Satjot Hospital

In Vitro Fertilization -Embryo Transfer(Test Tube Baby)

IVF treatment has assumed a prominent role in the management of infertile couples.
Since the birth of Louise Brown, world’s first ‘Test Tube Baby’ on 26th July 1978, Assisted Reproductive Technology(ART) has become frontier of infertility management. Nearly 20 million babies are already born the world over by various ARTtechniques. The IVF-ET procedure involves the extraction of oocytes, their fertilization in the lab and transfer of embryos at 4 to 8 celled stages into the uterus of the woman.

Louise Brown is the world's first 'test tube baby' born on July 25, 1978.

Kanupriya Agarwal, ‘Durga’ born on 3 October 1978

Indications

Tubal Problem

  • Blocked fallopian tubes
  • Absence of tubes due to surgery
  • Chronically infected tubes

Poor Semen Quality

  • < 5 million but > one million/mL.
  • Endometriosis the presence of endometrium (lining of the womb) outside the uterus
  • Poor responder to ovulation induction drugs.
  • Failed IUI for 4-5 repeated cycles.
  • Unexplained infertility.
  • Sperm antibodies in the wife's and/or husband's serum.
The success or failure of IVF-ET strongly depends upon the age of the female partner and indications for which the patient is taken for this procedure.
It is a multistep procedure and every step is closely monitored by ultrasound.
  • 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.
  • Hyperstimulation of Ovary : The ovaries are hyper stimulated to produce 10-12 mature oocytes by subjecting the patient to one of the many protocols available for induction of super ovulation

An IVF-ET Cycle

  • Maturation of Eggs : Finally, the hCG injection is given nearly 36 hours before the retrieval of oocytes to ensure the proper maturation of eggs.
  • Semen Preparation : The semen is washed off the cells, debris, bacteria, malformed sperm to optimize the concentration of motile sperm. Many such techniques are available to isolate motile sperm.
  • Extraction of Eggs : After 34-35 hours of hCG injection, the oocytes are taken out under the guidance of transvaginal sonography. This procedure is performed under general anesthesia. Nearly 80% eggs are retrieved.
  • Fertilization of Eggs : After retrieval, the oocytes are identified under a high powered microscope and placed in culture medium. Processed sperm is 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 generally fertilize. To ensure optimum success rates, choose the Best IVF Centre.

Fertilization

  • Embryo Transfer : At four to eight-celled stage which is generally attained after 48 hours, 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.

Cell Division of Fertilized Egg

  • Confirmation of Pregnancy : Fourteen days after embryo transfer, pregnancy test is carried out. If there is pregnancy, the progress of embryo development is monitored by regular check ups through ultrasound.

Pregnancy Test

  • Success Rate : It is 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 oocyte.
  • Failure of embryo to divide further.
  • The most serious reason for non-success of the procedure is the failure of 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. We, at our centre discuss the risks associated with multiple pregnancies in ART and the need to reduce the number of foetuses, in order to ensure the survival of viable foetuse/two foetuses(ART ACT permits maximum transfer of 3 embryos).
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