IVF: An Introduction
The increasing demand for infertility treatment leads to the need for better understanding of IVF (In Vitro Fertilization).
It is coined as a process of fertilization where an egg is blended with sperm outside the human body. The procedure constitutes the removal of an ovum from the woman’s ovaries and allowing the sperm to fertilize with it in a liquid medium. The embryo is cultured for a span of 2 to 6 days, which is transferred to the woman’s uterus, with the objective of establishing a successful pregnancy.
IVF is classified as a technology for reproduction for infertility treatment, in which a fertilized egg is transferred into a women’s uterus The availability of IVF treatment is giving rise to fertility tourism. Restrictions on the availability of IVF include IVF cost and age to carry a healthy pregnancy to term. IVF treatment helps many couples to get pregnant without any fertility treatments. It was calculated recently that five million children had been born worldwide using IVF and other assisted reproduction techniques.
If we talk about IVF success rates, the percentage of all IVF procedures result in a favorable outcome. Depending on the type of calculation used, this outcome may include the number of confirmed pregnancies, called the pregnancy rate, or the number of live births, called the live birth rate. The various factors on which success rate can be achieved are maternal age, a cause of infertility, embryo status, reproductive history, and lifestyle factors.
A young patient of IVF is more likely to get pregnant. Women older than 41 are more likely to get pregnant with a donor egg.
The who were pregnant earlier are successful with IVF technology in comparison to those who are never pregnant
Women who have been previously pregnant are in many cases more successful with IVF treatments than those who have never been pregnant. The advancement in reproductive technology has to lead to higher IVF success rates in comparison to what it was a few years ago. However, in the least cases, IVF does not possess a 100% conception rate which leads to patient’s heartbreaks. In spite of the fact that how much patients are explained, it is quite challenging to guide most of these patients at times since they are psychologically quite disappointed, and if their head recognizes that they have been provided with high-quality health care, their heart even now aches. Usually, they do not learn how to cope with these feelings.
Method for IVF
The process of IVF can be performed by content collection from fallopian tubes of a woman post natural ovulation, combining it with sperm, and inserting the fertilized egg again into the uterus. But, without additional techniques, the frequency or chances of pregnancy would be very small. The other procedure that is commonly used in IVF includes ovarian hyperstimulation for generation of multiple eggs post which the ova and sperm are prepared, as well as culture and selection of resultant embryos before embryo transfer into a uterus.
This is coined as a stimulation to develop multiple follicles of the ovaries. It is expected to start with the prediction by e.g. age, antral follicle count and level of anti-Mullerian hormone.
The resulting prediction of e.g. poor or hyper-response to ovarian hyperstimulation determines the rule and dosage for ovarian hyperstimulation.
There are some other methods termed as natural cycle IVF
The drugs are not used in IVF for ovarian hyperstimulation, but drugs for ovulation suppression may be used.
This technique can be utilized when women want to avoid taking ovarian stimulating drugs causing side-effects. The calculation of live-birth by HFEA is 1.3% per IVF cycle approximately if hyperstimulation drugs are not used in women aged between 40–42.
Another procedure, called Mild IVF, where a light dose of ovarian stimulating drugs is used for a small duration during a woman’s natural cycle with an objective to produce 2–7 eggs for healthy embryo creation. This method is advanced in the field to reduce complications and side-effects for women and it is aiming for quality and not a quantity of eggs.
Final maturation induction
This is the step when ovarian follicles reach some considerable development due to an induction of final oocyte maturation. It is achieved by injecting human chorionic gonadotropin (hCG). This is also called “trigger shot.” The confirmation of the risk of ovarian hyperstimulation syndrome is done by HCG injection.
This is a phase where an egg is collected from the patient by application of transvaginal technique coined as transvaginal oocyte retrieval, which involves ultrasound-guided needle piercing the vaginal wall to reach the ovaries. The follicles can be aspirated through this needle, and the follicular fluid is passed to an embryologist for identification of ova. The removal of egg between ten and thirty eggs is common which normally completes within 20 and 40 minutes depending upon mature follicles count, commonly done under normal anesthesia.
Egg and sperm preparation
The eggs are stripped of surrounding cells and prepared for fertilization in the laboratory. The selection of an oocyte can be performed before fertilization for selection of eggs with considerable chances of successful pregnancy. The semen is prepared within this duration for fertilization by removal of inactive cells and seminal fluid. This is termed as sperm washing. The semen available from sperm donor is usually prepared for treatment before it is frozen and ready for use.
The eggs are removed while gamete intrafallopian transfer from the woman and placed in one of the fallopian tubes, along with the sperm. This permits fertilization to take place inside the woman’s body. Conclusively, this variation is actually an in vivo fertilization, not in vitro.
The phase where embryo culture is performed is until the cleavage stage after which is a day or two after co-incubation or the blastocyst stage i.e. day five or six after co-incubation. Embryo culture not only confers a significant increase in live birth rate per embryo transfer but also confers a decreased number of embryos available for transfer and embryo cryopreservation, so the rates of clinical pregnancy are increased with cleavage stage transfer. Transfer day two instead of day three after fertilization has no differences in live birth rate. There are significantly higher odds of preterm birth (odds ratio 1.3) and congenital anomalies (odds ratio 1.3)
Scaling methods have been developed in laboratories for judgment of oocyte and embryo quality. To stabilize the rate of pregnancy, there is important evidence which is a morphological scoring system, the best way to select embryos.
The transfer of embryo depends on the number available, the age of the woman and other health and diagnostic conditions. A maximum of two embryos is transferred in countries such as Canada, the UK, Australia, and New Zealand, except for unusual reasons. HFEA regulations, in the UK, states that a woman over 40 may have up to three embryos transferred, however in USA, legal barrier is not a limit on the number of embryos which can be transferred. There are many clinics and country with regulatory departments who work for minimizing the risk of multiple pregnancies.
Men and IVF
Men consider themselves as ‘passive’ contributors as per the research data as they have ‘less physical involvement in IVF technology. Also, men feel distressed after knowing the number of hormonal injections and physical intervention on their partner. There are many cases where men have shared that they reported having been teased after opting for IVF and requires support and friendship. Some of them feel socially isolated. Men have shown less degradation in mental health in comparison to women after encountering a failed treatment.
Availability and utilization
IVF is out of availability for many developing countries because of its cost, however, Genk Institute for Fertility Technology, in Belgium on basis of their research claimed for finding a lower cost methodology leading to 90% reduction with similar deliverability.
The spread of communicable disease
By spermatozoon laundry, the chance that a chronic sickness within the male providing the spermatozoon would infect the feminine or offspring is delivered to negligible levels.
In males with serum hepatitis, the observation of Committee of the Yankee Society for fruitful medication advises that spermatozoon laundry isn’t necessary for IVF to forestall transmission unless the feminine partner has not been effectively insusceptible. The chance of vertical transmission in females with serum hepatitis throughout IVF is not different from the chance as in spontaneous conception.
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