In 1978, PC Steptoe and RG Edwards successfully ‘created’ human embryo out side the body after fertilizing female gamete - the oocyte using male gamete- the sperm in a test tube. Though the patient underwent this treatment had blocked fallopian tubes, subsequently clinicians found that many other indications can be effectively treated by this innovative treatment modality.
Over the past 30 years, In Vitro Fertilization has seen many changes that include continuous refinement techniques, development of patient selection criteria, and patient preparation.
The IVF Program
Many couples willing to have their own child are still unable to become pregnant after first line therapy such as ovulation induction, intrauterine insemination, or reproductive surgery. For these couples, the next logical step is to explore the Assisted Reproductive Technologies (ART) like In Vitro Fertilization (IVF) popularly known as Test Tube Baby.
IVF is a technological process where several eggs are retrieved from a woman's ovaries and then fertilized by the husband's sperm outside the body in a controlled environment of the laboratory. The fertilized eggs then develop into embryos and these are returned to the woman's uterus, by a procedure called embryo transfer.
Indications for ART
- Both Fallopian tubes are absent, blocked or hopelessly diseased.
- The husband has a reduced sperm count(Oligozoospermia)
- Sperms antibodies in wife's and /or husband's serum.
- Endometriosis i.e. the presence of endrometrium (lining of womb) outside the uterus.
- Unexplained Infertility(refer to couples in whome no obvious pathology is found but who can not conceive.
- IVF also helps women who have absent ovaries or where there are no eggs in the ovaries provided any young member of the family with proven fertility is willing to donate her oocytes.
We – at Fertility Clinic- have a dedicated team with more than 25 years of experience in he field of infertility and ART. We encourage you to learn as much as you can about the IVF program at our centre. This section of the Web site offers an overview of medications, procedures, success rates and financial issues related to IVF. You will also have the opportunity to tour our state-of-the-art medical facilities, post your querries you may have related to infertility.
IVF Medications
It is necessary to take certain medications during the IVF cycle in order to prepare the body for the treatment. The instructions for each medication vary from patient to patient. The medical team at fertility clinic will analyze your case closely to determine which medications to use, what dosage to take, when to administer the medications and how long to take them.
The Preliminary Investigations are:-
For Wife:-
1) Hysteroscopy & measurement of uterocervical length.
2) Ultrasound Examination of uterus and ovaries. To exclude uterine pathology and cyst in ovaries.
3) Hormonal Profile (TSH, Prolactin, FSH & LH on 3rd day of the period).
4) CBC, ESR, Blood VDRL, Blood Sugar PP, Blood group Rh factor, Australia Antigen/HIV /HCV antibodies Bleeding Time & Clotting Time, X-Ray chest & Chlamydia antibodies
For Husband:-
1) Semen analysis.
2) Semen culture and antibiotic sensitivity test.
3) Antisperm Antibody test for husband and wife.
4) Sperm Survival test and semen harvesting.
5) Blood for Australia Antigen, HIV Antibodies, HCV Antibodies.
N.B.:- (1), (2) & (4) are valid for 3 months only.
IVF Programme Step by Step
Initial Consultation
The couple should bring along their records of infertility workup that they possess, such as hysterosalpingogram films, semen analysis report, basal body temperature chart, previous laproscopy test results. The IVF team physician will counsel the couple about the program and some further investigations may be necessary to establish the chances of success. The woman may have to be scheduled for a screening laproscopy, hysteroscopy, and ultrasonography, if needed to assess the pelvic anatomy and accessibility of the ovaries for egg retrieval.
1) Hormonal Stimulation :
The woman is taken into the program from her previous cycle. Medication is given to the patient during the early phase of her next cycle to increase the likelihood of developing more than one egg.
2) Monitoring the maturity of the Eggs :
Blood tests are drawn frequently from the onset of stimulation to determine the progress of stimulated ovaries.
