IN-VITRO FERTILIZATION (IVF)

In-Vitro Fertilization, as the name implies involves the creation of an embryo by fertilising an ovum and a sperm which is then cultured in conditions that mirror the uterine mileu. A technique pioneered by Patrick Steptoe and Robert Edwards in 1978, it started finding widespread use in a society reeling from the dire consequences of subfertility. The birth of Louise Brown proved to be the turning point in providing a ray of hope for subfertile couple.

In-vitro fertilisation involves two distinct procedures: Conventional IVF and IVF-ICSI. Conventional IVF involves incubating oocytes with the required number of motile spermatozoa while IVF-ICSI involves injecting a morphologically normal spermatozoa into an oocyte. The resultant embryo is then cultured under conditions reflective the normal uterine mileu until it is ready for transfer.

Step 1

Fertility medications are prescribed to control the ova maturation and to increase the chance of collecting multiple ova during menstrual cycle referred to as ovulation induction. Multiple ova are desired because some of ova will not develop or fertilize after retrieval and ovum development is monitored by using ultrasound as well as urine or blood test samples are examined to check hormone levels

Step 2

Follicular aspiration was done by retrieving ova are retrieved through a minor surgical procedure by using ultrasound imaging to guide a hollow needle through the pelvic cavity which removes ova from the ovaries.

Step 3

Sperm, usually obtained by ejaculation is prepared for getting the fusion with the ova.

Step 4

By insemination, the sperm and ova are placed in incubators located in the laboratory which enabled fertilization and in some cases, lower probability of fertilization was found, intracytoplasmic sperm injection (ICSI) may be done. The ova are monitored to confirm that fertilization and cell division are taking place and it was considered embryos after successful fertilization.

Step 5

The embryos are usually transferred into the woman’s uterus from one to six days later, but in most cases the transfer occurs between two to three days following egg retrieval. At this stage, the fertilized egg has developed into a two-to-four cell embryo. The transfer process involves a speculum which is inserted into the vagina to expose the cervix. A predetermined number of embryos are suspended in fluid and gently placed through a catheter into the womb. These steps are followed sequentially under regular monitoring followed by all required blood tests and potential ultrasounds to determine successful implantation as well as finally desired occurrence of pregnancy.