VITRO FERTILIZATION

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This article is written by Soumya Shekhar, Som Law College Prayagraj, UP, 4^th Semester (LL. B), intern under Legal Vidhiya.

Abstract

The Latin term in vitro, meaning “in glass“, is used because early biological experiments involving cultivation of tissues outside the living organism were carried out in glass containers, such as beakers, test tubes, or Petri dishes. Today, 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 distinguish it from an in vivo procedure (such as in vivo fertilisation), where the tissue remains inside the living organism in which it is normally found.

A colloquial term for babies conceived as the result of IVF, “test tube babies”, refers to the tube-shaped containers of glass or plastic resin, called test tubes, that are commonly used in chemistry and biology labs. However, IVF is usually performed in Petri dishes, which are both wider and shallower and often used to cultivate cultures.

IVF is a form of assisted reproductive technology.

Keyword – IVF, Test tube, Petri dishes, In-vitro, vitro fertilisation.

Introduction

In vitro fertilization (IVF) is a complex series of procedures used to help with fertility or prevent genetic problems and assist with the conception of a child.

During IVF, mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs (embryos) are transferred to a uterus. One full cycle of IVF takes about three weeks. Sometimes these steps are split into different parts and the process can take longer.

IVF is the most effective form of assisted reproductive technology. The procedure can be done using a couple’s own eggs and sperm. Or IVF may involve eggs, sperm or embryos from a known or anonymous donor.

IVF is a type of assisted reproductive technology used for infertility treatment, gestational surrogacy, and, in combination with pre-implantation genetic testing, avoiding transmission of genetic conditions. A fertilised egg from a donor may implant into a surrogate’s uterus, and the resulting child is genetically unrelated to the surrogate. Some countries have banned or otherwise regulate the availability of IVF treatment, giving rise to fertility tourism. Restrictions on the availability of IVF include costs and age, in order for a woman to carry a healthy pregnancy to term. Children born through IVF are colloquially called test tube babies.

IVF (In vitro fertilization)

IVF is the most common form of assisted reproductive technology. Generally, it involves fertilizing an egg with sperm in a lab, outside of the human body. Then the fertilized embryo is transferred to the uterus in hopes that it leads to a successful pregnancy. While the concept is simple, IVF is a complex procedure that involves multiple steps. The first successful live birth from IVF was reported in 1978. The innovating doctors Dr. Robert Edwards and Dr. Patrick Steptoe, who achieved this first IVF birth, received the Nobel Prize in Medicine for their work on IVF.

Often several good quality embryos will be created. In these cases, it’s normally best practice to freeze the remaining embryos because putting two embryos back in the womb increases your chance of having twins or triplets, which carries health risks. You can use your frozen embryos later on if your first cycle is unsuccessful or you want to try for another baby.

History

The first successful birth of a child after IVF treatment, Louise Brown, occurred in 1978. Louise Brown was born as a result of natural cycle IVF where no stimulation was made. The procedure took place at Dr Kershaw’s Cottage Hospital (now Dr Kershaw’s Hospice) in Royton, Oldham, England. Robert G. Edwards, the physiologist who co-developed the treatment, was awarded the Nobel Prize in Physiology or Medicine in 2010. His co-workers, Patrick Steptoe and Jean Purdy, were not eligible for consideration as the Nobel Prize is not awarded posthumously.^[[1]][[2]]

The second successful birth of a ‘test tube baby’ occurred in India just 67 days after Louise Brown was born. The girl, named Durga, was conceived in vitro using a method developed independently by Subhash Mukhopadhyay, a physician and researcher from Kolkata. Mukhopadhyay had been performing experiments on his own with primitive instruments and a household refrigerator.^[[3]] However, state authorities prevented him from presenting his work at scientific conferences,^[[4]] and it was many years before Mukhopadhyay’s contribution was acknowledged in works dealing with the subject.

Who can have IVF?

The National Institute for Health and Care Excellence (NICE) fertility guidelines make recommendations about who should have access to IVF treatment on the NHS in England and Wales.

These guidelines recommend that IVF should be offered to women under the age of 43 who have been trying to get pregnant through regular unprotected sex for 2 years. Or who have had 12 cycles of artificial insemination, with at least 6 of these cycles using a method called intrauterine insemination (IUI).

