Medically assisted procreation (PMA) in case of infertility of a heterosexual couple

Medically assisted procreation (PMA) in case of infertility of a heterosexual couple

Medically assisted procreation (PMA), also called ART, is proposed to respond to a parental project in certain situations of infertility or after the failure of medical and/or surgical treatment. It can use different techniques such as artificial insemination and in vitro fertilization. The use of a third-party donor of gametes or embryos can be proposed.

WHAT HAS MEDICALLY ASSISTED PROCREATION (PMA) OR MEDICALLY ASSISTED PROCREATION?

Medically assisted procreation (PMA) also called “ medically assisted procreation (MAP) ” consists of clinical and biological practices allowing :   

  • in-vitro design ; 
  • preservation of gametes (oocytes and spermatozoa), germinal tissue (fragments of ovarian or testicular tissue), and embryos ; 
  • embryo transfer ; 
  • artificial insemination.

What is the difference between AMP and PMA? 

Any. Medically assisted procreation (MAP) is also called “ medically assisted procreation (MAP) ”. The term ” medically assisted procreation ” is the one that is included in the bioethics law, but the term most often used is PMA.    

The purpose of assisted reproduction is to remedy the infertility of a couple, without treating the cause. It is conducted by a medical team combining clinical doctors and biologists, in approved centers.

A medical check-up is necessary before the start of a PMA. It ensures that the couple is ready to take this step and that, medically, PMA is feasible.

In 2018 in France, 758,590 children were born, including 25,120 (3.3%) thanks to PMA after 148,711 attempts.

THE DIFFERENT TECHNIQUES OF PMA OR AMP

Three different techniques can be used to obtain a pregnancy, depending on the results of the complementary examinations and the origin of infertility, male, female, or couple.

artificial insemination

The technique of artificial insemination

Proposed as the first intention, artificial insemination consists in bringing together one or two oocytes obtained by ovarian stimulation and sperm introduced directly into the uterus.

Sperm is collected by masturbation in the laboratory and prepared on the day of insemination.

In the absence of sperm in the semen, sperm can be surgically removed from the male genital tract or the testicle and used right away or frozen.

If the spermatozoa have been previously frozen in the form of straws, these are thawed on the day of the puncture follicular to recover motile sperm.

In the event of infertility of male origin, it is possible to resort to donor sperm.

Sperm are deposited inside the uterus using a thin, flexible tube. Mobile spermatozoa naturally ascend towards the fallopian tubes to meet the oocyte. Fertilization can then take place according to the natural process.

Artificial insemination does not require hospitalization.

Indications for artificial insemination

Doctors offer this technique : 

  • in the event of a malfunction of the cervical mucus because insemination makes it possible to avoid contact with the cervical mucus at the level of the cervix ; 
  • when the semen is poor in spermatozoa, or when their mobility is reduced. If the sperm abnormalities are significant, insemination can be performed using donor sperm ; 
  • in case of unexplained infertility.

To be able to use artificial insemination, the woman’s fallopian tubes must be in good condition.

In vitro fertilization

The technique of in vitro fertilization or IVF

It consists of fertilizing an oocyte with a sperm ” in vitro “, that is to say outside the woman’s body, then implanting the fertilized egg in the uterus.  

As with insemination, IVF requires hormonal ovarian stimulation to allow multiple ovarian follicles to grow and mature. This treatment is monitored by ultrasounds and hormonal blood tests.

Then the ovulation is triggered and follicular puncture takes place. This puncture is performed vaginally, under ultrasound control, under local or general anesthesia.

In the event of female infertility with the absence of oocyte production, it is possible to use oocytes from a donor.

The gametes are prepared in the laboratory : 

  • the oocytes are collected from the follicles ; 
  • sperm are collected from the semen.

Semen is collected by masturbation on the same day of follicular puncture or obtained by thawing semen straws. In the absence of sperm in the semen, sperm can be surgically removed from the male genital tract or the testicle and used right away or frozen. It is also possible to use donor sperm.

Eggs and sperm are placed in a culture dish. Then, the mobile spermatozoa come spontaneously, without outside help, into contact with the oocyte: this is the natural process of fertilization, but this takes place in vitro.  

The next day, the fertilized oocytes are identified. Then the embryos develop.

Two to three days later, one or two embryos are introduced into the uterus through the vagina, using a fine catheter, during the consultation, and sometimes under ultrasound control. The embryo develops and implants in the mucosa of the uterus.

The number of embryos obtained in vitro may be greater than the number of embryos transferred. In this case, the embryos which are not transferred and which present satisfactory development criteria are frozen. These embryos, after thawing, can be placed in the woman’s uterus at a later date without it being necessary to perform a new IVF.

Indications for IVF

Doctors offer IVF when there is an obstruction or an absence of the tubes, endometriosis, abnormalities noted in the program, or when the infertility is unexplained.

Adverse effects and complications of IVF

During treatment for ovarian stimulation, transient adverse effects are frequent: hot flushes, abdominal pain, vaginal bleeding, weight gain. If the ovarian hormonal stimulation is too strong, more serious symptoms appear violent abdominal swelling and pain, sudden weight gain, digestive disorders… An urgent medical consultation is necessary. Complications related to the puncture are exceptional: hemorrhage, abdominal infection…  

In vitro fertilization with micro-injection or ICSI

The technique of in vitro fertilization with ICSI (Intracytoplasmic Sperm Injection)

IVF is coupled with a micro-injection technique: using a micropipette, a single spermatozoon is injected directly into the collected and prepared mature oocyte.  

The embryo is introduced into the uterus through the vagina, using a fine catheter, during consultation and sometimes under ultrasound control. The embryo develops and implants in the lining of the uterus.

This technique is used more and more often and accounts for 67 % of IVF cases. 

Indications for in vitro fertilization with ICSI

This technique is indicated when there are severe abnormalities in the spermatozoa, in the event of auto immunization (antibodies directed against the spermatozoa) or failure of conventional IVF.

Side effects and complications of IVF with ICSI

During ovarian stimulation treatment, transient adverse effects are frequent: hot flushes, abdominal pain, vaginal bleeding, weight gain.

If the ovarian hormonal stimulation is too strong, more serious symptoms appear violent abdominal swelling and pain, sudden weight gain, digestive disorders… An urgent medical consultation is necessary.

Complications related to the puncture are exceptional: hemorrhage, an abdominal infection.

By aamritri

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