November 15, 2018
In 1977, Leslie Brown, who had been suffering from infertility due to blocked fallopian tubes was referred to Dr Patrick Steptoe and Sir Robert Edwards who were willing to treat her by the experimental procedure of In Vitro Fertilisation. This procedure involved retrieving her follicle laparoscopically and uniting it with her husband’s sperm in the laboratory. Their dedicated efforts and Leslie Brown’s courage to undergo this procedure was successful and resulted in the birth of the world’s first test-tube baby, Louise Brown on 25th July 1978.
After 40 years, more than 10 million babies have been born by IVF and it is a well-accepted treatment for women who are unable to conceive by natural methods. The procedure which was initially done for blocked tubes is now done for many other reasons like a)Severe oligospermia ( presence of very less sperms in the semen) or even certain cases of Azoospermia ( complete absence of Sperms) b) Poor Ovarian Reserve in women who have very few eggs left in their ovaries. c) Polycystic Ovaries resistant to routine methods of treatment d) IVF using Donor eggs when the follicles are completely absent or are faulty e) Transferring the embryo in a surrogate uterus when the woman’s uterus is absent or damaged.
IVF procedure – Step by Step
1st step – Controlled Ovarian Hyperstimulation
Gonadotrophin injections are administered from the 2nd day of the menstrual cycle to achieve development of 10 to 15 follicles. Transvaginal ultrasound is done to monitor the development of the follicles.
2nd Step – Oocyte Retrieval ( Ovum Pickup )
The Ovum aspiration needle is inserted in the follicles under short General Anaesthesia and the aspirated fluid is scanned for the oocytes. These are fertilised with the husband’s sperms by the procedure of insemination if the husband’s sperm parameters are normal. About 1 lakh sperm are inseminated around one egg.B y doing the procedure of ICSI, one sperm is directly injected in one egg under the microscope. ICSI is commonly done for male factor infertility.
3rd Step -Development of the embryo
The embryo can be developed in specialised media under strict culture conditions till day 5 when a blastocyst would be formed. A blastocyst has a better potential for implantation and can have success rates of about 55% to 60%.
4th Step – Embryo Transfer
Embryos are transferred either on day 3 ( at 6-8 cell stage ) or on day 5 (Blastocyst stage). Embryo transfer does not require any anaesthesia. Embryos are loaded in a soft catheter and are gently placed in the uterine cavity through the cervix under sonographic guidance.
The addition of the procedure of Cryopreservation ( freezing of sperms/oocytes or embryos) by the latest technique of Vitrification has really made IVF very safe and has also improved the success rates. By vitrification, an extremely rapid cooling is done and the gametes or embryos can be kept frozen for several years using liquid nitrogen.