IN-VITRO FERTILIZATION

Abstract

Now a days, In Vitro Fertilization(IVF) is very challenging for women. IVF stands for “In- Vitro Fertilization”. The term “Vitro” is a Latin word which means “ in glass” is used because early biological investigations involving the development of tissues outside of living organisms were conducted in glass containers like beakers, test tubes or petri dishes. Now the scientific term “ in vitro” is used to refer to any biological procedure that is performed outside the organism in which it would normally have occurred, to differentiate it from an In Vivo Fertilization. Where the tissue remains inside the living organism in which it is normally found. Generally, In Vitro Fertilization(IVF) popularly known as “ Test tube baby” refers to the Tube- shaped containers of glass or plastic containers called Test tubes that are frequently used in biology and chemistry labs. IVF is an Assisted reproductive technology.

IVF is a medical procedure that involves retrieving eggs from the woman’s ovaries and fertilizing them with sperm of a men in a laboratory. The fertilized egg is transferred into woman’s uterus, to develop the pregnancy. In simple terms, IVF means “ where an egg of a woman and sperm of a men are fertilized outside a woman’s body i.e., fertilized a sperm in a laboratory. In- Vitro Fertilization(IVF) is an advanced clinical treatment to overcome infertility and to support surrogacy, single parent and LGBTIAQ+ community people can also use this IVF. In Vitro Fertilization is an advanced and miraculous process, which egg is fertilized by sperm outside the body. Where previously, so many other methods of Assisted Reproductive Technology(ART) has been failed. But, for the first-time successful birth of a “ test tube baby” born in 1978 named Louise Brown was born in July 25^th,1978 in London as a result of natural cycle In- Vitro Fertilization. His mother Lesley Brown had been facing this infertility issue since 9 years, then she took the help from Patrick Steptoe and Robert Edwards, he was a physiologist who developed this IVF treatment and also, he was awarded the Nobel prize in physiology in 2010.

Keywords

IVF, Test-tube, Petri dishes, In-Vitro, vitro fertilization, ovum, zygote, sperm, surrogacy, AFM, embryos.

Introduction

In Vitro Fertilization (IVF) is a complex series of techniques used to enhance fertility or avoid genetic issues and aid in childbirth. During, In Vitro Fertilization mature eggs are collected from ovaries and fertilized with a sperm in a laboratory. Then the fertilized embryo( fertilized egg) implant in the uterus of a women successfully to get a pregnancy. This overall full cycle of IVF takes two to three weeks. IVF is successful form of Assisted Reproductive Technology. IVF can be done using a couple’s own egg and sperm. IVF is used to cure infertility, facilitate gestational surrogacy, in combination with pre- implantation genetic testing, prevent transmission of genetic disorder to child. If a surrogate mother may carry a child, the baby was genetically no relationship with the surrogate mother. Fertility tourism has been banned in some nations and imposed restrictions on the use of the IVF treatments, Age and expenses limitation may apply to IVF access. so that a woman can carry a safe pregnancy. The babies who are born through IVF they are considered as test tube babies.[1]

Most of the couple’s having a problem of infertility, but now that comes to an end. Now a days there is a lot of treatment options and lot of successful ways to get a pregnancy with very encouraging success rate. Some of these medical procedures aim is to improve the chances of becoming pregnant by either increasing the number of eggs and sperm or bringing them closer together. They are using this type of medical treatments like Intracytoplasmic sperm injection(ICSI) and In Vitro Fertilization(IVF) are together known as assisted reproductive technologies. Till today, more than two million IVF childern have born.[2]

This IVF procedure involves monitoring and stimulating woman’s ovulatory process to remove ova or ovum from her ovaries and let sperm to fertilize those eggs in Artificial Fluid Medium(AFM) in a laboratory. The zygote or fertilized egg is placed into the mother’s uterus after being grown in an Artificial Fluid Medium for 2-6 days. This process is done with the intention of establishing a successful pregnancy and has the obvious benefit of boosting the odds of getting pregnant. Therefore, IVF helped to many couples and fulfilling their dreams of having a baby. It’s a great opportunity for couples who are struggling with infertility problem.

What is IVF?

