विवरण
In vitro fertilization (IVF) is a reproductive technology used to assist couples with infertility in conceiving a child. The process involves stimulating a woman's ovaries to produce multiple eggs, which are then retrieved and fertilized with sperm in a laboratory dish. After fertilization, the resulting embryos are cultured for a few days before being transferred to the woman's uterus. IVF may also involve techniques such as intracytoplasmic sperm injection (ICSI) or assisted hatching to increase the chances of successful fertilization and implantation. It offers hope to couples facing various infertility issues, including tubal factor infertility, male factor infertility, or unexplained infertility, providing them with the opportunity to build their families.
सारांश
- Infertility is defined as the inability to conceive after 12 months of regular intercourse without contraception. Global infertility prevalence was estimated at 17.5% lifetime and 12.6% period prevalence in 2022. ART (Assisted Reproductive Technology) has become the most recommended practice, with IVF (In Vitro Fertilization) evolving as a major treatment.
- IVF involves fertilizing an egg with sperm outside the body. IVF was started in 1965, and the first successful birth was on July 25, 1978. In October 1978, Subhash Mukherjee succeeded in performing IVF in India, but his work was not recognized internationally due to a lack of scientific evidence.
- IVF success depends on female age, previous treatment cycles, pregnancy history, and BMI. Lifestyle factors like smoking, alcohol, and caffeine consumption can also adversely affect success rates. Indications for IVF include ovulatory dysfunction, blocked fallopian tubes, unexplained infertility, endometriosis, PCOS, cancer, subnormal male factors, and genetic diseases.
- ICSI (intracytoplasmic sperm injection) with ejaculated spermatozoa is indicated for male factor infertility. ICSI with testicular sperm involves surgical retrieval of sperm in conditions like azoospermia. Patient evaluation before IVF includes history, physical examination, and lifestyle advice. Female evaluation involves ovulation assessment, ultrasound, and hormonal evaluation (TSH, prolactin, FSH, E2 levels).
- Ovarian reserve tests are crucial before IVF. Tests include assessing age, menstrual cycle characteristics, basal FSH and estradiol levels, AMH levels, and inhibin B levels. Ultrasound is used to determine antral follicle count and ovarian volume. Tubal patency is evaluated using hysterosalpingogram (HSG) for tube blocks. Abnormalities are checked by Laparoscopy and Hysteroscopy. Male evaluation includes semen analysis and hormonal tests.
- The IVF process includes pretreatment, ovarian stimulation, egg retrieval, sperm collection, fertilization, embryo development, and embryo transfer. Pretreatment with oral contraceptives or progesterone improves follicular synchrony. Ovarian stimulation, using urinary or recombinant gonadotropins, aims to develop multiple ovarian follicles.
- Protocols include long luteal agonist and antagonist protocols. Ovarian stimulation side effects include discomfort, bruising, mood swings, abdominal discomfort, and OHSS. Follicular development is monitored with vaginal ultrasound and hormone measurements. The trigger injection is used to achieve final oocyte maturation.
- Oocyte retrieval involves aspirating oocytes and follicular fluid under ultrasound guidance. Sperm collection involves providing a semen sample, or surgical sperm retrieval procedures like MESA and TESA can be used. Eggs are then placed in a culture media to support embryos development.
- Fertilization involves adding motile sperm to the culture media for IVF, while ICSI involves injecting a single sperm directly into the oocyte. Fertilization is checked 17 hours later with the presence of two nuclei. Grading blastocysts are performed as per the Gardeners classification.
- Embryo transfer is performed under transabdominal ultrasound guidance to place embryos 1-2 cm from the uterine fundus. Limits to the number of embryos transferred are based on guidelines from the American Society and Society for ART. A bed rest of more than 20 minutes does not improve outcomes. Progesterone is recommended for luteal phase support.
- IVF success rates depend on the woman's age and cause of infertility. Healthy lifestyle changes and maintaining a healthy weight are important. Average IVF pregnancy rates using fresh embryo transfers range from 41% (ages 18-34) to 6% (ages 43-50). For frozen embryo transfers, the average rate is 36%. ICSI is used to overcome low fertilization rates. It involves the selection and the injection of a sperm into the egg.
- While ICSI improves fertilization rates compared to IVF alone, pregnancy rates are not much different. After embryo transfer, additional good quality embryos can be cryopreserved for future use, with methods like slow cooling and vitrification.
- SET (Single embryo transfers) is the optimal strategy to prevent multiple pregnancies. PGT (Preimplantation genetic testing) helps identify genetic defects in embryos before pregnancy, especially in cases of recurrent implantation failure, pregnancy loss, or previous genetic defects.
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