Muhamad Zulhanif Bin Mat Harun 940610-11-5849 Cm071022

MUHAMAD ZULHANIF BIN MAT HARUN 940610-11-5849 CM071022

'Birth control' is a term that describes things that stop a woman or girl from becoming pregnant, or giving birth. Birth control can mean a wide range of things ± from

'contraceptives' (used to reduce the chances of a woman becoming pregnant) to other ways of avoiding pregnancy, like not having sex.

Contraception

Are there many different methods of contraception?

Yes. Contraceptives work by preventing a man¶s sperm from fertilising a woman¶s egg, and this can be done in several different ways.

There are two main types of contraception:

y Barrier methods - which physically prevent sperm from swimming into the uterus

and fertilising the woman¶s egg

y Hormonal methods - which alter a woman¶s hormonal cycle to prevent fertilisation.

These are the main types of contraception that are generally used by teenagers.

Condoms for sale in a Chicago pharmacy Other types of contraception, which are generally not used by young people, include natural methods such as only having sex at certain times of the month (these are often not effective enough), and sterilization, which is a permanent surgical procedure. The intrauterine device

(IUD) and intrauterine system (IUS), also known as 'the coil', are generally not used by young people although in some countries, such as the UK, they are now considered suitable for all age groups.

Barrier methods of contraception

There are three main barrier methods of contraception used by teens: the male condom, the female condom, and spermicides in the form of foams or gels.

The male condom

Condom

The male condom is the only method of contraception that boys can use. It's really just a rubber tube. It's closed at one end like the finger of a glove so that when a boy puts it over his penis it stops the sperm going inside a girl's body. An advantage of using male condoms is that a boy can take an active part in using contraception ± it's not just the girl's responsibility.

The female condom

female condom

The female condom is not as widely available as the male condom and it is more expensive. It is however very useful when the man either will not, or cannot, use a male condom. It¶s like a male condom, except it¶s bigger and worn inside the vagina.

It's a good idea to practice with condoms before having sex. You can get used to touching them, and it might help you feel more confident about using them when you do have sex.

Spermicides

Spermicides are chemical agents that both kill sperm and stop sperm from travelling up into the cervix (the lower part of the uterus, or womb, where babies develop). Spermicides come in different forms including creams, foaming tablets, gels and foam (which is squirted into the vagina using an applicator). Young people who use spermicide mostly choose foam.

Spermicides are not very effective against pregnancy when used on their own, but are very effective if used at the same times as a male condom. When used together, the male condom and spermicide can be a great combination for effectively protecting against both pregnancy and sexually transmitted diseases such as HIV.

Some condoms also come lubricated with spermicide (Nonoxynol 9). A spermicidal lubricant aims to provide an additional level of protection if some semen happens to leak out of the condom. This can help to reduce the likelihood of pregnancy, but regular use of Nonoxynol 9 can cause an allergic reaction in some people resulting in little sores that can actually make the transmission of HIV and other sexually transmitted infections more likely. Nonoxynol 9 is only a suitable spermicide for a woman who is HIV-negative, and whose partner does not have HIV either. It should only be used for vaginal sex.

Hormonal methods of contraception

There are two main types of hormonal contraceptive which can be used by teens: the contraceptive pill, and the injectable hormonal contraceptive. If used properly, both are extremely effective in providing protection against pregnancy ± but they provide no protection at all against sexually transmitted diseases. For very good protection against both pregnancy and sexually transmitted diseases like HIV, a hormonal method should be used at the same time as the male condom.

In some countries, contraceptive patches (that stick to the skin) and rings (that go inside the vagina) are also available.

The contraceptive pill (sometimes known as the birth control pill)

contraceptive pill

y What does 'going on the pill' mean?

People often talk about being 'on the pill'. This means they are using the oral

contraceptive pill as a method of contraception. This has nothing to do with oral sex,

and just means that the contraceptive is in pill form which is taken orally (swallowed).

y How does it work?

The pill contains chemicals called hormones. One type of pill called µthe combined

pill¶ has two hormones called Oestrogen and Progestogen. The combined pill stops the

release of an egg every month ± but doesn't stop periods.

The other type of pill only has Progestogen in it. It works by altering the mucous

lining of the vagina to make it thicker. The sperm cannot then get through, and as the

sperm can't meet the egg, the girl can't get pregnant.

y What do you do?

Usually a girl has to take one pill every day for about three weeks. She then takes a

break for seven days while she has her period, before starting the cycle again (or

instead, she may take µsugar¶ pills for those seven days, i.e. pills that don¶t actually

have any affect, but which are taken purely so she keeps in the routine) for seven days.

