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.
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.
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.
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.
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.
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.
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.
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).