In Vitro Fertilisation
What is In Vitro fertilisation?
In Vitro fertilisation is the technique of fertilising eggs outside the body. It is commonly attempted in cases of infertility. In this technique, the eggs from a woman are taken through a needle and incubated with sperms from her partner or a donor. This results in fertilisation and the fertilised egg is transferred back to the uterus to grow.
What are the necessary requirements for IVF?
IVF requires three basic necessities, a healthy egg, a healthy sperm and healthy uterus which can carry the pregnancy. This question is necessary because it is not necessary to have all three to produce a bay. Let’s for example consider women who are unable to produce eggs, but has a functional uterus. In this case egg donation is a reasonable option. Similarly if sperms of the male partner are defective then donor sperms can also be used. This is called surrogacy. There is another form of surrogacy; many women have problems with their uterus which prevents them from carrying a pregnancy. The embryos produced by fertilisation of their eggs with their partner’s sperms can be transferred to another woman who has functioning uterus.
Can you describe the process?
You will first be given a course of hormonal drugs to boost your ovaries to produce more follicles (follicles contain eggs). These hormones are mostly FSH analogues and they stimulate the ovaries to produce between 50-60 such follicles. The growth of these follicles will be monitored closely by testing for hormones and serial ultrasound scans. On around the 10th day a shot of inject able HCG is given which causes these follicles to mature further. These follicles are then aspirated by a needle passed through the vagina and around 30 of these follicles will be aspirated at one time. It will take about 20 min to complete this procedure and during this time women will either be under sedation or general anaesthesia.
Once these follicles are aspirated, they are sent to the lab where they will be processed. The eggs are cleaned of their surrounding cells and the best eggs for fertilisation are selected. They then mixed with washed sperms (sperms that are removed of all inactive cells and seminal fluid) in a petridish and incubated at 37 degree Celsius for 18 hours. During this time the fertilised egg will have two pronuclei.
In cases where the sperm has difficulty penetrating the ovum, it can be directly injected in to the egg by a process called Intra-cytoplasmic Sperm Injection.
Once the eggs are fertilised they are transferred to a culture chamber where they grow for the next 3-5 days before being implanted in the female. These embryos may be cultured in artificial culture media or endometrial coculture. In endometrial coculture the embryo is cultured on cells from women’s own endometrium.
At any time 3-5 embryos are placed in the uterus for implantation depending upon many factors.
What is live birth rate?
Live birth rate is the number of pregnancies that end up with a viable child. So it includes abortions and miscarriages. Many a time the embryos implant into the uterus, but they are unable to attach properly to the lining of the uterus. This leads to a state of transient chemical pregnancy. Hence implantation should always be confirmed with ultrasound.
The live birth rate varies from centre to centre, country to country and varies between different individuals. IVF is more successful in younger women than those over 37 years of age.
In one series of studies the live birth rate was projected as 35.3% for those 21 and younger, with 37-year-olds at 27.4% and no live births for those older than 48. In another series some clinics in US have reported rates as high as 41 % in women younger than 35. Whether it is due to superior skill or turning away of difficult patients is not known.
What are the success or failure factors?
There are many factors that determine success. Amongst the factors that lead to failure include tobacco smoking, alcohol consumption, stress and obesity.
Does Acupuncture help with success rates?
In various studies acupuncture has been found to have beneficial effect on the rate of live births when used as an adjunct with embryo transfer. Acupuncture exerts its effects by the following postulated mechanisms. It is believed to modulate neuroendocrinal signals to a more favourable pregnancy out come. It also increases blood flow to uterus and ovaries and modulates cytokines. Apart from these actions, acupuncture also reduces stress, anxiety, and depression.
What are the complications?
The commonest complication of IVF is multiple births. This is due to the practice of inserting more embryos in the uterus to improve chances of pregnancy. Multiple births cause plenty of problems and there is a high risk of prematurity and maternal problems like hyperemesis, hypertension, excess amniotic fluid, diabetes of pregnancy and so on.
The stimulation of ovaries can lead to ovarian hyperstimulation syndrome.Are IVF babies more prone to birth defects?
Many studies have studied this and this has been one of the most controversial topics in IVF. Most studies have not found a direct co-relation between birth defects and IVF, but a recent analysis of long term birth defects data has suggested that birth defects of heart septum, cleft lip/palate, esophageal atresia and ano-rectal atresia are slightly more common in IVF babies. However, the study has not established any causality.
What is pre-implantation genetic diagnosis?
This is a advanced technique used in conjunction with IVF. In this procedure a few cells from the embryo are analysed for any chromosomal abnormalities or cytogenetic abnormalities. Only embryos found free from defects are introduced in to the uterus. By picking out the best embryos, it also enhances live birth rate and multiple pregnancy rate.
This technique is most appropriate for people who have been unsuccessful with prior IVF. It can also be used to screen for genetic disorders.
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