It's very important not to forget to take these pills. If this happens, protection against

pregnancy is lost. The Progestogen-only pill also has to be taken at the same time

every day. y How effective is the pill?

It's a very effective method of contraception if it is taken correctly. If the pill is taken

exactly according to the instructions, the chance of pregnancy occurring is practically

nil. But if a girl forgets a pill, or is very unwell, its effectiveness is reduced. Another

disadvantage of the pill is that it does not provide any protection against STDs. For

very good protection against both pregnancy and STDs, the birth control pill should be

used at the same time as the male condom.

Sperm bank

The development of sperm banks, whilst considered by some to be controversial, has enabled people to have greater control over their reproductive lives. By providing sperm from donors who are checked and screened, thousands of women every year are able to bear their own children in circumstances where this might otherwise not be possible. Controversy stems from the fact that donors effectively father children for others, often in considerable numbers, and usually take no part in the upbringing of such children, and also from the fact that single women and coupled lesbians frequently use sperm banks in order to have their own biological children.

Storage

The sperm is stored in small vials or straws of holding between 0.4 and 1.0 ml and cryogenically preserved in liquid nitrogen tanks. It has been proposed that there should be an upper limit on how long frozen sperm can be stored, however a baby has been conceived in the UK using sperm frozen for 21 years[1]. Before freezing, sperm may be prepared so that it can be used for intra-cervical insemination (ICI), intrauterine insemination (IUI) or for IVF(or

Use

Sperm supplied by a sperm bank may be used where a woman's partner is infertile or where he carries genetic disease. Increasingly, donor sperm is used to achieve a pregnancy where a woman has no male partner, including among lesbian and bisexual mothers-to-be. Sperm from a sperm donor may also be used in surrogacy arrangements and for creating embryos for embryo donation. Donor sperm may be supplied by the sperm bank directly to the recipient to enable a woman to perform her own artificial insemination which can be carried out using a needle-less syringe or a cervical cap conception device. The cervical cap conception device allows the donor semen to be held in place close to the cervix for between six to eight hours to allow fertilization to take place. Alternatively, donor sperm can be supplied by a sperm bank through a registered medical practitioner who will perform an appropriate method of insemination or IVF treatment using the donor sperm in order for the woman to become pregnant.

From a medical perspective, a pregnancy achieved using donor sperm is no different from a pregnancy achieved using partner sperm, and it is also no different from a pregnancy achieved by sexual intercourse.

Sperm banks may supply other sperm banks or a fertility clinic with donor sperm to be used for achieving pregnancies. Sperm banks may also supply sperm for research or educational purposes.

In countries where sperm banks are allowed to operate, the sperm donor will not usually become the legal father of the children he produces as the result of the use of the sperm he donates, but he will be the 'biological father' of such children. In cases of surrogacy involving embryo donation, a form of 'gestational surrogacy', the 'commissioning mother' or the

'commissioning parents' will not be biologically related to the child and may need to go through an adoption procedure.

As with other forms of third party reproduction, the use of donor sperm from a sperm bank gives rise to a number of moral, legal and ethical issues. Men may also use a sperm bank to store their own sperm for future use particularly where they anticipate traveling to a war zone or having to undergo chemotherapy which might damage the testes.

Selection

Sperm banks make information available about the sperm donors whose donations they hold in the sperm bank to enable customers to select the donor whose sperm they wish to use. This information is often available by way of an on-line catalog. A sperm bank will also usually have facilities to help customers to make their choice and they will be able to advise on the suitablitity of donors for individual donors and their partners.

Where the recipient woman has a partner she may prefer to use sperm from a donor whose physical features are similar to those of her partner. In many cases, the choice of a donor with the correct blood group will be paramount with particular considerations involving the use of sperm from donors with negative blood groups. If a surrogate is to be used, such as where the customer is not intending to carry the child, considerations about her blood group etc will also need to be taken into account. Information made available by a sperm bank will usually include the race, height, weight, blood group, health and eye colour of the donor. Sometimes information about his age, family history and educational achievements will also be given.

Some sperm banks make a 'personal profile' of a donor available and occasionally more information may be purchased about a donor, either in the form of a DVD or in written form.

Catalogs usually state whether samples supplied in respect of a particular donor have already given rise to pregnancies, but this is not necessarily a guide to the fecundity of the sperm since a donor may not have been in the program long enough for any pregnancies to have been recorded. If a woman intends to have more than one child, she may wish to have the additional child or children by the same donor. Sperm banks will usually advise whether sufficient stocks of sperm are available from a particular donor for subsequent pregnancies, and they normally have facilities available so that the woman may purchase and store additional vials from that donor on payment of an appropriate fee. These will be stored until required for subsequent pregnancies or they may be onsold if they become surplus to the woman's requirements.

