In Vitro Fertilization -Embryo Transfer(Test Tube Baby)

Since the birth of Louise Brown, world's first 'Test Tube Baby' on 26th July 1978, Assisted Reproductive Technology has become frontier of infertility management. Millions of babies are already born the world over by various ART procedures. The IVF-ET procedure involves the extraction of oocytes, their fertilization in the laboratory or test Tube Baby center in Amritsar and transfer of embryos at 6 to 8 celled stages into the uterus of the woman.

Indications

Tubal Problem

1. Blocked fallopian tubes
2. Absence of tubes due to surgery
3. Chronically infected tubes

Poor Semen Quality,

< 5 million but > one million/mL.

1. Endometriosisi.e. the presence of endometrium (lining of the womb) outside the uterus
2. 4. Poor responder to ovulation induction drugs.
3. 5.Failed IUI for 4-5 repeated cycles.
4. 6. Unexplained infertility.
5. 7. Sperm antibodies in the wife's and/or husband's

serum. The success or failure of IVF-ET strongly depends upon the indications for which the patient is taken for this procedure.
Procedure It is a multistep procedure and every step is closely monitored by ultrasound.
i) Down Regulation The natural production of egg in the patient’s ovary is checked by suppressing the release of hormones with drugs or nasal spray. This establishes the baseline from where to start the ovarian stimulation.
ii) Hyperstimulation of Ovary The ovaries are hyper stimulated to produce 10-15 mature oocytes by subjecting the patient to one of the many protocols available for induction of super ovulation iii) Maturation of Eggs Finally, the HCG injection is given nearly 36 hour to ensure the proper maturation of eggs.

1. iv) Semen Preparation

The semen is washed off the cells, debris, bacteria, malformed sperms, which optimizes the concentration of motile sperm. Many such techniques are available to isolate motile sperm.

1. v) Extraction of Eggs

After 34-35 hours of HCG injection, the oocytes are taken out under the guidance of transviginal sonography. This procedure is performed under general anesthesia. Nearly 80% eggs are retrieved.

1. vi) Fertilization of Eggs

After retrieval, the oocytes are identified under a high powered microscope and placed in a culture medium. Processed sperm are added to the culture 4-6 hours after retrieval. There should be approximately 50,000 sperm/oocyte. After a day of insemination, careful observations are made for embryo formation. 60% - 80% of the mature oocytes will fertilize. To ensure success rates, choose the Best IVF Treatment Centre in India. vii) Embryo Transfer At four to eight-celled stage which is generally attained after 48 hrs, two or three embryos are transferred to the uterus of the woman through vaginal route. Although the transfer of more than one embryo poses a potential risk of multiple pregnancies but the chances of pregnancy are enhanced. The actual numbers of embryos to be transferred are decided according to the age and medical condition of the woman. viii) Confirmation of Pregnancy Fourteen days after embryo transfer, a pregnancy test is carried out. If there is pregnancy, the progress of embryo development is monitored by regular check ups through ultrasound. IVF treatment in Amritsar, Punjab success rate is nearly 30-40% all over the world. The overall carry home baby rate is 25-30% per cycle. Reasons for IVF-ET Failure

• The ovaries do not respond to ovulation stimulating drugs.
• Failure of sperm to fertilize the oocyte.
• Failure of embryo to divide further.
• The most serious reason for non-success of the procedure is the failure of the embryo to implant.

Risks in IVF

• The stimulated cycle is very carefully monitored. However, in any cycle there is a small risk of hyper stimulation which may result in enlargement of the ovaries (ovarian hyper stimulation syndrome-OHSS). Conservative treatment usually results in total resolution of the cysts.
• Chance of multiple pregnancies is 30%. One should be prepared to accept twins and triplets. However, triplets are rare. There can be a need to reduce the number of viable foetuses in order to ensure the survival of at the most two foetuses.

Pregnancies following IVF-ET have slightly higher miscarriage rate than natural pregnancy.