In non-medical terms, In Vitro Fertilization (IVF) is referred to as “test tube baby”. It is a procedure that involves the picking up of eggs from a woman, fertilizing them outside the body with the male partner’s sperm, and replacing the resultant embryos into the female partner’s uterus.
IVF treatment is a boon for couples with infertility or genetic disorders, helping such couples achieve pregnancy. IVF may be the solution for either male or female infertility as early as the 1950s, Robert Edwards had the vision that IVF Treatment could be the answer for infertile people. He worked systematically to realize this goal, discovered important principles of human fertilization, and succeeded in accomplishing fertilization of human egg cells in test tubes (or more precisely, cell culture dishes). His efforts were finally crowned by success on 25 July 1978, when the world’s first “test tube baby” was born. During the following years, Edwards and his co-workers refined IVF treatment technology and shared it with colleagues around the world. Approximately four million individuals have so far been born following IVF. Robert Edwards was awarded the 2010 Nobel Prize for the development of human in vitro fertilization (IVF) therapy. His achievements have made it possible to treat infertility, a medical condition afflicting a large proportion of people including more than 10% of all couples worldwide. (Source: Nobel Prize Summary).
There is an increased number of cases where couples are unable to conceive naturally due to various reasons, some of which are unknown or unnoticed. Scientists are constantly coming up with new medical advancements that enable older women, irrespective of their age, to give birth to their own biological children. IVF or In Vitro Fertilization is one of the most widely practised treatments for infertility.
Procedures for IVF Treatment:
IVF Treatment usually involves the following steps:
- Monitoring and Stimulation of Ovaries using hormones
- Collecting the eggs from the ovaries
- Fertilization of the ovum with sperm in a culture dish – a zygote is formed
- The fertilized zygote is then allowed to grow for 5-6 days and then implanted in the uterus of the prospective mother
- Pregnancy tests are done by using blood samples after two weeks of implantation Indication
In Vitro Fertilization (IVF) is the treatment of choice for couples with blocked fallopian tubes, severe abnormalities in the semen parameters, low sperm count, genetic diseases in either parent resulting in miscarriages or stillbirths, women whose ovaries are failing due to age or even unexplained infertility.
Stages of an IVF treatment:
Down-regulation is a process by which your doctor shuts off your ovaries, temporarily to be able to control ovulation and egg maturation during treatment. Downregulation is accomplished by administering drugs called GnRH antagonists and GnRH agonists. suppress your body’s production of FSH and LH. FSH and LH are hormones that trigger egg development and ovulation. The response is monitored by blood tests and ultrasound scans. The duration of down-regulation may vary between 8 to 21 days depending on the individual response.
2. Ovarian Stimulation:
Injections called gonadotrophins are the most commonly used injections to develop a good number of follicles in the ovary. They are given each day, starting on day 2 of the menstrual cycle, till the follicles reach a diameter of 18 to 22mm. This takes on an average 10 to 12 days of IVF treatment. On some occasions, ovarian stimulation may be achieved by tablets such as clomiphene citrate in combination with gonadotrophins. Hormonal assays in the blood and ultrasound scans are carried out at regular intervals to assess the patient’s response to these drugs. At the same time, the endometrial lining is also assessed.
3. Ovulation Trigger:
This is accomplished by administration of another drug called Human Chorionic Gonadotropin or HCG, which is necessary for final maturation and release of the egg also known as ovulation.
4. Oocyte Retrieval or Ovum Pick up:
This stage is a short, safe, outpatient procedure performed vaginally under ultrasonographic guidance. Oocyte retrieval is scheduled at 34 to 36 hours after the administration of HCG. It is usually done under sedation, but general anesthesia can also be used. The patient needs to be fasting for at least 5 hours prior to the procedure. The procedure is carried out in sterile surroundings under aseptic conditions. The aspirated fluid is examined under the microscope to identify the eggs. The eggs are removed, washed and placed in small dishes containing the culture medium, which is stored in a special incubator in IVF treatment.
After the oocyte retrieval, the patient may experience mild, cramp-like pain or slight bleeding from the vagina which will subside in a few hours. Oral antibiotics are given to the woman as prophylaxis against infection. The patient can go home 2 to 3 hours after the procedure.
5. Sperm Preparation:
On the day of egg pick-up, the husband is required to produce a semen sample in a clean wide-mouthed container supplied by the lab. There is a period of abstinence observed for 2 to 3 days. If the husband cannot be present at the scheduled time, a semen sample is collected in advance and frozen for use during the IVF treatment.
A measured volume of the prepared sperm suspension is added to the dish containing the oocytes 3 to 6 hours after the oocyte retrieval. The following day the dish is checked for fertilization of the eggs. They are then placed in fresh dishes of culture medium and replaced in the incubator.
7. Embryo Transfer:
ET is carried out on any day, between the second day and fifth day after oocyte retrieval. It is a simple and straightforward procedure done under aseptic conditions. No sedation is required. The embryos are gently placed in the uterine cavity through a fine hollow tube (cannula) introduced directly into the uterus via the vagina and cervix. After the ET, the patient is advised bed rest for about 6 hours. After that, she can resume her normal activities.
Once the embryos are transferred, it should follow the natural event of implantation. The embryo hatches out of its shell covering and implants into the endometrium by burrowing into it. It then continues to develop to the fetus. Within two weeks after embryo transfer, the embryo starts producing a hormone called Human Chorionic Gonadotrophin (HCG). Detection of this confirms the presence of a pregnancy.
A blood test indicating hCG levels to the confirmed pregnancy is done on the 28th day of the cycle. In order to support a conception, the woman is given progesterone in the form of injections, oral tablets or vaginal pessaries.
When IVF Suggested By Doctor?
- Fallopian tubes are damaged
- A decrease in Sperm Count
- Uterine fibroids with unusual menopause
- In absence of fallopian tubes
- Genetic disorder
- Unexplained infertility
The patients with the following problems are benefitted by IVF:
- Blocked or Damaged fallopian tubes
- Low sperm count
- Ovarian issues
- Reproductive health problems
- Ovulation disorders in women
- Uterine Fibroids
- Advanced age group.
The IVF Cycles:
- IVF is not just a procedure, it is a sequence of processes to follow to achieve pregnancy.
- First, the Ovaries are stimulated with hormones to produce more eggs than the normal one egg per cycle.
- Several eggs are collected at the right time.
- Then semen sample is cultured with eggs in a culture dish in a laboratory.
- If a sperm fertilizes an egg a zygote formed.
- The zygote is allowed to grow under laboratory conditions.
- After the zygote attains the right size or grows to the blastocyst stage, it is transferred into the uterus.
This is the usual process during IVF Treatment. In case you have been diagnosed with Infertility and need IVF treatment it would be better not to waste time. A solution may be just around the corner.