The catalogue will also state whether samples of sperm are available for Intracervical

Insemination ICI,IUI Intrauterine Insemination)or IVF use. ICI is for vaginal or cervical insemination and IUI are 'washed' samples prepared for intrauterine insemination where sperm is injected directly into the uterus. IVF treatment refers to 'in vitro' use, i.e. where fertilisation takes place outside the body, literally 'in glass', and therefore to treatments involving donor sperm where an egg is removed from the body and an embryo is created which is then re-inserted, or inserted, into a woman. The preparation for IUI is normally done by a gradient centrifugation where prostaglandins and bacteria is removed from the plasma.

Sperm prepared for [IVF] use normally contains a smaller sample of highly concentrated sperm.

Gender selection

Some sperm banks enable recipients to choose the gender of their child. Although the methods used do not guarantee 100% success, the chances of being able to select the gender of a child are held to be considerably increased.

. Artificial insemination

Artificial insemination, or AI, is the process by which sperm is placed into the reproductive tract of a female for the purpose of impregnating the female by using means other than sexual intercourse or natural insemination. In humans, it is used as assisted reproductive technology, using either sperm from the woman's male partner or sperm from a sperm donor (donor sperm) in cases where the male partner produces no sperm or the woman has no male partner

(i.e., single women, lesbians). In cases where donor sperm is used the woman is the gestational and genetic mother of the child produced, and the sperm donor is the genetic or biological father of the child.

Artificial insemination is widely used for livestock breeding, especially for dairy cattle and pigs. Techniques developed for livestock have been adapted for use in humans.

Specifically, freshly ejaculated sperm, or sperm which has been frozen and thawed, is placed in the cervix (intracervical insemination ± ICI) or, after washing, into the female's uterus

(intrauterine insemination ± IUI) by artificial means.

In humans, artificial insemination was originally developed as a means of helping couples to conceive where there were 'male factor' problems of a physical or psychological nature affecting the male partner which prevented or impeded conception. Today, the process is also and more commonly used in the case of choice mothers, where a woman has no male partner and the sperm is provided by a sperm donor.

Preparations

A sperm sample will be provided by the male partner of the woman undergoing artificial insemination, but sperm provided through sperm donation by a sperm donor may be used if, for example, the woman's partner produces too few motile sperm, or if he carries a genetic disorder, or if the woman has no male partner. Sperm is usually obtained through masturbation or the use of an electrical stimulator, although a special condom, known as a collection condom, may be used to collect the semen during intercourse.

The man providing the sperm is usually advised not to ejaculate for two to three days before providing the sample in order to increase the sperm count.

A woman's menstrual cycle is closely observed, by tracking basal body temperature (BBT) and changes in vaginal mucus, or using ovulation kits, ultrasounds or blood tests.

When using intrauterine insemination (IUI), the sperm must have been ³washed´ in a laboratory and concentrated in Hams F10 media without L-glutamine, warmed to 37C.[1] The process of ³washing´ the sperm increases the chances of fertilization and removes any mucus and non-motile sperm in the semen. Pre and post concentration of motile sperm is counted.

If sperm is provided by a sperm donor through a sperm bank, it will be frozen and quarantined for a particular period and the donor will be tested before and after production of the sample to ensure that he does not carry a transmissible disease. Sperm samples donated in this way are produced through masturbation by the sperm donor at the sperm bank. A chemical known as a cryoprotectant is added to the sperm to aid the freezing and thawing process. Further chemicals may be added which separate the most active sperm in the sample as well as extending or diluting the sample so that vials for a number of inseminations are produced. For fresh shipping, a semen extender is used. If sperm is provided by a private donor, either directly or through a sperm agency, it is usually supplied fresh, not frozen, and it will not be quarantined. Donor sperm provided in this way may be given directly to the recipient woman or her partner, or it may be transported in specially insulated containers. Some donors have their own freezing apparatus to freeze and store their sperm. Private donor sperm is usually produced through masturbation, but some donors use a collection condom to obtain the sperm when having sexual intercourse with their own partners.

Procedure

When an ovum is released, semen provided by the woman's male partner, or by a sperm donor, is inserted into the woman's vagina or uterus. The semen may be fresh or it may be frozen semen which has been thawed. Where donor sperm is supplied by a sperm bank, it will always be quarantined and frozen and will need to be thawed before use. Specially designed equipment is available for carrying out artificial inseminations.