However, the final decision about who can have NHS-funded IVF in England is made by local integrated care boards (ICBs), and their criteria may be stricter than those recommended by NICE.

What happens during IVF

IVF involves 6 main stages:

Suppressing your natural cycle – your menstrual cycle is suppressed with medicine.
Helping your ovaries produce extra eggs – medicine is used to encourage your ovaries to produce more than 1 egg at a time.
Monitoring your progress and maturing your eggs – an ultrasound scan is carried out to check the development of the eggs, and medicine is used to help them mature.
Collecting the eggs – a needle is inserted through your vagina and into your ovaries to remove the eggs.
Fertilising the eggs – the eggs are mixed with the sperm for a few days to allow them to be fertilised.
Transferring the embryo(s) – 1 or 2 fertilised eggs (embryos) are placed into your womb.

Once the embryo(s) has been transferred into your womb, you’ll need to wait 2 weeks before taking a pregnancy test to see if the treatment has worked.

IVF Success rate in India

IVF or In-vitro fertilization has been a boon to those infertile couples dreaming to start a family. IVF is a process with her partners sperm outside their body. The outcome of an IVF procedure varies from one couple to another and one clinic to another.

The success rate of IVF procedure depends upon varies factors as given below:

Age of the female partner
Duration of infertility
Type of infertility (primary or secondary)
Cause of infertility
Quality of the sperm, egg, and embryo
The endometrial development
Luteal phase post transfer

With respect to the above-given factors, in India, the success rate of IVF success rate is around 40% in young women. The chance of success rates also increases in women younger than 35 years of age. The success rate of this most commonly used assisted reproductive technology or ART is usually measured on the basis of live birth per embryo transfer. Live birth per embryo transfer is known as Live birth rate.

Nowadays, most of the clinics have adopted a “freeze all” technique, where the embryos generated after ICSI or conventional IVF are frozen and not eggs. With the use of new age reproductive techniques, the IVF success rates in India have increased considerably. Endometrial receptivity analysis (ERA) is one such technique that can be helpful in patients with recurrent implantation failure by studying the endometrium at a molecular level.

In case of advanced maternal age, most of the implantation failures happen due to the chromosomal abnormalities of the embryos, a Pre implantation Genetic Screening (PGS) is highly recommended to increase the chance of implantation.

In certain couples, the conventional IVF treatments may not be of much help. For them, the Intra Cytoplasmic Sperm Injection (ICSI) which is a further classification of IVF could be a ray of hope. It is a laboratory procedure where a single sperm is picked up and injected directly into an egg with a fine glass needle.

A lot of challenges are faced during an IVF treatment; one must undergo these procedures and screening to ensure a greater chance of success.

Statistics about IVF in 2022

IVF (in vitro fertilization) is a popular artificial reproductive technology (ART) used to treat male and female factor infertility. The success rates of IVF are higher than most ARTs, but not all women who undergo the cycle are successful. If you have questions about your unexplained infertility or if you know someone who has experienced IVF failure, here are some things to consider:

Assisted reproductive technologies like IVF have facilitated the birth of millions of healthy babies. However, the procedures can be intensive and costly, and success depends on various factors like age and number of cycles. Although IVF isn’t always successful, working with an experienced fertility expert can boost your odds. At ReceptivaDx, we offer a proactive test for BCL6, which could indicate abnormal endometrial tissues. You can take the test before starting IVF.

A 2019 national report published by SART (Society for Assisted Reproductive Technology) revealed age as a critical factor. According to the report, 55% of women under 35 achieved a live birth following one egg retrieval cycle. The percentage dropped to 4.3% for women over 42 years.

Another study by researchers at the University of NSW Australia also revealed the same findings. Here’s a breakdown of their findings on IVF success rates:

Two out of three women who begin IVF before 35 have a baby within three IVF cycles.
After their first cycle, women younger than 30 have a 44% chance of having a baby. After seven cycles, their odds increase to 69-92%.
Women between the ages of 40 and 44 have an 11% chance of having a baby after the first IVF cycle. That likelihood increases to 21-37% after eight IVF cycles.

