IVF 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. In non-medical terms, in vitro fertilization (IVF) is referred to as “test tube baby”. IVF treatment is the most successful technique in Assisted reproductive technology (ART)
As early as the 1950s, Robert Edwards had the vision that IVF Treatment could be useful as a treatment for infertility. He worked systematically to realize his goal, discovered important principles for 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 25th 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 humanity including more than 10% of all couples worldwide. (Source: Nobel Prize Summary)
With infertility on the rise, scientists are constantly coming up with new medical advancements that enable older women, irrespective of their age, to give birth to their biological children. Read – Recent advances in fertility treatment.
In Vitro Fertilization (IVF) is an ideal treatment for couples with blocked fallopian tubes, severe abnormalities in the semen parameters, genetic diseases in either parent resulting in miscarriages or stillbirths, women whose ovaries are failing due to age or other causes of infertility.
The following stages briefly explain how IVF process is done.
Downregulation is accomplished by administering a drug called gonadotrophin-releasing hormone agonist (GnRHa). The response is monitored by blood tests and ultrasound scans. The treatment duration may vary between 8 and 21 days depending on the individual response.
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 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 tests in the blood and ultra sound 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.
This is accomplished by administration of another drug called Human Chorionic Gonadotropin or HCG, which is necessary for final maturation of the egg prior to ovulation.
This stage is a short, safe, outpatient procedure performed vaginally under ultra-sonographic guidance. Oocyte retrieval is scheduled at 34 to 36 hours after the administration of HCG. It is usually done under sedation but general anaesthesia can also be used. The patient is 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.
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 fertilized eggs. They are then placed in fresh dishes of culture medium and replaced in the incubator.
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 total bed rest for 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 28 days of the cycle. In order to support a conception, the woman is given progesterone in the form of injections.
Why choose IVF?
Falling to the traps of the modern lifestyle and job trends, infertility has become an increasing threat for most of the couples seeking parenthood. Most of the couples are in the pursuit of fertility clinics offering infertility treatments, whereas some couples are sceptical about the procedure involved and possible complications during the treatment. In any case, it is always advisable to consult a physician or fertility specialist in order to gain an insight about the treatments.
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