In the case of vaginal artificial insemination, semen is usually placed in the vagina by way of a needleless syringe. A longer tube, known as a 'tom cat' may be attached to the end of the syringe to facilitate deposit of the semen deeper into the vagina. The woman is generally advised to lie still for a half hour or so after the insemination to prevent seepage and to allow fertilization to take place.

A more efficient method of artificial insemination is to insert semen directly into the woman's uterus. Where this method is employed it is important that only 'washed' semen be used and this is inserted into the uterus by means of a catheter. Sperm banks and fertility clinics usually offer 'washed' semen for this purpose, but if partner sperm is used it must also be 'washed' by a medical practitioner to eliminate the risk of cramping. Semen is occasionally inserted twice within a 'treatment cycle'. A double intrauterine insemination has been theorized to increase pregnancy rates by decreasing the risk of missing the fertile window during ovulation. However, a randomized trial of insemination after ovarian hyperstimulation found no difference in live birth rate between single and double intrauterine insemination.[2]

An alternative method to the use of a needless syringe or a catheter involves the placing of partner or donor sperm in the woman's vagina by means of a specially designed cervical cap, a conception device or conception cap. This holds the semen in place near to the entrance to the cervix for a period of time, usually for several hours, to allow fertilization to take place.

Using this method, a woman may go about her usual activities while the cervical cap holds the semen in the vagina. One advantage with the conception device is that fresh, non-liquified semen may be used.

If the procedure is successful, the woman will conceive and carry to term a baby. A pregnancy resulting from artificial insemination will be no different from a pregnancy achieved by sexual intercourse. However, there may be a slight increased likelihood of multiple births if drugs are used by the woman for a 'stimulated' cycle.

Donor variations

Either sperm provided by the woman's husband or partner (artificial insemination by husband, AIH) or sperm provided by a known or anonymous sperm donor (artificial insemination by donor, AID or DI) can be used.

Techniques

Intrauterine insemination, Intravaginal insemination, Intracervical insemination, and

Intratubal insemination

Intracervical insemination

ICI is the easiest way to inseminate. This involves the deposit of raw fresh or frozen semen

(which has been thawed) by injecting it high into the cervix with a needle-less syringe. This process closely replicates the way in which fresh semen is directly deposited on to the neck of the cervix by the penis during vaginal intercourse. When the male ejaculates, sperm deposited this way will quickly swim into the cervix and toward the fallopian tubes where an ovum recently released by the ovary(s) hopefully awaits fertilization. It is the simplest method of artificial insemination and 'unwashed' or raw semen is normally used. It is probably therefore, the most popular method and is used in most home, self and practitioner insemination procedures.

Intrauterine insemination

'Washed sperm', that is, spermatozoa which have been removed from most other components of the seminal fluids, can be injected directly into a woman's uterus in a process called intrauterine insemination (IUI). If the semen is not washed it may elicit uterine cramping, expelling the semen and causing pain, due to content of prostaglandins. (Prostaglandins are also the compounds responsible for causing the myometrium to contract and expel the menses from the uterus, during menstruation.) The woman should rest on the table for 15 minutes after an IUI to optimize the pregnancy rate.[4] To have optimal chances with IUI, the female should be under 30 years of age, and the man should have a TMS of more than 5 million per ml.[5] In practice, donor sperm will satisfy these criteria. A promising cycle is one that offers two follicles measuring more than 16 mm, and estrogen of more than 500 pg/mL on the day of hCG administration.[5] A short period of ejaculatory abstinence before intrauterine insemination is associated with higher pregnancy rates.[6] However, GnRH agonist administration at the time of implantation does not improve pregnancy outcome in intrauterine insemination cycles according to a randomized controlled trial.[7]

Intrauterine tuboperitoneal insemination

Intrauterine tuboperitoneal insemination (IUTPI) is insemination where both the uterus and fallopian tubes are filled with insemination fluid. The cervix is clamped to prevent leakage to the vagina, best achieved with the specially designed Double Nut Bivalve (DNB) speculum.

The sperm is mixed to create a volume of 10 ml, sufficient enough to fill the uterine cavity, pass through the interstitial part of the tubes and the ampulla, finally reaching the peritoneal cavity and the Pouch of Douglas where it would be mixed with the peritoneal and follicular fluid. IUTPI can be useful in unexplained infertility, mild or moderate male infertility, and mild or moderate endometriosis.[9]

Intratubal insemination

IUI can furthermore be combined with intratubal insemination (ITI), into the Fallopian tube although this procedure is no longer generally regarded as having any beneficial effect compared with IUI.[10] ITI however, should not be confused with gamete intrafallopian transfer, where both eggs and sperm are mixed outside the woman's body and then immediately inserted into the Fallopian tube where fertilization takes place. In vitro fertilisation

