Tell Tale of Test Tube Babies

Author Name: Dr. Sushma B.R. || Mentor Name: Dr. Sagarika Manish Aggarwal on April 13, 2020

“Nothing in life is to be feared its only to be understood”: Marie Curie
Let’s understand the science behind test tube babies and know what is IVF.

Test Tube baby is the colloquial term for babies born from IVF. IVF in Latin means ‘‘in glass”. The 1st test tube baby was born in 1978 at London and was named Louis Brown. “DURGA”, the first Indian IVF baby was born exactly 67 days after IVF baby in UK, created by Dr. Subhas Mukhopadhaya.

IVF Basically means egg fertilized by sperm outside the body. The process involves sequence of highly coordinated steps starting from controlled ovarian hyper stimulation with exogenous gonadotrophin followed by oocyte retrieval under guidance of USG, fertilization in lab and trans cervical transfer of embryo into uterus.

Thus, IVF aids an infertile couple to conceive their own biological child, yet donor programs surrogacy also play major role modern ART.

WHO REQUIRES IVF

• Tubal disease
• Endometriosis
• Ovulatory Dysfunction
• Fertility preservation in cancer patient
• Age related infertility
• Male factor infertility
• Unexplained infertility
• PGS/PGD;

Most recent advances in ART is related to PGD/PGS. In the couple who have serious genetic disorders, ART provides an opportunity to couples to have a healthy offspring.

Prerequisites before IVF

Any couple who is unable to conceive after one year of unprotected intercourse should be investigated.
Women with advanced age of 35 years’ valuation is mandatory after 6 months. Generally, includes below
• Ovarian reserve test
• Semen Analysis
• Infectious diseases screening
• USG to identify Polyps/myomas.

After the initial evaluation the following flow chart is followed

• Stimulation generally extend till 12 to 13 days.
• Patient might experience mild bloating or heaviness in abdomen during stimulation
• Sperm recovery can be done by various other methods like Testicular sperm extraction, testicular sperm aspiration, microsurgical epididymis sperm aspiration, percutaneous epididymis sperm aspiration, microsurgical testicular sperm extraction
• Sperms when extracted by above procedure fertilization by ICSI (single egg fertilized with single sperm) yields better outcome.

EMBRYO TRANSFER

In order to achieve successful pregnancy embryos, need to be transferred back into the uterus. Embryo transfer can be fresh or frozen.
• Fresh embryo transfers: Embryos formed are transferred in the same menstrual cycle of stimulation.
• Frozen embryo transfer: In this, embryos formed are cryopreserved and thawed just before transfer.
Vast majority of art clinics prefer frozen embryo transfer than fresh for various reasons.
Embryo transfer can be done at any stage of development. Procedures like blastocyst culture (day 5 embryo) and laser assisted hatching before embryo transfer have proven efficacious in yielding successful pregnancy.

UTERINE PREPARATION

• In a stimulated or a cycle where a “frozen” embryo is transferred, woman should first be given estrogen preparations (about 2 weeks), then a combination of estrogen and progesterone so that the lining becomes receptive for the embryo.

PROCEDURE: Embryos loaded in soft catheter are placed inside the uterus meticulously under ultrasound guidance.
Although, rest for 10 to 30 minutes is advocated there is no proven evidence that it improves the outcome. Lady can resume daily normal activities. Physical activities or diet have no role to play in the outcomes of IVF.

What is the success of IVF
Various factors influence the outcome of IVF like maternal age, endometriosis, quality of embryos, reasons of infertility other factors like obesity, use of alcohol.

RISK FACTORS IN IVF

MULTIPLE BIRTH: Since the procedure involves transfer of more than one embryo chances of multiple pregnancy is increased. Multiple pregnancy in turn leads to premature delivery and low birthweight babies

MISCARRIAGE: Rate of miscarriage in IVF is similar to natural conception but as maternal age increases and risk of miscarriage increases.

ECTOPIC PREGNANCY: Overall chances of having an ectopic pregnancy is 2%, but with history of previous ectopic or unhealthy tubes chances of ectopic pregnancy increases.

OVARIAN HYPERSTIMULATION SYNDROME (OHSS): This can result when a patient has polycystic ovaries and undergoing IVF Treatment. Patient can experience mild, moderate to severe OHSS. Mild to moderate OHSS usually subside on its own. Only severe OHSS requires hospitalization. OHSS subsides within 7 to 10 days of procedure. With the advent of new techniques like use of agonist trigger for final maturation of follicles, avoiding fresh embryo transfer and going for frozen embryo transfer have reduced the risk of OHSS in modern ART.

In a nutshell IVF holds a valuable position in the life infertile couples.