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IVF
 

In Vitro Fertilisation

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Overview


In Vitro Fertilization Introduction


Infertility is the inability of a couple to become pregnant (regardless of cause) after 1 year of unprotected sexual intercourse -using no birth control methods.

Infertility affects about 6.1 million people in the United States, about 10% of men and women of reproductive age. New and advanced technologies to help a woman become pregnant include in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and other similar procedures.

IVF was used successfully for the first time in the United States in 1981. More than 250,000 babies have been born since then as a result of using the in vitro fertilization technique. IVF offers infertile couples a chance to have a child who is biologically related to them.

With IVF, a method of assisted reproduction, a man's sperm and the woman's egg are combined in a laboratory dish, where fertilization occurs. The resulting embryo is then transferred to the woman's uterus (womb) to implant and develop naturally. Usually, 2-4 embryos are placed in the woman's uterus at one time. Each attempt is called a cycle. The term test tube baby is often used to refer to children conceived with this technique. The first so-called test tube baby, Louise Brown, reached age 25 years in 2003. She was born in England.

Less than 5% of infertile couples actually use IVF. IVF is usually the treatment of choice for a woman with blocked, severely damaged, or no fallopian tubes. IVF is also used to overcome infertility caused by endometriosis or problems with the man's sperm (such as low sperm count). Couples who simply can't conceive and have tried other infertility methods that have not worked for them can also try IVF

Factors to Consider : -


  • Age: Women younger than 35 years who do not have problems with their partners' sperm may try IVF.
  • Multiple births: Generally, in women who use IVF to establish a live birth, about 63% are single babies, 32% are twins, and 5% are triplets or more.
  • Cost: One cycle of IVF costs an average of $12,400.
  • Reduced surgery: If a woman has IVF, she may not have to undergo surgery on her fallopian tubes. It is estimated that the IVF technique has reduced such surgeries by half.
  • Safety: Studies suggest that in vitro fertilization is safe. A recent study covered nearly 1,000 children conceived through these methods in 5 European countries and found that the children, monitored from birth to age 5 years, were as healthy as children conceived naturally. However, other studies have found a slightly increased risk of genetic disorders in children conceived through assisted reproductive technologies.


Technique

With in vitro fertilization, eggs are surgically aspirated from the woman's ovary under ultrasound guidance and mixed with sperm outside the body in a laboratory dish. After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (now called embryos) are then placed in the women's uterus, thus bypassing the fallopian tubes where this process normally occurs. IVF is now recognized worldwide as an established treatment for infertility.

This is how the procedure takes place : -


  • The woman may be given certain drugs (hormones) to stimulate her ovaries to produce several eggs before the procedure to remove them.
  • A surgeon then inserts a needle through the vagina into the woman's ovary to remove eggs. This procedure used to be done with laparoscopic surgery, but the needle technique is much less invasive and much easier. General anesthesia is not required for this part of the procedure, but the woman may be given some sedating medication.
  • The fluid removed is examined in the laboratory to make sure eggs are present.
  • At the same time, the man provides a semen sample. He is asked not to have sexual intercourse for a few days before the eggs are retrieved from the woman and before he produces a semen sample (usually by masturbation). The sperm are separated from the semen in a laboratory procedure.
  • The active sperm are combined in the laboratory dish with the eggs. This may be referred to as in vitro fertilization.
  • About 18 hours after this fertilization procedure, it is possible to determine if the egg or eggs have been fertilized and have begun to grow as embryos. They are incubated and observed over the next 2-3 days or longer.
  • The doctor then transfers the embryos into the woman's uterus through the cervix with a catheter (a long slender tube). The woman should then remain in a resting position for the next hour or so.
  • She is given certain hormones for the next 2 weeks. If implantation works (the egg or eggs attach to the uterine wall and grow), the pregnancy test result is positive.

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Other assisted reproduction techniques

The following procedures have been used as alternatives to IVF but are not discussed in detail here : -


  • Gamete intrafallopian transfer (GIFT): - GIFT is similar to IVF. It is used when a woman has at least one normal Fallopian tube. Eggs are placed in this tube along with a man's sperm to fertilize there.


  • Zygote intrafallopian transfer (ZIFT) : - ZIFT is tubal embryo transfer in which a woman's eggs are taken from her ovaries, fertilized in the laboratory, and put back in the fallopian tubes rather than the uterus.


  • Assisted fertilization techniques when not enough sperm are available or sperm quality is not sufficient to fertilize include the following : -
    • Partial zona dissection
    • Subzonal sperm injection
    • Intracytoplasmic sperm injection
  • Embryo cryopreservation (frozen fertilized egg and sperm)


Success Rate

Techniques for assessing the viability of an embryo when genetic issues are present are cell biopsy and evaluation and pronuclear biopsy and evaluation. The pregnancy rate by age is similar to that of normally conceived pregnancies: 37% among women younger than 35 years and 28% for those aged 36-39 years. The success rate is about 13% in those older than 40 years. Pregnancy in women older than 44 years is rare.

The rate of miscarriages with IVF pregnancies is the same as that with normally conceived pregnancies. Ectopic pregnancy occurs in about 3-5% of cases. An ectopic pregnancy is a serious condition that requires emergency medical care. The embryo is growing outside the uterus and does not survive.


Egg and sperm donors

Donors may contribute the egg or the sperm (or even a frozen embryo) to an IVF program when a partner is not able to produce the egg or sperm.

  • Egg donation : - Sometimes eggs are used from another woman if the recipient has impaired ovaries or has a genetic disease that could be passed on to her baby. The egg donor may be anonymous or known (such as a younger relative for an older woman or a designated donor).

    Ideally, the donor should be aged 21-30 years. The donor's eggs are removed the same way they are with IVF. The recipient takes increasing doses of estrogen to synchronize her hormone levels in preparation for the embryo transfer. Both the donor and recipient should talk with a counselor about the psychological aspects of this procedure. Everyone signs a consent form to cover the legal issues of such a donation.

    Success rates for this type of donation are higher than the rates with conventional IVF. The rate of multiple pregnancy is high, so doctors try to transfer only 2 embryos at one time.


  • Sperm donation : - This can be routinely done for women whose male partners have impaired sperm or low sperm counts. Donation may be anonymous from a sperm bank. In some cases, a male partner may "bank" sperm if he anticipates problems with chemotherapy or other medical conditions that may affect his sperm later in life.


  • Embryo donation : - Receiving a donor embryo (usually from a frozen embryo created in the laboratory from another couple) is the earliest form of adoption. The donor couple must sign an advance directive regarding embryo ownership and disposition. Those directives should include statements regarding (1) embryo donation to another couple, (2) donation of the embryos for research, or (3) disposition of the embryos after thawing.




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