Oocyte with surrounding granulosa cells "Naked" Egg

In vitro fertilization (IVF) is a process by which egg cells are fertilised by sperm outside the body, in vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman's ovaries and letting sperm fertilise them in a fluid medium. The fertilised egg (zygote) is then transferred to the patient's uterus with the intent to establish a successful pregnancy. The first successful birth of a "test tube baby", Louise Brown, occurred in 1978. Robert G. Edwards, the doctor who developed the treatment, was awarded the Nobel Prize in Physiology or Medicine in 2010. Before that, there was a transient biochemical pregnancy reported by Australian Foxton School researchers in

1953 and an ectopic pregnancy reported by Steptoe and Edwards in 1976.

The term in vitro, from the Latin root meaning in glass, is used, because early biological experiments involving cultivation of tissues outside the living organism from which they came, were carried out in glass containers such as beakers, test tubes, or petri dishes. Today, the term in vitro is used to refer to any biological procedure that is performed outside the organism it would normally be occurring in, to distinguish it from an in vivo procedure, where the tissue remains inside the living organism within which it is normally found. A colloquial term for babies conceived as the result of IVF, "test tube babies", refers to the tube-shaped containers of glass or plastic resin, called test tubes, that are commonly used in chemistry labs and biology labs. However, in vitro fertilisation is usually performed in the shallower containers called Petri dishes. One IVF method, Autologous Endometrial Coculture, is actually performed on organic material, but is still considered in vitro.

Indications

IVF may be used to overcome female infertility in the woman due to problems of the fallopian tube, making fertilisation in vivo difficult. It may also assist in male infertility, where there is defect sperm quality, and in such cases intracytoplasmic sperm injection (ICSI) may be used, where a sperm cell is injected directly into the egg cell. This is used when sperm have difficulty penetrating the egg, and in these cases the partner's or a donor's sperm may be used. ICSI is also used when sperm numbers are very low. ICSI results in success rates equal to those of IVF.

For IVF to be successful it typically requires healthy ova, sperm that can fertilise, and a uterus that can maintain a pregnancy. Due to the costs of the procedure, IVF is generally attempted only after less expensive options have failed.

IVF can also be used with egg donation or surrogacy where the woman providing the egg isn't the same who will carry the pregnancy to term. This means that IVF can be used for females who have already gone through menopause. The donated oocyte can be fertilised in a crucible. If the fertilisation is successful, the embryo will be transferred into the uterus, within which it may implant.

IVF can also be combined with preimplantation genetic diagnosis (PGD) to rule out presence of genetic disorders. A similar but more general test has been developed called

Preimplantation Genetic Haplotyping (PGH).

Method

Theoretically, in vitro fertilisation could be performed by aspirating contents from a woman's fallopian tubes or uterus with a plastic catheter after natural ovulation, mix it with semen from a man and reinsert into the uterus. However, without additional techniques, the chances of pregnancy would be extremely small. Such additional techniques that are routinely used in

IVF include ovarian hyperstimulation to retrieve multiple eggs, ultrasound-guided transvaginal oocyte retrieval directly from the ovaries, egg and sperm preparation, as well as culture and selection of resultant embryos.

Ovarian hyperstimulation

There are two main protocols for stimulating the ovaries for IVF treatment. The long protocol involves downregulation (suppression or exhaustion) of the pituitary ovarian axis by the prolonged use of a GnRH agonist. Stimulation of the ovaries using a gonadotrophin starts once the process of downregualtion is complete generally after 10 to 14 days.

The short protocol consist of a regimen of fertility medications to stimulate the development of multiple follicles of the ovaries. In most patients, injectable gonadotropins (usually FSH analogues) are used under close monitoring. Such monitoring frequently checks the estradiol level and, by means of gynecologic ultrasonography, follicular growth. Typically approximately 10 days of injections will be necessary. Spontaneous ovulation during the cycle is typically prevented by the use of GnRH agonists that are started prior or at the time of stimulation or GnRH antagonists that are used just during the last days of stimulation; both agents block the natural surge of luteinising hormone (LH) and allow the physician to start the ovulation process by using medication, usually injectable human chorionic gonadotropins.

