Most research is done, I need it rewritten to not be accused of plagiarism. I’m not sure I have used the correct style, but it needs to be APA. The instructor is requesting an original essay of at least 1500 words in which you analyze a contemporary topic in human sexual or reproductive biology. I’ve included my bibliography too. Also, the majority of the information detailed in your paper should come from periodicals and high-quality Internet sources from the past three (3) years. No more than half of your sources should be Internet sites. At least 6 sources.

Advancements in the Field of Assisted Reproduction

Researched by Farilde Porquin

Introduction.

Assisted reproductive technology (ART) is used to treat infertility. It includes fertility treatments that handle both a woman’s egg and a man’s sperm. It works by removing eggs from a woman’s body. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the woman’s body. In vitro fertilization (IVF) is the most common and effective type of ART. ART procedures sometimes use donor eggs, donor sperm, or previously frozen embryos. It may also involve a surrogate or gestational carrier. A surrogate is a woman who becomes pregnant with sperm from the male partner of the couple. A gestational carrier becomes pregnant with an egg from the female partner and the sperm from the male partner.

The Past

Since the delivery of the first in vitro fertilization neonate in 1978, the clinical practice of assisted reproductive techniques has undergone many changes and variations. The first successful pregnancy has been achieved in a natural cycle, the pendulum of clinical practice has soon after swung over to control ovarian super ovulation with the rationale that retrieval of many oocytes may increase the clinical pregnancy rate. Milder ovarian stimulation protocols were developed for minimizing the adverse effects of ovarian hyperstimulation syndrome (OHSS) and multiple gestations. (Gautam N Allahbadia, 2017)

Assisted reproductive technologies (ART) have received considerable attention, both clinically and empirically. Drs. Steptoe and Edwards removed one oocyte surgically from a woman with infertility related to tubal disease. They fertilized this oocyte in vitro and transferred the formed embryo to the woman’s uterus and achieved pregnancy and delivery. The technique of in vitro fertilization (IVF) and embryo transfer (ET) quickly became widely utilized for other causes of infertility as well as for tubal disease. In the last 5 years there has been a number of new developments. The most important and now widely practiced technology has been direct intracytoplasmic injection (ICSI) of the husband’s sperm into the wife’s oocyte. This was developed for treatment of infertility related to low sperm count. Subsequently it was shown that sperm can be aspirated from epididymis or found in testicular biopsy in obstructive azoospermia. Another promising development is in vitro maturation (IVM) of immature oocytes. This has the potential of avoiding ovarian hyperstimulation, which can be uncomfortable and occasionally dangerous. Some oocytes are unable to fertilize and/or develop into normal embryos. It may be possible that the problem is with the machinery of cytoplasm of the oocyte. Therefore, cytoplasmic transfer from a normal oocyte to an abnormal oocyte may overcome the problem. Infertile couples may be faced with many psychological problems that become even more complex with various treatments. Whereas donation of oocytes or embryos can be technically quite simple, there are many psychological issues involved. As can be gathered from aforementioned discussions, the treatments developed for infertility appear to be somewhat illogical and in the style of “shot gun therapy.” In the field of infertility, as in other areas of medicine, it is of paramount importance to know the details of disease mechanisms. This in turn will allow specific and logical treatments to be developed. (Khamsi F, 1998)

The Present.

IVF has literally transformed the field of infertility since its inception in 1978. Initially, the techniques required to perform IVF were unrefined with relatively poor pregnancy rates. Major milestones in perfecting IVF, however, were developed quickly, including the use of controlled ovarian hyperstimulation, luteal phase support, and improved culture media. Other significant advances soon followed with the development of intracytoplasmic sperm injection (ICSI), assisted hatching, and description of optimized ET techniques. These advances both improved the success rates associated with ART and increased the number of individuals that were candidates to pursue infertility treatments. However, some trends in the use of ART during this period were less than positive. Two of the chief concerns that emerged during the development of ART were the persistent risk of patients experiencing ovarian hyperstimulation syndrome (OHSS) and/or a marked increase in the risk of multiple gestation pregnancies. (Paul R. Brezina, 2012)

Not only did these aggressive COH dosing protocols result in increased risk, they also presented a significant financial burden on patients. Recently, there has been an increased emphasis on exploring “minimal stimulation” COH protocols. In several trials, utilization of such protocols that utilize lower doses of injectable gonadotropins results in comparable pregnancy rates with decreased medical complications and cost compared with more standard COH protocols. Another recent strategy for minimizing the risk of OHSS in COH cycles is the use of gonadotropin releasing hormone (GnRH) agonist, instead of human chorionic gonadotropin (hCG), to trigger ovulation during an IVF cycle. Taken together, minimal stimulation COH protocols and the appropriate utilization of GnRH agonist to trigger ovulation have the potential to mitigate the incidence of IVF associated OHSS, significantly improving the safety of women undergoing ART.

