Seven steps for IVF
  • Preliminary testing
  • Development of Oocytes (eggs)
  • Oocyte (egg) Retrieval
  • Sperm Collection and Insemination
  • Incubation and Fertilization of Eggs
  • Formation and cleavage of embryos
  • Embryo transfer
  • Cropreservation (freezing) programme
Introduction :
In vitro fertilisation1 (IVF) is a technique in which egg cells are fertilised outside the woman's body. IVF is a major treatment in infertility where other methods of achieving conception have failed.
The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman's ovaries and letting sperm fertilise them in a fluid medium. The fertilised egg (zygote) is then transferred to the patient's uterus with the intent to establish a successful pregnancy. "In vitro" is Latin for "in glass", referring to the test tubes, however neither glass nor test tubes are being used; the term is used generically for laboratory procedures.
Indications :

Initially IVF was developed to overcome infertility due to problems of the fallopian tube, but it turned out that it was successful in most other infertility situations as well. The introduction of intracytoplasmic sperm injection addresses the problem of male infertility to a large extent.

Thus, for IVF to be successful it may be easier to say that it requires healthy ova, sperm that can fertilise, and a uterus that can maintain a pregnancy. Cost considerations generally place IVF as a treatment when other less expensive options have failed.

Oocyte retrieval
When follicular maturation is judged to be adequate, human chorionic gonadotropin (ß-hCG) is given. This agent, which acts as an analogue of luteinising hormone, would cause ovulation about 42 hours after injection, but a retrieval procedure takes place just prior to that, in order to recover the egg cells from the ovary. The eggs are retrieved from the patient using a transvaginal
technique involving an ultrasound-guided needle piercing the vaginal wall to reach the ovaries. Through this needle follicles can be aspirated, and the follicular fluid is handed to the IVF laboratory to identify ova. The retrieval procedure takes about 20 minutes and is usually done under conscious sedation or general anaesthesia.
IVF laboratory
In the laboratory, the identified eggs are stripped of surrounding cells and prepared for fertilisation. In the meantime, semen provided by the male partner is prepared for fertilisation by removing inactive cells and seminal fluid. The sperm and the egg are incubated together (at a ratio of about 75,000:1) in the culture media for
about 18 hours. By that time fertilisation should have taken place and the fertilised egg would show two pronuclei. In situations where the sperm count is low a single sperm is injected directly into the egg using intracytoplasmic sperm injection (ICSI). The fertilised egg is passed to a special growth medium and left for about 48 hours until the egg has reached the 6-8 cell stage.
Embryo transfer
The embryos judged to be the "best" are transferred to the patient's uterus through a thin, plastic catheter, which passes through her vagina and cervix. Often, several embryos are passed into the uterus to mprove chances of implantation and pregnancy.
Post - Transfer
The patient has to wait two weeks before she returns to the clinic for the pregnancy test. During this time she may receive progesterone—a hormone that keeps the uterus lining thickened and suitable for implantation. This hormone is secreted from the pituirity gland and also is known as the hypophysis. Many IVF programmes provide additional medications as part of their protocol.

The chance of a successful pregnancy is approximately 25-35% for each IVF cycle. Although selected clinics are now able to quote rates up to 50% per cycle. There are many factors that determine success rates
including the age of the patient, the quality of the eggs and sperm, the duration of the infertility, the health of the uterus, and the medical expertise. It is a common practice for IVF programmes to boost the pregnancy rate by placing multiple embryos during embryo transfer.
A flip side of this practice is a higher risk of multiple pregnancy, itself associated with obstetric complications.
IVF programmes generally publish their pregnancy rates, however comparisons between clinics are difficult as many variables determine outcome. Furthermore, these statistics depend strongly on the type of patients selected.


The major complication of IVF is the development of multiple births. This is directly related to the practice of placing multiple embryos at embryo transfer. Multiple births are related to increased pregnancy loss,
premature labour, obstetrical complications, prematurity, and neonatal morbidity with the potential for long term damage. Strict embryo transfer policies have been enacted to reduce this problem, but are not niversally followed or accepted. Spontaneous splitting of embryos in the womb
after transfer does occur, but is rare (1%) and would lead to identical twins. Recent evidence suggest that singleton offspring after IVF is at higher risk for lower birth weight for unknown reasons.
Another major complication, related to the use of ovarian stimulation is the evelopment of the ovarian hyperstimulation syndrome.

If the underlying infertility is related to abnormalities in spermatogenesis, it is plausible, but too early to examine that male offspring is at higher risk for sperm abnormalities.


Intracytoplasmic sperm injection (ICSI) is a more recent development associated with IVF which allows the sperm to be directly injected in to the egg using micromanipulation. This is used for sperm that have difficulty penetrating the egg and when sperm numbers are very low. ICSI results in success rates equal to IVF fertilisation.

Preimplantation genetic diagnosis (PGD) can be performed on embryos prior to the embryo transfer.

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