from 15 fertile donors with normal semen analysis and the motile sperm were collected by swim-up procedure. Microinjection was performed by injecting a varied number of sperm into the perivitelline space of 222 hamster eggs pretreated with sucrose solution (0.1 M). The rate of damage of eggs during microinjection was 7.2% (16/222). The rates of penetration in the microinjection group were 5.1% (4/79) for 1-5 sperm injected, 10.9% (11/101) for 6-10 sperm injected, and 11.5% (3/26) for 11-15 sperm injected. The average rate of penetration per egg was 8.7% (18/206), and the polyspermic rate was 11.1% (2/18). Simultaneously SPA was performed in each sample of semen as a positive control, and the average rate of penetration of SPA was 51.4% (108/210). The rate of penetration in the microinjection group was significantly smaller (p < .05) than that in the SPA group. Whether the penetration rate and polyspermic rate in a hamster model reflect similar results in human oocyte requires further investigation. However, the hamster egg provides an ideal model to develop a micromanipulation technique for human beings.

Animals↗

Cumulus removal and addition of follicular fluid possibly improves pregnancy rates with in vitro fertilization for male factor.

This study evaluated the use of in vitro fertilization (IVF) for patients with subnormal semen parameters without the use of micromanipulation. All patients were characterized as having male factor as follows: normal morphology (NM) < or = 10% according to strict criteria [15] and motile density (MD) < or = 10 x 10(6)/mL. Strict morphology was divided into three groups: group I (n = 72), < or = 2% group II (n = 24), 3-5%; and group III (n = 29), 6-10%. Modification of standard IVF techniques included manual cumulus removal (CR) from oocytes, pooling up to ten oocytes together in 1 mL of media, and supplementing media with 20% human follicular fluid (FF). Rates of fertilization and pregnancy were compared. The overall fertilization rate (FR) was 57.7% and the pregnancy rate (PR) per retrieval cycle was 14.8%. There was no significant improvement in the fertilization or PRs when IVF was modified using CR and FF, although the FR was higher in group I for patients who received the modified procedures. In patients with < or = 5 x 10(6) sperm/mL, there were no pregnancies in five cycles and four transfers following the conventional method, but two sets of twins with the modified protocols in seven cycles. Clinical pregnancies were achieved with male factor without the need for micromanipulation. The most severe cases were automatically assigned to modified IVF techniques, e.g., CR with or without FF. Prospective randomized studies are needed to determine if modified procedures are superior to conventional therapy.

Culture Media↗

IVF and related technology. The present and the future.

OBJECTIVE: To describe the current status of in-vitro fertilisation (IVF) and related technologies, including: the indications for the procedures and the problems associated with the use of stimulated cycles; the use of frozen embryos and donor eggs; and the newer procedures of gamete micromanipulation for male infertility, immature egg collection as a possible alternative to the stimulated cycle, and preimplantation genetic diagnosis. DATA SOURCES AND STUDY SELECTION: The clinical experience and research at Monash IVF and the Centre for Early Human Development, Monash University, were reviewed in association with key original or review articles in the world literature. DATA SYNTHESIS: Cumulative pregnancy rates for IVF and the gamete intrafallopian transfer (GIFT) procedure at Monash IVF demonstrate that 29% of IVF patients and 55% of GIFT patients will have a live baby, the average number of treatments pursued being 3.4. Analogues of gonadotrophin releasing hormone (GnRH) have improved pregnancy rates, reduced blood sampling, and prevented natural ovulation. Disadvantages of stimulated cycles include a higher risk of multiple pregnancy, a higher risk of hyperstimulation, and behavioural changes due to the effects of drugs. Natural cycles or immature egg collection at incidental laparoscopy may become alternatives to the use of the stimulated cycle. In Australia the GIFT procedure is more successful than IVF and is nearly always used if the fallopian tubes are normal. Multiple pregnancies may be reduced, particularly triplets, by reducing the number of eggs or embryos transferred to two when egg or embryo quality is high. Embryo freezing has made a small but important contribution to overall pregnancy rates by enabling patients to use excess eggs and embryos. The social and legal concerns resulting from the use of frozen embryos have required new ethical and legal considerations. Donor eggs have made a small contribution to achieving pregnancy in women with absent or inappropriate eggs and increased the chance of conception in women over the age of 40. Micromanipulation of sperm and eggs has enabled fertilisation and conception when sperm are defective in quantity or quality. Sampling of cells in early embryos enables genetic diagnosis and may be used in selecting chromosomally normal embryos in IVF procedures or in couples at risk of recessive genetic disease. CONCLUSION: Assisted reproductive technology has developed over a decade to become useful for couples with infertility which cannot be cured by simpler treatments. The birth rates are comparable to natural conception and the incidence of congenital malformation is not increased. The costs and complexity of treatment have been reduced to in turn reduce the stress and social inconvenience of therapy. Problems related to the high risk of multiple pregnancy and the use of the stimulated cycle are being reduced and new techniques for severe male infertility and the detection of genetic abnormalities in the embryo are being introduced.

Female↗