In-vitro Fertilization ( IVF/ Test tube baby)

What is IVF?

IVF is an acronym for In vitro fertilization ('in vitro' meaning 'in glass' hence also called test tube baby). Simply put IVF is adding the husband's sperm to his wife's eggs in the laboratory to produce embryos. In vitro fertilization is an option for many couples who cannot conceive through conventional therapies. These embryos are put back into the wife's uterus (womb) after 3 to 5 days of being in the incubator, hopefully they will then grow into a baby. The reasons IVF is done may include - poor sperm quality and/or quantity, obstructions between the egg and sperm, ovulation problems, and sperm-egg interaction problems. These problems can prevent couples having a baby naturally, and IVF helps to solve this.

Specific conditions that might require IVF include:Tubal blockage or failed tubal reversal ,Endometriosis ,Cervical factor ,Pelvic adhesions ,Male factor ,Unexplained infertility/ failed conventional therapy , Genetic testing (PGD) for inheritable diseases , Genetic testing (PGD) for possible reasons for multiple miscarriages.

Management of an IVF Treatment Cycle

In order to obtain the best results, we stimulate the development of multiple ovarian follicles using a combination of drugs tailored to each individual's requirements. The therapeutic regime is in two phases- The first is called 'down regulation', the second 'stimulation'.

Down regulation involves 'switching off the pituitary gland'. This means that the pituitary supply of hormones [FSH and LH] is switched off so that the ovarian production of endogenous hormones [which could interfere with follicle production] also get switched off. Down regulation may be achieved by drugs.

In the stimulation phase gonadotrophin drugs are given over a 10-12 day period, to stimulate the ovaries to produce several follicles. Ideally each ovary should produce 5-10 follicles giving a total of 10-20 follicles. The dose of gonadotrophin required varies widely, but is basically age dependent. Patients with polycystic ovaries are usually started off on a slightly lower dose.
The growth of the ovarian follicles and the development of the endometrium are monitored by serial ultrasound scanning. When the follicles are considered to be mature enough and the endometrium appropriately developed, arrangements will be made for the patient to receive an injection of Human chorionic gonadotrophin - hCG to cause further maturation of the eggs.The egg recovery will be planned some 36 hours after the hCG injection.

The Technique of Egg Collection

For the IVF procedure the eggs are routinely collected under anaesthesia. Eggs are recovered using ultrasound to guide needle aspiration of ovarian follicles through the vagina. Once all the eggs are recovered, the patient is taken to the recovery room. The patient will normally be fit enough to leave after 2/3 hours.The eggs will be taken to the laboratory and, they will be inseminated with a prepared sample of sperm. At 24 hours after recovery the eggs will be examined for signs of fertilisation, and at 48 hours the normally fertilised eggs will be examined for division (cleavage). If cleaved embryos have developed at this stage, then the embryo transfer can proceed.

After The Egg collection

IVF patients will be given pessaries of a hormone called progesterone to support the uterine lining.

The Embryo Transfer

This is normally carried out 48 hours after the egg collection. For this procedure a fine tube (catheter) is passed through the cervix and the embryos are injected high into the uterus in a minute amount of culture medium. This technique does not normally require sedation. A urine pregnancy test (BhCG) can be carried out 15 days following the embryo transfer.

The Success Rate of IVF

Success rates vary to a large degree depending on the different types of problem requiring treatment and the different factors that exist in individual patients. These are predominately:

• The age of the woman producing the eggs
• The number of eggs produced following drug induction
• The quality of the semen
• The number of embryos resulting
• The number of embryos transferred

Problems with IVF

IVF is generally a very safe treatment indeed. Do not be put off by what follows in this section!

• Minor symptoms such as hot flushes may occur due to the down regulating drugs.
• There is a very remote risk of internal haemorrhage from the egg collection.
• Any tendency to infection is prevented by the administration of an antibiotic at the time of the egg collection.
• Although the embryos are carefully placed into the uterine cavity they can very rarely migrate into the Fallopian tube and develop there leading to an ectopic pregnancy.
• One problem is that the ovaries may fail to respond to the gonadotrophins and follicles are not recruited or do not develop. This is more likely to happen in the older woman. We try so far as is possible to try and predict this by testing the ovary's ability to respond [the day 2-3 FSH test]. However sometimes the ovary simply does not respond and the treatment cycle has to be abandoned.
• Sometimes the opposite happens and there is an exaggerated response with many follicles developing. After embryo transfer the ovaries continue to grow and may reach a very large size. This is known as the ovarian hyperstimulation syndrome. Patients may have lower abdominal pain, abdominal bloating, nausea and vomiting and thirst. It occurs in less than 5% of treatment cycles. Very rarely patients need to be admitted to hospital for rehydration with intravenous fluids. The problem which is more common if you have conceived always settles with time.
• Lastly there is a risk of multiple pregnancy. The chance of multiple pregnancy depends on several factors other than maternal age, such as the cause of infertility, duration of infertility, number of eggs collected, number of embryos created and the use of frozen embryos.

Also Read:
Ovulation Induction
Intra-Utreine Insemination (IUI)
In-vitro Fertilization ( IVF/ Test tube baby)
Intra-cytoplasmic Sperm Aspiration ( ICSI)
Percutaneous Epididymal Sperm Aspiration (PESA) / Testicular Sperm Aspiration (TESA)
Egg Donation / Sperm Donation/ Embryo Donation
Frozen Embryo Transfer