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What is Assisted Reproduction

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What is Assisted Reproduction


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.

To explain what happens in IVF we have divided the procedure into six stages.


STAGE I : DOWN REGULATION

Normal hormone production in the female partner is temporarily switched off (down-regulated) with a (gonadotrophin releasing hormone) GnRH analogue (Leupride and Decapeptyl), to give the clinic control of egg production.

These injections are taken from 21st day of previous menstrual cycle and by subcutaneous route.

STAGE II : OVARIAN FOLLICLE DEVELOPMENT THROUGH CONTROLLED OVARIAN STIMULATION

In a natural menstrual cycle one egg is produced from either of the two ovaries. In contrast during IVF cycle it is desirable for several eggs to mature simultaneously. We use Inj. FSH/HMG to cause stimulation of multiple follicles. The response of ovaries is monitored with ultrasound and Blood tests.

STAGE III : HCG Trigger

When the follicles have reached maturity is size 18 to 22 mm trigger with injection HCG is given. This helps in final maturation of egg and loosening of egg from follicle wall. It is usually injected (34-36 hours) prior to egg retrival/ egg Collection which usually is at night. The trigger injection timing is extremely important.

STAGE IV : EMBRYO RETRIEVAL THROUGH PUNCTURE/ASPIRATION

If the last hormone blood test and ultrasound evaluation indicates healthy growth of follicles, then aspiration of mature follicles takes place. This entire procedure takes approximately 18-20 minutes performed under short general anesthesia .The physician locates each follicle through ultrasonic guidance and carefully aspirates them. The contents of the follicles are immediately taken to the IVF lab. Patients usually recover for one to two hours following Oocyte retrieval and are then discharged. Progesterone supplementation initiated from the day of the retrieval.

STAGE V : OOCYTE CULTURE, INSEMINATION, AND FERTILIZATION

In the IVF laboratory, follicular fluid is examined under a microscope to locate all eggs, which are then incubated in a special media. Generally, semen collection occurs at about the time of the egg retrieval but, in some cases, may be several hours later. The are then added to the eggs in culture, here fertilization occurs. Any resulting embryos are stored in the incubator. and maintained in culture until the time of embryo transfer and/or cryopreservation.

STAGE VI : EMBRYO TRANSFER

Usually, transfer of the embryos takes place on day two to three post retrieval. The embryos are examined under the microscope and carefully aspirated to a thin transfer catheter. The loaded catheter introduced into the uterus through the cervix where the embryos are placed. This procedure takes a few minutes and does not require anesthesia. The physician administers a mild sedative to provide complete relaxation of the cervix and prevent cramping. The maximum number of embryos to be transferred at one time are 3.

After the transfer, the patient rests for two hours prior to discharge.. Twelve days after the embryo transfer, a serum base pregnancy test is taken. During this period, patients are advised to perform light activity and remain in contact with the Center. If pregnancy does not occur,our team reviews the IVF cycle and make specific recommendations for follow-up. The patient will speak with the clinical staff to review and if necessary, to discuss other options.

CRYOPRESERVATION

Ovarian stimulation and egg collection in ICSI (intracytoplasmic sperm injection) and IVF are exactly the same. However, in an ICSI cycle each suitable mature egg is injected with a single prepared sperm cell. This is obtained from the partner or from a donor sperm sample.

ICSI was developed to treat cases of male infertility in which too few (or only poor quality) sperms were available in the ejaculate for in vitro fertilisation.

Embryos of sufficient quality that are not transferred can be cryopreserved. The embryologist will select embryos that are suitable for freezing. Embryos that are ideal for freezing have blastomeres of equal size and display minimal or no fragmentation.

A Word of Caution: There is approximately a 68% chance of survival following the cryopreserved embryos. The quality of embryos undergoing cryopreservation is a major determinant of survival. Depending stage of embryo development, frozen embryos are thawed for 2 days before the transfer. The patient is informed of survival of the thawed embryos and posted for a frozen thawed embryo transfer (FET).

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