ART, as currently practiced, is also associated with an increased rate of multiple gestation pregnancies. In IVF cycles, this is principally a result of the routine transfer of multiple embryos into the uterus. Multiple gestation pregnancies are clearly associated with increased health risks, both to mother and child, as well as increased medical costs. For these reasons, there is a concerted effort by many to limit the number of embryos transferred in IVF cycles. Many countries outside the United States have mandated that only certain numbers of embryos may be legally transferred. The American Society for Reproductive Medicine (ASRM) has made formal recommendations regarding this issue (Pract Committee 2009). Many advocate the use of single embryo transfer (SET) in IVF cycles, essentially eliminating the risk of IVF associated multiple gestations. Several clinics using SET report no decrease in the pregnancy success rate while almost eliminating multiple gestation pregnancies. The trend toward decreasing the number of transferred embryos represents an improvement in ART that will significantly improve the cost and safety associated with IVF in the coming years. (Paul R. Brezina, 2012)

The Future.

The field of assisted reproductive technology is rapidly progressing with many new advances in the last decade. The present review discusses methods to improve oocyte quality in older women and new stimulation protocols that may improve the number of mature oocytes retrieved during an in vitro fertilization cycle. (Robert Casper, 2017)

There have been explosive advances in assisted reproductive technologies (ART). Current optimizations surrounding the delivery of in vitro fertilization (IVF) including the utilization of minimal stimulation protocols and gonadotropin releasing hormone (GnRH) agonist cycle triggers are being increasingly utilized to maximize patient safety. Modifications, such as those seen in the embryology laboratory, continue to improve pregnancy rates. Concurrent with these advancements in IVF have been the emergence of related technologies, such as embryonic genetic testing and oocyte preservation, which potentially have broad applications to both fertile and infertile couples. As these relevant applications of ART become increasingly utilized, it is incumbent upon society to ensure that these resources are made available in a morally responsible and equitable manner. (Paul R. Brezina, 2012)

After the initial emergence of the robot as a technology to assist minimally invasive surgery, more and more investigators started to amass data with respect to operative outcomes using this new innovation. (Tommaso Falcone, 2011) As technology continues to improve, advances will be made in the current robotic system that will further enhance its use. One limitation previously mentioned that exists in the robotic system is its lack of tactile feedback. Another limitation of the system is its large size. The three components of the robotic apparatus are very bulky and may not fit in some operating rooms.

Robotic surgery is emerging as a viable option for gynecological surgeons in general gynecology, urogynecology, oncology, and reproductive surgery. As institutions and surgeons become more and more familiar with the technology, hopefully these results will become available to develop the incorporation of robotic technology in gynecological surgery. (Tommaso Falcone, 2011)

Conclusion

As a person currently looking at ART options for myself, I am excited at the advancements that have yet to come in this field. I am not blessed with the art of forming meaningful relationships easily, but that doesn’t take away my desire to be a mother. ART/IVF offers that possibility for me. I have started looking at the options available and those yet to come. I feel hopeful by seeing the advances in the field of assisted reproduction that have developed in the past four decades; I can only imagine that it will continue to evolve and bring more hope to women in my position. The financial aspect of invitro is definitely something that has kept this field from growing further because it comes with a large price tag. According to the article by IVIRMA, yearly federal funding for infertility research is approximately 60 million US dollars. While this seems like a large number, when indirect costs (paid to academic institutions), and investigator and trainee salaries are removed, the remaining funding for actual experiments (based on our calculations) is less than 15 million US dollars per year. What is more, investigators are not allowed to experiment on embryos or even oocytes that interacted with sperm, limiting the potential for discoveries relevant to human assisted reproduction. This is where organizations like IVIRMA that are committed to scientific research and willing to channel resources to scientific discovery come into play.

The author, Emre Seli, M.D., states that they are hopeful that “a collaborative effort between private organizations such as IVIRMA, federal funding agencies such as the National Institute of Child Health and Development (NICHD), and professional societies (such as the American Society for Reproductive Medicine (ASRM) and the European Society for Human Reproduction and Embryology (ESHRE)) will enable us to reach our ambitious goal of enabling each one of our patients reach their dream of parenthood.”

Bibliography

Alghrani, A. (2018). Regulating Assisted Reproductive Technologies New Horizons. Cambridge University Press.

Christopher L. R. Barratt, C. J. (2002). Assisted Reproductive Technology Accomplishments and New Horizons. Cambridge University Press.

Emre Seli, M. (2019). Scientific priorities for assisted reproduction in the 21st century. IVIRMA.

Gautam N Allahbadia, R. B. (2017). The Art & Science of Assisted Reproductive Techniques (ART). Jaypee Brothers,Medical Publishers Pvt. Limited.

Khamsi F, L. I. (1998). Recent advances in assisted reproductive technologies. Retrieved from NCBI Pub Med.gov: https://www.ncbi.nlm.nih.gov/pubmed/9798726

Paul R. Brezina, N. N. (2012). Recent Advances in Assisted Reproductive Technology. . Current Obstetrics & Gynecoly Reports.

Robert Casper, J. H.-B. (2017). NCBI PMC. Retrieved from Recent advances in in vitro fertilization : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583738/pdf/f1000research-6-12642.pdf

Tommaso Falcone, B. R. (2011). Human Assisted Reproductive Technology Future Trends in Laboratory and Clinical Practice. Cambridge University Press.

1. BenRafael, N. L. (1990). Advances in Assisted Reproductive Technologies. Springer US.