IVF is the most successful form of Assisted Reproductive Technology in the world. In In Vitro Fertilization is a process, where an egg is combined with the sperm outside the body “ in vitro” ( in glass) in a laboratory. IVF process involves monitoring and stimulating a woman’s ovulatory process, removing an egg or eggs( ovum or ova) from the woman’s ovaries and let the sperm fertilize those eggs in an artificial fluid medium in a laboratory. Then after the fertilized egg(zygote) is placed into the mother’s uterus after being grown in an Artificial Fluid Medium for two to five days. This process done with the intention of establishing a successful pregnancy. There will frequently be multiple high- quality embryos produced, in these cases it’s usually best practice is to freeze the remaining embryos because re- implementation of two embryos in the womb leads to the possibility of having twins or triple pregnancy, which carries health risks. In that, situation you can use your frozen embryos at a later on if your first cycle fails or if you decided to try for another baby. IVF treatment is done only after checking the patient’s health conditions, check sexual and reproductive history, age, physical findings, diagnostic checking, or any need for the medical intervention.

History of IVF

The first successful IVF baby named Louise Brown was born in July 25^th 1978 in London. Her mother Lesley Brown had been facing this infertility issue for 9 years, then she took the help from Patrick Steptoe and Robert Edwards. He was a physiologist and he was developed this IVF treatment and also, he awarded the Nobel Prize in physiology in 2010. This treatment was originally developed to treat infertility problem caused by blocked Fallopian Tubes, but now IVF is used to treat for variety infertility problems.

The second successful birth of IVF happened in India, only after 67 days of Louise Brown born. The baby name Durga was conceived In Vitro using a method developed independently by Subhash Mukhopadhyay he was a physician and also Researcher from Calcutta.

In 1981, Elizabeth Carr was the result of the first successful IVF procedure performed in the United States, carried out in Norfolk, Virginia. By Drs. Howard and Georgeanna seegar Jones. Since then the use of In Vitro Fertilization (IVF) has exploded in popularity with over 115,000 births occurring in the United States to date.

Advaina Iliescu held a record as the oldest woman to give birth through using IVF and a donor egg, she gave birth baby in 2004 at the age of 66 years. After the IVF medical treatment some couples are able to get pregnant without need of any fertility treatments. In 2008, it was estimated nearly 8 million babies have been born worldwide using IVF and also using other Assisted reproductive techniques.[3]

Who might choose IVF?

The National Institute for Health and Care Excellence(NICE) fertility guidelines make recommendations regarding who should have access to IVF treatment. In Vitro Fertilization(IVF) treatment for infertility. These guidelines recommended that IVF should be used to women under the age of 43 who have been trying to get pregnant or who have had 12 cycles then using a method called Intrauterine insemination(IUI).

IVF is done, may be an option if you or your partner has the following situations:-

Fallopian Tubes blocked: Generally, eggs move from the ovaries to uterus through this Fallopian Tubes. If both tubes get damage or blocked, then that makes it hard for an egg to be fertilized.
Ovulation problems: If ovulation does not happen or occur fewer eggs are available to be fertilized by sperm.
Endometriosis: This was happen, when tissue lining of the uterus grows outside of the uterus. Endometriosis affects the ovaries, uterus and Fallopian Tubes.
Uterine Fibroids: Fibroids means fibroids are tumors in the uterus. Most frequently they are not cancer. They are common in who is age of 30s and 40s. Fibroids can cause a fertilized egg to have trouble attaching to the lining of uterus.
Previous surgery to stop pregnancy: There is an operation called “ tubal ligation” involves having the fallopian tubes cut or blocked to stop pregnancy for good. In that case, if you wish to conceive after the tubal ligation then IVF may help you.
Seminal issues for the man: Low number of sperms, size or shape can make if difficult for sperm to fertilize an egg. In medical tests if you find any issues regarding sperm, then visit infertility specialist it might be treatable problem or any other health concerns.
Cancer or any other health issues: If cancer treatments, such as radiation or chemotherapy can harm fertility. If you are taking treatment for cancer, IVF could be away to still have child in the future. Eggs can be fertilized and frozen as embryos for future or people who do not have a working uterus or to whom pregnancy possess a serious health risk they choose IVF, using another person to carry the pregnancy. The person will be called as “ gestational carrier or surrogate”. In such case your eggs are fertilized with sperm, but the embryos are placed in the gestational carrier’s uterus.[4]