Ovarian stimulation carries the risk of excessive or hyperstimulation. This complication is life-threatening and ovarian stimulation using gonadotrophins must only be carried out under strict medical supervision

Egg retrieval

Main article: Transvaginal oocyte retrieval

When follicular maturation is judged to be adequate, human chorionic gonadotropin (hCG) is given. Commonly, this is known as the "trigger shot."[1] This agent, which acts as an analogue of luteinising hormone, makes the follicles perform their final maturation, and would cause ovulation about 42 hours after injection, but a retrieval procedure takes place just prior to that, in order to recover the egg cells from the ovary [2]. The eggs are retrieved from the patient using a transvaginal technique (transvaginal oocyte retrieval) involving an ultrasound-guided needle piercing the vaginal wall to reach the ovaries. Through this needle follicles can be aspirated, and the follicular fluid is handed to the IVF laboratory to identify ova. It is common to remove between ten and thirty eggs. The retrieval procedure takes about 20 minutes and is usually done under conscious sedation or general anaesthesia.

Egg and sperm preparation

In the laboratory, the identified eggs are stripped of surrounding cells and prepared for fertilisation. An oocyte selection may be performed prior to fertilisation to select eggs with optimial chances of successful pregnancy. In the meantime, semen is prepared for fertilisation by removing inactive cells and seminal fluid in a process called sperm washing. If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined, and it will be thawed ready for use.

Fertilisation

The sperm and the egg are incubated together at a ratio of about 75,000:1 in the culture media for about 18 hours. In most cases, the egg will be fertilised by that time and the fertilised egg will show two pronuclei. In certain situations, such as low sperm count or motility, a single sperm may be injected directly into the egg using intracytoplasmic sperm injection (ICSI).

The fertilised egg is passed to a special growth medium and left for about 48 hours until the egg consists of six to eight cells.

In gamete intrafallopian transfer, eggs are removed from the woman and placed in one of the fallopian tubes, along with the man's sperm. This allows fertilisation to take place inside the woman's body. Therefore, this variation is actually an in vivo fertilisation, not an in vitro fertilisation.

Embryo culture

Typically, embryos are cultured until having reached the 6±8 cell stage three days after

c retrieval. In many Canadian, American and Australian programmes[ itation needed], however, embryos are placed into an extended culture system with a transfer done at the blastocyst stage at around five days after retrieval, especially if many good-quality embryos are still available on day 3. Blastocyst stage transfers have been shown to result in higher pregnancy rates.[3] In Europe, transfers after 2 days are common. Culture of embryos can either be performed in an artificial culture medium or in an autologous endometrial coculture (on top of a layer of cells from the woman's own uterine lining). With artificial culture medium, there can either be the same culture medium throughout the period, or a sequential system can be used, in which the embryo is sequentially placed in different media. For example, when culturing to the blastocyst stage, one medium may be used for culture to day 3, and a second medium is used for culture thereafter.[4] Single or sequential medium are equally effective for the culture of human embryos to the blastocyst stage.[5] Artificial embryo culture media basically contain glucose, pyruvate, and energy- providing components, but addition of amino acids, nucleotides, vitamins, and cholesterol improve the performance of embryonic growth and development.[6]

Embryo selection

Laboratories have developed grading methods to judge oocyte and embryo quality. In order to optimise pregnancy rates, there is significant evidence that a morphological scoring system is the best strategy for the selection of embryos.[7] However, presence of soluble HLA-G might be considered as a second parameter if a choice has to be made between embryos of morphologically equal quality.[7] Also, two-pronuclear zygotes (2PN) transitioning through

1PN or 3PN states tend to develop into poorer-quality embryos than those who constantly remain 2PN.[8] In addition to tests that optimise pregnancy chances, Preimplantation Genetic

Diagnosis (PGD) or screening may be performed prior to transfer in order to avoid inheritable diseases.[9] Methods are emerging in making comprehensive analyses of transcriptomes of embryos in order to assess embryo quality.[10]

Embryo transfer

Embryos are graded by the embryologist based on the number of cells, evenness of growth and degree of fragmentation. The number to be transferred depends on the number available, the age of the woman and other health and diagnostic factors. In countries such as Canada, the

UK, Australia and New Zealand, a maximum of two embryos are transferred except in unusual circumstances. In the UK and according to HFEA regulations, a woman over 40 may have up to three embryos transferred, whereas in the USA, younger women may have many embryos transferred based on individual fertility diagnosis. Most clinics and country regulatory bodies seek to minimise the risk of pregnancies carrying multiples. The embryos judged to be the "best" are transferred to the patient's uterus through a thin, plastic catheter, which goes through her vagina and cervix. Several embryos may be passed into the uterus to improve chances of implantation and pregnancy.

