April 11, 2020
Author Name: Dr. Yasha Pandey || Mentor Name: Dr. Amol Wankhede on April 11, 2020
Infertility have increased worldwide in the last few decades due to urbanization, late marriages and changing lifestyle habits. Amongst the various Assisted Reproductive Technologies (ART) available today, In Vitro Fertilization (IVF), commonly known as “test-tube baby” is the treatment of choice in many cases. Not very long ago, IVF was an uncommon treatment for infertile patients, practiced by the select few. However, IVF has become a common procedure now-a-days.
Louise Brown is the first baby born in the world by IVF in England in 1978. This was milestone in the treatment of infertility. This pregnancy was achieved after many experiments and procedure, that were a way different than what we are using today. Several advances have been made in this field thereafter improving its outcome. This involves the administration of newer recombinant hormone preparations, safer techniques for oocyte retrieval, modified laboratory equipment and techniques to make better embryo and so on.
IVF procedure involves giving hormonal injections to the female to grow number of eggs in the ovary. Once the eggs are grown adequately, final trigger injection is given to mature the eggs. These eggs are taken out of the body by a simple procedure called ovum pick up. At the same time, semen is collected from the male partner, prepared and both are then combined by various techniques in IVF laboratory to form embryos. Once the embryos are formed, depending on the services available, quality of the embryos and condition of patient, clinician may decide to transfer the embryos in same cycle or to freeze those embryos.
Couples with infertility faces many psychosocial problems like feeling of incompleteness in life, depression and can lead to disturbed relationships. In country like India, infertility is looked upon as a social stigma and couple has to suffer blame from relatives and society. Taking IVF treatment is also very difficult for most of population due to cost issue, unavailability of experts and lack of good IVF centres. Also taking IVF treatment may be uncomfortable for some patients which involves regular injections, egg retrieval, embryo transfer and taking so many medications. In brief every couple undergoing this process wants to know about chances of success in their case.
Generally, the IVF success can be described as pregnancy rate per cycle, oocytes
(eggs) obtained or embryo formed. Better indicators of IVF success rate are cumulative pregnancy rate (percentage of all attempts that leads to pregnancy) and live birth rate (number of deliveries that resulted in a live born neonate).
The result of IVF depends on various factors which can be divided into patient related factor and IVF centre related factor.
Patient related factors for predicting success of IVF (Intrinsic factors):
IVF is the treatment option for the following types of infertility-
Poor Ovarian (egg) reserve
Tubal factor infertility
Infertility associated with uterine abnormalities
Cervical factor disorders
Decreased sperm counts
Multiple intrauterine insemination (IUI) failures
Unexplained infertility (no defined cause has been detected)
Age of woman at the time of undergoing IVF treatment is most important factor in deciding the success rate. With advancing age the capacity of ovary to develop good eggs decreases. Generally after 35 years of age, ovarian reserve starts declining and it significantly decreases after 40 years, thus affecting the outcome of IVF treatment. This decrease in ovarian reserve can also occur in younger women. Chances of occurrence of genetic problems in such embryos are higher in such cases for which Genetic study required. Alternatively, IVF with the help of donor eggs of younger woman can be done in these women.
If fallopian tubes are not healthy and are filled with water or pus, it adversely affect IVF outcome by preventing the embryo from implantation or by dislodging it from implantation site.
Endometrial thickness of 7 or 8 mm and above are associated with significantly good success rates. Also presence of polyp, fibroid in endometrium can prevent implantation of embryos. Uterine diseases such as Adenomyosis (swelling in uterus) or fibroids can affect the result of IVF.
Among the male factors, low sperm count and motility and abnormal morphology adversely affects the embryo formation and thus the IVF outcome.
Other factors which adversely affects the success rate are longer duration of infertility, high BMI of patient, poor response to drugs, other medical conditions of patients etc.
In IVF centre many factors which can decide outcome of IVF treatment are treating consultant, embryologist and facilities available at centre.
An expert consultant can improve IVF results with correct diagnosis and performing procedures meticulously. Good ultrasonography machines, blood testing facilities helps consultant to arrive at diagnosis and treating these conditions.
Embryo laboratory is the heart of IVF centre. Availability of advanced equipment’s for IVF/ICSI, strict temperature monitoring if IVF lab and incubators containing embryos along with necessary aseptic precautions, helps in producing good embryos.
Growing the embryos up to 5 or 6 days till formation of Blastocyst stage is known as the Blastocyst Culture. Blastocyst have better potential for implantation and the embryos with poor quality shows lacks adequate growth. Hence the good quality embryos can be selected for embryo transfer and has better chance for implantation.
Process known as Laser Assisted Hatching is done by which the outer shell of the embryo is made thinner with the help of laser so as to increase the chances of implantation (sticking of the embryo on the uterine lining).
IVF in recent times has become a comparatively common, easy, less time consuming, process bearing better affordability, having better success rate though the outcome of the procedure is influenced by variables parameters.
There are multiple factors which ultimately decides success but briefly younger patients with good ovarian potential, absence of uterine and fallopian tube pathologies, good semen quality and good IVF centre with advanced facilities can have better success rates.
Older age, decreased ovarian potential, poor semen quality, poor embryos and lack of advanced techniques can adversely affects the success in IVF treatment.
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