What happens during IVF

There are 6 main stages during IVF

Suppressing your natural cycle- your menstrual cycle is suppressed with using medicine.
Producing extra eggs- medicine is used to encourage your ovaries to produce more eggs at a time.
Monitoring the process of yours and treatment to make maturing your eggs- an ultra sound scan is carried to check the development of the eggs and also medicine is used to develop the maturity.
Collecting the all eggs- A needle is inserted through your vagina and into your ovaries to remove the eggs. This procedure done 34 to 36 hours takes its all done in doctors office or clinic.
Fertilizing the eggs in a laboratory- After, removing the eggs then the eggs are mixed with the sperm for a few days until fertilized. There are 2 common methods can be used to fertilize eggs with the sperm:
Conventional insemination: Healthy sperm and mature eggs are mixed and kept in an “incubator”, for 5 days. After five days placed into mother’s womb to get a pregnant.
Intracytoplasmic sperm injection(ICSI): A healthy sperm is injected into a mature egg after ICSI is used when semen quality or number is an issue or during the prior cycle did not work.
Transferring the embryo- After Fertilized embryo, transferred into your womb. Once if the embryo’(s) has been implanted into your womb, you will have to wait at least 2 weeks before taking a pregnancy test to see if the treatment has worked.[5]

Complications or Risks associated with IVF procedure

There are some risks of IVF include:-

Multiple births
Low birth weight
Premature delivery
Ovarian hyper stimulation syndrome( excess of fluid in the abdomen and chest)
Miscarriage( pregnancy loss)
Complications in egg retrieval procedure
Ectopic pregnancy( when the eggs impart outside the uterus)
Cancer
Birth defects for a baby
Leads to over bleeding
Infection
Damage to the bladder( happened in rare cases)

Cost of IVF treatment

The cost of IVF treatment can be very high, depending upon the medical tests are required and the dose of medicines cost is high, the number of cycles required to become pregnant. The average cost of an IVF cycle in the USD $ 15000, in our country the average cost of IVF treatment is nearly 6 to 8 lakhs. Some states , insurance policies cover the infertility treatment cost.

IVF success rate in India

In vitro fertilization or IVF has been a blessing for infertility couples hoping to become parents. Her partner’s sperm are used outside of their body during IVF process. IVF process results differ from clinic to clinic and the couple to couple.

The following list of various factors affects the success rate of IVF procedure:-

The Female partner age
Infertility duration
Type of infertility( first or second)
The reason behind the infertility
Quality of egg, sperm and embryo

In 2019, the “ Centre for Disease Control and prevention(CDC)” estimated that the percentage of intended egg retrieval that resulted in live birth delivery was:

52.7% among people aged under 35 years
38% among people aged between 35-37 years
24.4% among people who aged between 38-40 years
7.9% among people who aged over the 40 years

The IVF success rate depends on age, age of your partner, donors age, the high success if you are under age of 35 years. At the age of 44, the success rate in 1 in 100 members.

According to above mentioned factors, in India also the chance of success rate of IVF is higher under the age of 35 years. The success rate of this most commonly used ART( assisted reproductive technology) is usually measure of live birth per embryo transfer( live birth per embryo transfer means “ Live birth rate)”.

Now a days, the majority of clinics use the “ Freeze all” method, in which the embryos created using ICSI or traditional IVF are frozen rather than eggs. In India, the success rates of In vitro fertilization have significantly increased with the advent of new age reproductive technology. One such method that can help individual with repeated implantation failure is Endometrial receptive analysis(ERA), Which looks at the Endometrium at the molecular level.

In case of advanced technology maternal age, most of the implantation failures happen due to chromosomal abnormalities in the embryos, a pre- implantation genetic screening( PGS) is strongly advised in order to maximum the chances of successful implantation. In some of couples the IVF treatments may not help. For those, the Intra Cytoplasmic Sperm Injection(ICSI) is used, where a single sperm taken and injected directly into an egg with a Fine glass needle. This procedure done in a laboratory so, many challenges are faced during IVF treatment.