Success or failure factors

The main potential factors that influence pregnancy (and live birth) rates in IVF have been suggested to be maternal age, duration of infertility or subfertility, bFSH and number of oocytes, all reflecting ovarian function.[15] Optimal woman¶s age is 23±39 years at time of treatment.[16]

Stress

In a 2005 Swedish study,[17] 166 women were monitored starting one month before their IVF cycles, and the results showed no significant correlation between psychological stress and IVF outcome. The study concluded with the recommendation to clinics that it might be possible to reduce the stress experienced by IVF patients during the treatment procedure by informing them of those findings. While psychological stress experienced during a cycle might not influence an IVF outcome, it is possible that the experience of IVF can result in stress that leads to depression. The financial consequences alone of IVF can influence anxiety and become overwhelming. However, for many couples, the alternative is infertility, and the experience of infertility itself can also cause extreme stress and depression.

Acupuncture

An increasing number of fertility specialists and centers offer acupuncture as a part of their

IVF protocol. Limited but supportive evidence from clinical trials and case series suggests that acupuncture may improve the success rate of IVF and the quality of life of patients undergoing IVF and that it is a safe adjunct therapy.[18] A systematic review and meta-analysis published in the British Medical Journal found that complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (where the expected number of patients needed to be treated to produce 1 additional pregnancy was 10), ongoing pregnancy (NNT 9), and live birth

(NNT 9).

Surrogate motherhood

Surrogate motherhood is a practice in which one woman (the surrogate mother) intentionally becomes pregnant and gives birth to an infant who will be adopted by another woman (the adoptive mother), as arranged by a legal contract prior to conception. The surrogate mother may be impregnated by artificial insemination with the adoptive mother's husband's semen or may have implanted in her uterus an embryo conceived in vitro (outside the body). The contract frees the surrogate mother of parental rights and responsibilities; it may guarantee financial support and payment of medical costs but does not involve a direct payment for the child. Relevant ethical issues include reproductive freedom and rights, informed consent of the surrogate mother, and the best interests of the child. Roman Catholicism and Islam object to the procedure. In practice, some problems have occurred when surrogate mothers have been reluctant to give up children, and some adoptive parents have refused to accept children.

Sexually Transmitted Diseases

Welcome to the site where you can find out everything you need to know aboutContracting

STDs,Chlamydia and Gonorrhea, HPV and Hepatitis B, HIV/AIDs, and all Other Types of

STDs

General Facts About STDs

Sexually transmitted diseases (also called STDs, or STIs for sexually transmitted infections) are infections that can be transferred from one person to another through sexual contact.

According to the Centers for Disease Control and Prevention, there are over 15 million cases of sexually transmitted disease cases reported annually in the United States. There are more than 25 diseases that are transmitted through sexual activity. Other than HIV, the most common STDs in the United States are chlamydia, gonorrhea, syphilis, genital herpes, human papillomavirus, hepatitis B, trichomoniasis, and bacterial vaginosis. Adolescents and young adults are the age groups at the greatest risk for acquiring an STD. Approximately 19 million new infections occur each year, almost half of them among people ages 15 to 24.

Some STDs can have severe consequences, especially in women, if not treated, which is why

it is so important to go for STD testing. Some STDs can lead to pelvic inflammatory disease,

which can cause infertility, while others may even be fatal. STDs can be prevented by

refraining from sexual activity, and to a certain extent, some contraceptive devices, such as

condoms.

Specific STDs: An Overview

Human Papilloma Virus:The human papilloma virus is thought to be HUMAN one of the main causes of cervical cancer. It has also been linked with PAPILLOMA VIRUS other types of cancers of the female reproductive system. While HPV can About HPV be treated to reduce the signs and symptoms, there is currently no cure for HPV Symptoms this virus. However, the HPV vaccine has recently been developed to HPV Treatments prevent HPV infection. Cervical Cancer HPV Vaccine

Herpes Virus:Herpes is another STD that presently has no cure. Or is HERPES SIMPLEX 2 there a cure for Herpes? Today, treatment is available and there are a Herpes Overview number of things you can do yourself at home to help relieve your genital Herpes Symptoms herpes, as well as natural herpes treatment. Herpes symptoms include Natural Treatment blisters or sores that periodically break out on the genitals. Take a look at Herpes Treatments our FAQs on genital herpes to learn even more about this uncomfortable Herpes FAQ

STD.

