April 8, 2020
Author Name: Dr. Navjot Kaur Mentor Name: Dr. Gaurav Satyadeo Sharma on April 08, 2020
Let’s begin with some history. It has been more than 40 years since Louis Brown’s first test-tube baby was born in 1978. The mother of this baby had a condition in which both the fallopian tubes were blocked which made it it impossible to conceive naturally, so IVF came to the rescue. Since then, IVF techniques have undergone tremendous advancements which has made it more accessible, acceptable and effective since the early days.
Let’s start with basics first. What is IVF? Also known as test tube baby, IVF is a process during which more than one follicle is stimulated to maturity using hormonal injections. This process is also known as controlled ovarian stimulation. Once these follicles are mature, the eggs from them are harvested and fertilised by the sperm in embriology lab. This leads to formation of embrios which are later transferred into the uterine cavity at the appropriate time of menstrual cycle.
Later on a new technique for IVF was invented called as ICSI (Intracytoplasmic Sperm Injection) which involves directly injecting a mature egg with a healthy sperm.This technique is very useful in cases of severe deficiency of sperm (total sperm count < 1 million) or when few sperms are retrieved directly from epididymis or testes of the male partner or in cases of IVF done with cryopreserved oocytes.
Well to begin with, let us understand that couples who are not able to conceive by the natural way go through tremendous mental distress for the want of a baby. For such couples IVF is like a boon. There can be various reasons for inability to conceive naturally. I am enlisting a few here.
Endometriosis causes infertility by distorting tubal relations with the ovary, interfering with egg development, or impairing implantation of the embryo inside uterus lining. Chronic anovulation is a common cause of infertility. Most of such patients have an irregular menstrual cycle. Approximately 60-70% of such females have PCOS. In this group of females with long-standing infertility, IVF is a feasible therapeutic option.
Unexplained infertility is a term used when no detectable cause is attributed to the reason for infertility. The incidence is 10-30% among infertile couples. This is frustrating for the couple to be unable to get a reason for their inability to conceive. IVF technique eliminates the unknown factors of infertility and helps them conceive.
Congenital anomalies of uterus: Some females have anatomical defects in their uterus like septate uterus or unicornuate uetrus. These pateints undergo corrective surgeries followed by IVF. Thus IVF can help such patinets who were born with defects and couldn’t conceive naturally.
Women with advanced maternal age (greater than or equal to 35 years) and with male partners with severe deficiency of sperm count face a different type of problem. These couples have a high risk of delivering a congenitally abnormal baby. But with IVF these couples stand a good chance of having a successful pregnancy and healthy baby by a technique of Preimplantation Genetic Screening (PGS). PGS screens each embryo by taking its biopsy. Only genetically healthy embryos are transferred in the uterus leading to more chances of successful pregnancy and live birth.
IVF has emerged as a tool for fertility preservation in females with cancer who have to undergo chemotherapy and radiation therapy. As both these therapies are toxic to eggs in the ovaries, she can go for oocyte preservation or embryo freezing (with her male partner). Fertility preservation is also useful for females with premature ovarian failure and aging females. In today’s world when women are very ambitious and do not want to hamper their career by bearing a child in young age can also opt for oocyte freezing and then conceive later in life by IVF.
Donor eggs and sperms: IVF has proved to be a boon for females who have premature ovarian failure. These women do not have enough eggs to conceive. Some women who have attained manopause but still still desire for a baby. Such women can opt for donor eggs from another female and conceive a baby. Men who have azzospermia either due to congenital defects or some infection can opt for donor sperms. A few decades ago such couple would have spent their lives as a childless couple. But with the advent of IVF, child bearing has become a distinct possibility for such couples.
Surrogacy: some women are unlucky that they do not have a normal uterus or even an absent uterus They can fulfill their dream of motherhood by implantation of their embryo in the healthy uterus of some other female (Gestational surrogacy). Females with severe uterine abnormalities like multiple fibroids or adhesions in the uterine cavity or who have undergone a hysterectomy due to some reason can also benefit from Gestational surrogacy.
So coming back to the question, how effective is IVF?
I think by reading above applications of IVF treatment one can comprehensively assume that IVF has come up as most effective form of technique which has helped millions of women all over the world to embrace motherhood despite various medical conditions and congenital disorders. IVF has helped those women whowant to plan their motherhood later in life without compromising their careers. For those women going through oncology treatment there is nothing as beneficial as an IVF through oocyte cryopreservation. And for women who have attained menopause or ovarian failure, IVF is the only way to conceive through a donor egg. All in all, IVF is without doubt the most effective tool for the couples who are not lucky enough to conceive naturally.
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