In-Vitro Fertilization

A detailed explanation about the protocol behind the use of IVF
Test tube babies

1. In-Vitro Fertilization Presented By, Sonia John II M.Sc.Zoology

2. INTRODUCTION Assisted reproductive technology(ART)- Manipulation of reproduction in humans and animals Used primarily in infertility treatments ,hence ART a.k.a FERTILITY TREATMENT Includes: IVF ZIFT,GIFT IUI,ICSI etc

3. In-Vitro Fertlization (IVF) Process by which egg is fertilized outside the body in-vitro Fertilization of the oocytes in the laboratory conditions. This is in contrast with the natural fertilization,which occurs in the uterus Reasonably successful as it results in 70-80% of fertilized eggs Through IVF technology,a large number of offsprings can be produced from a single individual

4. When it is Done For infertility treatments: Female infertility caused due to problems n the fallopian tubes Male infertility caused due to low sperm quality

5. The first successful birth of a "test tube baby", Louise Brown, occurred in 1978. Robert G. Edwards , the physiologist who developed the treatment, was awarded the Nobel Prize in Physiology or Medicine Subhash Mukhopadhyay  ,was a physician from Kolkata, India, who created the world's second and India's first child using in-vitro fertilisation ,  Durga   Kamala Rathnam - South India’s 1 st test tube baby

6. With IVF, women who are past  menopause can still become pregnant.  Adriana Iliescu held the record as the oldest woman to give birth using IVF and donated egg, when she gave birth in 2004 at the age of 66.

7. PROTOCOL OF IVF Following are the stages involved in IVF Ovarian stimulation Egg retrieval Sperm collection Fertilization in the laboratory Embryo culture Embryo transfer

8. Ovarian Stimulation Both the male and female partner made to undergo fitness tests and check-ups Injectable medications are provided to the female partner daily for an average of 10 – 12 days to stimulate the woman’s ovaries to produce multiple eggs. The ovarian response to the medications are monitored with the help of ultrasound and blood work and medication dosing is adjusted accordingly.

9. 2.Egg Retrieval When the eggs are mature and ready, the woman undergoes an ultrasound guided egg retrieval procedure under light sedation. The eggs are retrieved from the patient using a transvaginal technique called  transvaginal oocyte retrieval involving an ultrasound-guided needle piercing the vaginal wall to reach the ovaries. Through this needle follicles can be aspirated, and the follicular fluid is passed to an embryologist to identify ova. Usually takes between 20 to 40 minutes;10-30 eggs retrieved

10. 3.Sperm Collection In the meantime, semen is prepared for fertilisation by removing inactive cells and seminal fluid in a process called  sperm washing . If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined, and it will be thawed ready for use.

11. 4.Co-incubation and Fertilization in the Laboratory After the eggs and sperm have been analyzed and prepared, the eggs are then inseminated. The sperm and the egg are incubated together in a culture media in order for the actual  fertilisation  to take place. The duration of this co-incubation should be about 1 to 4 hours to have higher pregnancy rates 

12. 5.Embryo Culture  After fertilization, the embryos are allowed to grow in special media for 3 – 5 days until they have reached optimal growth. The main durations of embryo culture are until cleavage stage (day two to four after co-incubation) or the  blastocyst  stage (day five or six after co-incubation).   Embryo culture until the blastocyst stage confers a significant increase in live birth rate per embryo transfer.

13. 6.Embryo Transfer Laboratories have developed grading methods to judge oocyte and embryo quality. 1-3 embryos are then transferred into the uterus 3-5 days after egg retrieval. Under ultrasound guidance, a thin long catheter containing the embryos is passed through the cervix into the uterus where the embryos are placed. After embryo transfer, 3-5 days of pelvic rest is recommended. A pregnancy test is scheduled 12 days later.

14. Risks Multiple pregnancy – up to 30%, mostly twins. Ovarian hyperstimulation syndrome (OHSS) – ovarian enlargement with multiple cysts in association Ovarian torsion –twisting of ovaries, may require surgery. Increased rate of abortion Premature delivery, low birth weight baby etc

15. References Rastogi.S.C . Biotechnology:Principles and Applications. Narosa Publishing House Satyanarayana.U.Biotechnology.Books and Allied (P)Ltd www.americanpregancy.com http://en.wikipedia.org/InVitroFertilization www.emedicinehealth.com www.webmd.com