Suggestions

If you want high chances of conceiving during IVF then follow these tips it’s given by doctor:

Stop smoking
Maintain a correct weight
Optimize sperm healthy
Don’t take too much stress
Ensure vitamin D

Legal Aspects

Government agencies in china bans use of IVF in 2003 by unmarried people or by couples with certain infectious diseases. In India the use of IVF means of sex selection( pre implantation genetic diagnosis) is banned under the pre- conception and Pre- Natural Diagnostic Techniques Act, 1994.

Some Sunni Muslim nations generally allow IVF between married couples when conducted with their own respective sperm and egg, but not with donor eggs from other couples. In Iran Shia Muslim has more complex, Iran bans sperm donation and allows donation of both Fertilized eggs( fertilized eggs are donated from married couples to unmarried couples) and unfertilized eggs( unfertilized eggs are donated in the context of mutah or temporary marriage to the father).[6]

In India, there is no legislation regarding artificial insemination. A child is born through artificial insemination is considered as legitimate. The child was born during wedlock, the baby born through IVF shall be taken as the legitimate child of the parents as it is done with the proper consent of the parents. The couple must given mandatory counseling before the procedure. The central government notified the Surrogacy Regulation Act 2021 and Assisted Reproductive Technology Regulation Act 2021, these 2 acts aims to regulate in vitro fertilization clinics and prohibit commercial surrogacy in India under surrogacy regulation act of 2021. Only altruistic surrogacy allows in India.

Future of In Vitro Fertilization( IVF)

Fertilization(IVF) aim for better and high success rates by transferring a single, carefully chosen embryo with an 80% success rate rather than numerous embryos to increase the likelihood of a successful IVF cycle, which can occasionally result in multiple births. After that, Non- invasive blastocyst cultivation and embryo testing were conducted, in- vitro maturation was used rather than moving the blastula from the petri dishes, and cryopreservation of ovarian oocytes for later use was increased in order to reduce waste as an un- ethical practice too and use embryonic stem cells for haplodization of cells to create gamates. These are all only achieved by streamlining and simplifying protocols while reducing the amount of time nudged for monitoring. This would allow the IVF method to become a clinically affordable treatment option for lower class of developing and underdeveloped countries.

Conclusion

IVF is a treatment that allows those who were not able to experience motherhood to do so. Approximately 10% of people suffer from infertility. Since it is a viable option and legally recognized, a special law pertaining to it is needed. The government’s first priority ought to be passing the Assisted Reproductive Technology Regulation Bill. This measure has the potential to improve women’s choices and reproductive rights in India. Since ethical and legal concerns about the use of IVF vary from society to society, it is impossible to address them completely, but this bill can be seen as a starting point for addressing many of the ethical and legal issues surrounding the practice. As the use of IVF treatment is increasing and creating a special law regarding IVF will have a Clear way to bloom in India.[7]

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1936357/ Visited on 06/04/2024
https://en.m.wikipedia.org/wiki/In_vitro_fertilisation visited on 06/04/2024
https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716 visited on 07/04/2024
https://www.legalserviceindia.com/articles/art_ins.htm visited on 07/04/2024
https://www.uptodate.com/contents/in-vitro-fertilization-ivf-beyond-the-basics/print visited on 08/04/2024
https://www.healthline.com/health/in-vitro-fertilization-ivf#preparation on 08/04/2024

[1] Wikipedia, https://en.m.wikipedia.org/wiki/In_vitro_fertilisation [( Apr 7 2024, 1:00)]

[2] Mayo clinic, https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716 [ ( Apr 7 2024, 14:30)]

[3] Legal services, https://www.legalserviceindia.com/articles/art_ins.htm [( Apr 7 2024, 15:00)]

[4] Legal services, https://www.legalserviceindia.com/articles/art_ins.htm [( Apr 7 2024, 17:20)]

[5] Mayo clinic, https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716 [( Apr 7 2024, 19:40)]

[6] Health line, https://www.healthline.com/health/in-vitro-fertilization-ivf#preparation [ ( Apr 8 2024, 13:00)]

[7] Wikipedia, https://en.m.wikipedia.org/wiki/In_vitro_fertilisation [( Apr 8 2024, 19:00)]

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