Hepatitis: Although there is no cure for those already infected, there is HEPATITIS now a Hepatitis B (HBV) vaccine available to prevent the spread of this About Hepatitis B infection. Many are asymptomatic, however those who do suffer from Hepatitis B

Hepatitis B symptoms may have many unpleasant discomforts. Even Symptoms though there is a possibility that the infection will clear up on its own, Hepatitis B some people suffer from chronic infections for many years. Treatment is Treatment available for chronic sufferers. Other types of hepatitis infections that can Hepatitis A be passed through sexual contact include Hepatitis A and Hepatitis C. HIV/AIDS: One STD that many people are worried about getting is HIV. HUMAN IMMUNO-

While new ways of treating this infection can significantly prolong an DEFICIENCY VIRUS infected person's life, for far too many people this infection eventually About HIV progresses to AIDS and, ulitmately, death. More than 40 million people HIV Symptoms worldwide are infected with the HIV virus; women account for 50% of HIV Treatment those infected. Recently, studies have found a link between the use of HIV Testing hormonal birth control and HIV. In the US, African Americans account HIV Prevention HIV and for a disproportionate number of HIV cases. Many people may not realize Microbicides they are infected, as the HIV virus is often asymptomatic for the first few HIV & Pregnancy years. HIV testing is the only sure way to know if you are infected. HIV and Birth However, you can take steps to help prevent the infection. Find out about Control a new method that could prevent an HIV infection in women using the HIV/AIDS & African cervical cap and microbicides. Americans

Syphilis: Throughout history, cases of syphilis have been recorded. SYPHILIS

While this STD has not always been effectively dealt with, nowadays, About Syphilis syphilis can easily be treated and cured. However, as history has shown, Syphilis Symptoms without treatment, syphilis symptoms can progress and affect the nervous Syphilis Treatment system and brain leading to dementia and even death.

Trichomoniasis:Trichomoniasis is one of the most common, curable TRICHOMONIASIS

STDs out there. However, symptoms of trich may be mistaken for a yeast About infection causing a women to use the wrong type of treatment for her Trichomoniasis vaginal discharge. Trich Symptoms

Trich Treatment Common Infections:Chlamydia and gonorrhea often infect a person at CHLAMYDIA & the same time. Although the symptoms of chlamydia are different from GONORRHEA gonorrhea symptoms, it is not unusual for a person to be asymptomatic. If About Chlamydia you are testing for chlamydia, it may be a good idea to also test for Chlamydia gonorrhea at the same time. Both STDs can be cured but can also do Symptoms damage to your reproductive system if left untreated. Chlamydia Testing About Gonorrhea

Gonorrhea

Symptoms

Gonorrhea Testi

Pubic Lice: A very common STD, crabs are very similar to head lice. PUBIC LICE

While the itchy symptoms can be hard to miss, treatment for pubic lice About Crabs can easily take care of the discomfort these pests can cause. Crab Symptoms

Crab Treatment

Rare Infections: Some STDs, like granuloma inguinale and chancroid, RARE STDS are not so well known in North America, but that doesn't mean your not Granuloma at risk of contracting these infections. Other lesser-talked about STDs Inguinale include nongonococcal urethritis, molluscum contagiosum, and Chancroid lymphogranuloma venereum. Nongonococcal

Urethritis

Lymphogranuloma

Venereum

Molluscum

Contagiosum Make No Mistake:Sometimes STD symptoms can be confused with mononucleosis.

Characterized by a fever, sore throat, and extreme weakness, mono is a viral infection that

needs to be treated right away. If you think you have the illness, seek mono treatment as soon

as possible. Also, yeast infection can cause painful itching and burning, and can even be

transmitted sexually.

Get all of the answers you need about STDs in our STD forum.

Find out more about how you can learn how to identify if you have an STD.

Learn more about STDs and other reproductive tract infections with facts and photos at STDs in Color.

What is family planning? Family planning means planning when and how many children you are going to have and how to prevent unwanted pregnancy.

Family planning means working out a plan with your partner on how you want to deal with procreation within the context of a sexual relationship. This covers things as varied as when and why to get pregnant, the number of children that are wanted, how to deal with fertility issues, how to avoid getting pregnant, whether to consider an abortion or adoption if an unwanted pregnancy occurs, etc., to say nothing of working out parental strategies with your partner. Family planning is having children that you planned on having, and not children concieved by accident.

How is sperm stored in a sperm bank? Storing and freezing biological tissues at very low temperatures is called cryopreservation. The semen is mixed with a special liquid called a "cryopreservation medium" before it can be frozen, which helps the sperm survive the damaging process of being frozen and then thawed before use. The mixture is then put into one or more containers (vials or straws) before being stored in liquid nitrogen, or in the vapour from liquid nitrogen. Storage temperatures range between about -150*C to -196*C.

How is artificial insemination carried out? When someone manually retrieves the semen from the male and injects it into the female. Artificial meaning the male and female could be a million miles apart and still get the job done.

Basically, the doctors will take a sample of a man's sperm and place it inside a woman's uterus, so that the woman can get pregnant without a partner or if she and her partner have difficulty conceiving, then she can get someone else's semen to make a baby for her.