IVF ICSI

Brief history of IVF?

‘Test-Tube Baby is also known as IVF/ICSI .On July 25, 1978,first test tube baby was born in UK named  Louise Joy Brown a female baby by Steptoe and Edwards. In India First IVF or test tube baby was born in 1986 by Dr Indira Hinduja, the gynaecologist was responsible for the birth of Harsa Chawda.Before that on 3rd October 1978, first IVF baby named Kanupriya was born by the help of Dr.Mukhopadhyay ,but it was controversy and not published publicly.In context of Nepal on  March 3rd  2058 BS or 2005AD first baby was born at Om Hospital,Kathmandu named Om Mani Lama.

What is IVF?

In Vitro Fertilization is the most successful method of fertility treatment utilized today to help couple to conceive. The basic components of the IVF process include stimulation of  ovaries to produce multiple eggs at a time, retrieval of eggs from the ovarian follicles, fertilization of eggs in the laboratory, and subsequent placement of the resulting embryos into the uterus (embryo transfer).The chances of pregnancy from IVF depend primarily on the age of the women, causes and duration of infertility,gynaecological pathology,hormonal  and other factors related to the quality of IVF laboratory.

Who are the candidate for IVF?

1. Previous six cycle of IUI failed.

2. Bilateral tubal blocked.

3. Women age more than 35 years.

4. Poor ovarian reserve or follicles are poor respond to ovulation induction medicines.

5. Severe oligoasthenoteratozoospermia,,a male partner has low number of sperm count less than 5 million/ml,low motility less than40% and poor morphology less then 4%.

6. Severe endometriosis means endometrial tissue disseminated out of the endometrial cavity to different part of genital organs mainly Fallopian tube and ovary. It may  spread into cervix,vagina,previous ceserian section and episiotomy scar.

7. Use of donor egg.

8. Abnormal pelvic anatomy not amenable to microsurgical repair.

How it can be done?

First of indication to be clear and existing diseases to be treated. After assessment of  hormonal assay like TSH, Prolactin, (AMH, FSH,LH,ESTRADIOL,and PROGESTERON and endometrial thickness on day 2 of the period),if  these are within normal limit then ovulation induction is started on the same day or day 3 with injectable ovulation induction drugs with different protocols mainly agonist or antagonist. If we are planning to transfer fresh embryo, the endometrium should be prepared side by side by estradiol 2mg two or three times a day. If we transfer frozen embryo on next cycle depend upon indication or demand of patient, endometrium should be prepare on the next or subsequent cycle.Routinly follicular or endometrium should be monitored on day 7,10 or others day as necessary. When 3 or 4 dominant follicles reached 18 to 20 mm then trigger has been given and around 34 to 36 hour of trigger oocytes is retrieved with special technique under intravenous anaesthesia.Retrieved oocytes is given to embryologist and processed semen is mixed with oocytes in petridish with embryo culture media,then keep it in incubator for at least 72 hours, the formed embryo should be 6 to 8 cells. It can bring to blastocyst or day 5 embryo with the help of trigasincubator.The formed embryo can be transfer either fresh or frozen depend upon the situation, accordingly endometrium is to be prepared and embryo is transfer to the endometrial cavity with special technique which is ultrasound guided and it can be seen by the client herself in USG monitor. This is the process of IVF or test tube baby. Then luteal phase support to be given to each and every  IVF clients with certain medicines.

After 2 weeks of IVF serum beta HGC test to be done to confirm the pregnancy.

What is ICSI?

ICSI means Intra Cytoplasmic Sperm Injection, in this process the ovulation stimulation protocol and embryo transfer technique is same as IVF but difference is only the technique of fertilization, it is done in sever oligoasthenoteratozoospermia, sperm retrieve by TESA, PESA, MESA and testicular biopsy. In this procedure one sperm is injected into the cytoplasm of the oocyte with the help of ICSI machine or micromanipulation technology.

Side Effects
-Chances of Multiple pregnancies are the only reported ‘side effect’ of IVF.

-Ovarian Hyper Stimulation Syndrome

-Side effects of the related medications occasionally.
 

Success Rates

Success rate of IVF or ART depend on various factors: Age during the time of treatment, numbers of previous IUI cycles and, IVF number of cycles, recent or previousgynaecological problems and its medical or surgical treatment, status of ovarian reserve and quality of receptive endometrium Universally, overall success rate of IUI is 15 to 20%,conventional IVF is 45 to 50% and ICSI is 60% resumed in our center  also. The best reproductive age for the pregnancy is 20 to 30 years. After 30 the ovarian reserve decline and after 40 years the chances of pregnancy rate from her own egg is only 5%. The success rate also depend upon etiology of infertility and proper patient selection, optimum stimulation protocol, improvement of the technique of oocyte retrieval, ICSI and sperm selection methods, proper embryological technique with high quality embryos, move toward extended embryo culture and blastocyst transfer, efficient cryopreservation program, optimizing  laboratory technique, highly receptive endometrium, skilled atraumatic  embryo transfer, adequate luteal phase support and competent antenatal management.