Challenges and risks with IVF

The most important challenges of IVF are as follow:

Reprogenetics:

As there is an increase in technology and the knowledge of scientific genomics it can give access to our personal genetic information. This will allow the people to edit the DNA of embryos according to them by considering Reprogenetics along with IVF before transferring them into the uterus. It might help in preventing genetic disorder but can create discrimination and division in society.

Financial challenges:

As IVF treatment is very costly. In India, the treatment of IVF is around 1.5 lakhs to 2.5 lakhs. Therefore, due to the cost of this treatment, it can be a limiting factor for many couples to wanted to opt for this treatment. This should include the insurance of the couple opting for this treatment as the success rate for this is 40%. but many insurance companies fail to give insurance for this treatment as insurance is for illness whereas treatment of fertility is not an illness.

Risks of IVF include:

Multiple births. IVF increases the risk of multiple births if more than one embryo is transferred to your uterus.
Premature delivery and low birth weight.
Ovarian hyperstimulation syndrome.
Miscarriage.
Egg-retrieval procedure complications.
Ectopic pregnancy.
Birth defects.
Cancer.

Suggestions

If you’re looking to increase your chances of conceiving during IVF, here are eight 5. Quit smoking.

Tips from fertility doctors:

Maintain a healthy weight.
Optimize sperm health.
Partner with an excellent doctor and embryology laboratory.
Reduce your stress.
Look into taking supplements.
Ensure you have adequate levels of vitamin D.
Focus on persistence and patience.

Legal aspects

Government agencies in China passed bans on the use of IVF in 2003 by unmarried people or by couples with certain infectious diseases.

In India, the use of IVF as a means of sex selection (preimplantation genetic diagnosis) is banned under the Pre-Conception and Pre-Natal Diagnostic Techniques Act, 1994.

Sunni Muslim nations generally allow IVF between married couples when conducted with their own respective sperm and eggs, but not with donor eggs from other couples. But Iran, which is Shi’a Muslim, has a more complex scheme. Iran bans sperm donation but allows donation of both fertilised and unfertilised eggs. Fertilised eggs are donated from married couples to other married couples, while unfertilised eggs are donated in the context of mut’ah or temporary marriage to the father.

In India there is no legislation regarding artificial insemination. But the doctor has to follow general principal of law. A child born as a result of artificial insemination is considered as legitimate, provided the child was born during lawful wedlock.

The child born through IVF shall be presumed as the legitimate child of the parents as it is done with the proper consent of the parents. The couple must be given mandatory counselling before the procedure.

India now officially has a law in place for regulating surrogacy services in the country. The central government on notified the Surrogacy (Regulation) Act 2021 and the Assisted Reproductive Technology (Regulation) Act 2021. The two Acts aim to regulate in vitro fertilisation (IVF) clinics and prohibit commercial surrogacy in India.

“As per Section 53 of the Surrogacy (Regulation) Ac, 2021, there is a gestation period of 10 months from the date of coming into force of the aforesaid Act to existing surrogate mothers to protect their wellbeing,” tweeted the department of health research under the Union Health Ministry, which notified both the acts commencing from January 25.

“While the Surrogacy Acts aims to regulate surrogacy in India, it is likely to become counter-productive to any efforts for ending the exploitation of vulnerable women. Given the stigma associated with infertility, the pressure of producing children and the lack of agency that women have over their bodies, commercial activities around surrogacy are likely to go underground and deny legal protection to women who choose to be surrogates,” said Poonam Muttreja, Executive Director at Population Foundation of India.

Conclusion

Around 10% of people suffer from infertility and IVF is a technique through which people who were not able to experience parenthood are experiencing parenthood. As we know it is legal and a good option, it is essential to have a specific law regarding it. The first priority of the government should be to pass the Assisted Reproductive Technology Regulation Bill. This bill can bring positive impacts on reproductive rights and choice of women in India. As we know there are many ethical and legal questions regarding the implementation of IVF, we cannot solve all those ethical and legal questions because those questions differ from society to society but this bill can be treated as a hallmark to solve such questions related to IVF. As the use of IVF treatment is increasing, creating a specific law IVF will have a clear way to bloom in India.

References