Assisted reproductive technologies (ART) encompass all techniques involving direct manipulation of oocytes outside the body. IVF involves a sequence of highly co-ordinated steps beginning with controlled ovarian hyperstimulation with exogenous gonadotropins , followed by retrieval of oocytes from the ovaries under the guidance of transvaginal ultrasonography , fertilization in laboratory and transcervical transfer of embryo into uterus.

The first child resulting from IVF was Louise Brown in 1978. She is mother of a child now!

In most cases IVF is used to help an infertile couple conceive their own biological child , but donor sperm , donor oocytes and gestational surrogates also play an important role in modern ART.

Indications For IVF

1. Tubal factor Infetility :- Like infections (including tubercular) bilateral tubal block , bilateral ectopic/tubal sterilization.
   


2. Endometriosis :- 20-40 % of infertile women have endometriosis and accumulative evidence indicate that fertility decrease with severity of disease.Surgical treatment with restroration of anatomy followed by IVF is the ideal treatment.
   


3. Male factor infertility :- Poor semen quality is sole cause of infertility in approx 20 % of infertile couples. ICSI offers hope to the couples with poor semen parameters (less than (2-3 million post wash count.
   In ICSI , a single sperm is first immobalized by compressing the sperm tail with injection pipette then the sperm is injected into oocyte.
   


4. Ovulatory Dysfuntion :- In patients with premature ovauan failure , IVF donor oocyte offers great hope for successful pregnancy. Patients with reproductive aging/menopause it is treatment of last resort.
   Patients with severe PCOS who require exogenous gonadotropins , ovulation induction proves difficult resulting in excessive ovarian stimulation (OHSS) , higher order multiple gestation.
   


5. Unexplained infertility :- Incidence of unexplained infertility range from 10 % to 30 %. There is no question that IVF is most effective treatment for couples with unexplained infertility.
   

Diagnosis Among Couples Using ART

Prognostic Factors :

1. Maternal age :- It is most important factor in determining the likely hood for success with IVF.
   


2. Diagnosis and past reproductive performance :- The overall IVF live birth rate per cycle is approximately 29 % in average of 50 countries.
   Women with previous live birth are more likely to succeed with IVF then nulli parous women.
   


3. Other Prognostic factors: :- (a) All smoking women should quit smoking before IVF because smoking decreases the likely hood for success by upto one-half.
   
   (b) B/L hydrosalpinges adversely affect the IVF outcome. Laparoscopic salpingectomy before IVF is generally recommended for women with Hydrosalpinx.
   
   (c) Subserosal myomas : Significantly decreases the likely hood for success , subserosal myomas have no significant impact and effect of intramural myoma is unclear.
   
   

Risks Assicated With IVF

1. Hyper stimulation syndrome :- some times the stimulates might result in OHSS (ovarian hyper stimulates syndrome). Some cycles have to be cancelled due to it & embryos can be cryopreserved for future transfer.
   


2. Multiple Pregnancies :- As 2-3 embryos are transferred the chances of multiple pregnancies and risks associated with it are present . There are more chances of preterm delivery. Risk of eclopic preg is on higher side as compared to natural pregnancy.
   


3. Surrogacy: :- For women with normal ovaries but no functional uterus (miillerian agenesis , severe intrauterine adhesions , presious hysterectormy ) and those with medical disorder that preclude pregnancy due to serious health risk , IVF with embryo transfer to a gestational surrogate still offers the possibility of genetic offspring.