Serial Ultrasound examinations are conducted several times to visualize the developing follicles. The size of the follicles and result of the blood testes will determine the time of egg collection.
3) Egg Collection :
Eggs are retrieved transvaginally by needle aspiration guided by ultrasonic imaging. This requires local / general anaesthesia. The eggs thus obtained are immediately placed in a cultured dish that contains a special nourishing fluid. The patient can leave the IVF centre soon after egg retrieval.
4) Semen Specimen Collection :
Semen sample is collected preferably by masturbation in the morning of collection of the eggs. There is a facility of freeing the semen sample before the day of egg collection if required. The sperm cells are separated from the seminal fluid, mixed with the eggs and then are placed in incubator unit till such time, as the eggs are ready to be fertilized.
5) Fertilization and Cleavage
Fertilization is the process of sperm penetrating the egg. The egg being fertilized is now called an embryo. These are observed further to be certain that they are dividing (cleaving) normally.
6) Embryo Transfer
Embryo transfer is done between day 2 to day 5 depending upon number and quality of embryos available
The embryos are placed into uterus using thin tube (catheter) through the mouth of the womb (Cervix). The procedure is done on outpatient basis. The patient leaves IVF centre soon after transfer procedure. When indicated, blastocyst stage transfer is offered. Generally 2 to 3 embryos are transferred and spare embryos, if any, are cryopreserved for future use with patient’s consent.
7) Luteal support:
In order to improve implantation of embryo in uterus, pure progesterone is given as luteal support in the form of.vaginal pessaries, or gel or injectables.
8) Blood Tests:
Blood test for beta HCG titre is performed to confirm pregnancy approximately 12 days following embryo transfer.
9) Causes for cancellation in a treatment cycle prior to ovum pick up:
The aim of incentive monitoring program is to obtain a good number of healthy mature eggs at sonography. Thus if the cycle is unsatisfactory, it may be cancelled at any stage. The reasons for this are :
- Too few follicles are developing which would decrease the chance of obtaining at least one mature egg.
- There are no follicles developing at all. This is rare but may occur.
- The blood Oestrogen levels are too low for development of healthy eggs or according to the patterns seen over the last 18 months, unlikely to lead to pregnancy.
- The follicles may have ovulated prior to sonography. Occasionally some women ovulate earlier than the expected or ovulate without our being able to detect the time when the ovulation commenced. Thus it is impossible to accurately predict when ovum pick up should be performed.
- Sometimes ovarian cysts develop in response to the drugs. These are not serious or harmful. They usually resolve within one month or may require to be aspirated before starting the stimulation.
- Sometimes the patient gets hyperstimulated and it is dangerous to continue the stimulation.
Assisted Laboratory Procedures
When beginning an IVF cycle, the ultimate goal of our team is to enable the patient to take home a healthy baby while minimizing the risk of multiples. New advances in laboratory techniques have made it possible to achieve this. Assisted reproductive technologies also include Intracytoplasmic sperm injection, Blastocyst culture, assisted hatching and cryopreservation.
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Intracytoplasmic sperm injection-This is a well established technique that enables an embryologist to manipulate both male and female gametes out side the body to maximize the probability of fertilization. This technique was initially developed for sever male factor indication where, it was not possible for the sperms to reach the egg on their own. Later on, this innovative procedure was also found to be effective in other indications like unexplained infertility, patients having Immunological factor, repeated failed IVF etc. Here, a morphologically normal sperm is selected and is injected into the centre of an egg. Whole procedure is closely monitored under inverted microscope at the magnification of about 400X. 
Preservation of sperm and embryos has its own significance in IVF. In some situations semen freezing becomes absolute necessity. e.g. male partner is not available at the time of Ovum Pick up or female partner is coming from out of country, in those males where sperm count is very low or males having ejaculatory dysfunction or those undergoing chemotherapy in near future etc. in such cases their semen can be effectively frozen and used for IVF.
