In Vitro Fertilization

In Vitro Fertilization

Female reproductive system

Male reproductive system

Normal Fertilization

IVF: In vitro fertilization

In vitro: in glass

Fertilization: Ova + Sperm

Hormonaltreatment

Female

Harvestthe ovum

Mix in a test tubeMature Ova Keep to

developembryo

Basic Principle of IVF

Naturalejaculation

Collect semen

Motile sperms

Keep todevelopembryo

Transferto mother

Male

Hormonal Treatments

Drugs currently in use include:• clomiphene citrate (Clomidâ, Seropheneâ)• human menopausal gonadotropin (hCG)• gonodotropin releasing hormone (GnRH) analog called leuprolide(Lupronâ)

Most of these drugs may be used alone or in a combination withothers.

Drugs currently in use include:• clomiphene citrate (Clomidâ, Seropheneâ)• human menopausal gonadotropin (hCG)• gonodotropin releasing hormone (GnRH) analog called leuprolide(Lupronâ)

Most of these drugs may be used alone or in a combination withothers.

Egg Harvest

1. Ultra Sound Guided Aspiration

2. Laproscopy

Fig 1

Oocytes withgranulosa cells

"Naked" Oocyte

8-cell embryo for transfer

Blastocyst for transfer

Implantation

Fourteen Days after Initial Cell Division

Viable Fetus

After Birth

Gamete intrafallopian transfer (GIFT): GIFT is similar to IVF. It is used when awoman has at least one normal fallopian tube. Eggs are placed in this tubealong with a man’s sperm to fertilize there.

Zygote intrafallopian transfer (ZIFT): ZIFT is tubal embryo transfer in which awoman’s eggs are taken from her ovaries, fertilized in the laboratory, and putback in the fallopian tubes rather than the uterus.

Assisted fertilization techniques when not enough sperm are available or spermquality is not sufficient to fertilize include the following:

• Partial zona dissection• Subzonal sperm injection• Intracytoplasmic sperm injection• Embryo cryopreservation (frozen fertilized egg and sperm)

Alternates of IVF

Gamete intrafallopian transfer (GIFT): GIFT is similar to IVF. It is used when awoman has at least one normal fallopian tube. Eggs are placed in this tubealong with a man’s sperm to fertilize there.

Zygote intrafallopian transfer (ZIFT): ZIFT is tubal embryo transfer in which awoman’s eggs are taken from her ovaries, fertilized in the laboratory, and putback in the fallopian tubes rather than the uterus.

Assisted fertilization techniques when not enough sperm are available or spermquality is not sufficient to fertilize include the following:

• Partial zona dissection• Subzonal sperm injection• Intracytoplasmic sperm injection• Embryo cryopreservation (frozen fertilized egg and sperm)

ICSIStands for intracytoplasmic sperm injection. This process is used to injecta single sperm into each egg before the fertilized eggs are put back into thewoman's body. The procedure may be used if the male has a low spermcount.

Cryopreservation of Ova, Sperm and Embryo

Risks

Superovulation Stimulates Egg Development

Ovarian Hyperstimulation Syndrome (OHSS)Ovarian Hyperstimulation Syndrome (OHSS)

1. There may be a failure to recover an egg because:- follicles that contain mature eggs may not develop in the treatment cycle

2. - ovulation has occurred before time of egg recovery- one or more eggs cannot be recovered- pre-existing pelvic scarring and/or technical difficulties prevent safe egg recovery

3. The eggs that are recovered may not be normal;4. There may be insufficient semen to attempt fertilization of the recovered eggs

because the man is unable to produce a semen specimen, because the specimencontains an insufficient number of sperm to attempt fertilization, because thelaboratory is unable to adequately process the specimen provided, or because theoption to use a donor sperm as a "backup" was declined;

5. Fertilization of the eggs to form embryos may fail even when the egg(s) and spermare normal;

6. The embryos may not develop normally or may not develop at all. Embryos thatdisplay any abnormal development will not be transferred;

7. Embryo transfer into the uterus may be difficult/impossible, or implantation(s) maynot occur after transfer, or the embryo(s) may not grow or develop normally afterimplantation;

8. Any step in the IVF-ET process may be complicated by unforeseen events, such ashazardous or catastrophic weather, equipment failure, laboratory conditions,infection, human error and the like.

1. There may be a failure to recover an egg because:- follicles that contain mature eggs may not develop in the treatment cycle

2. - ovulation has occurred before time of egg recovery- one or more eggs cannot be recovered- pre-existing pelvic scarring and/or technical difficulties prevent safe egg recovery

3. The eggs that are recovered may not be normal;4. There may be insufficient semen to attempt fertilization of the recovered eggs

because the man is unable to produce a semen specimen, because the specimencontains an insufficient number of sperm to attempt fertilization, because thelaboratory is unable to adequately process the specimen provided, or because theoption to use a donor sperm as a "backup" was declined;

5. Fertilization of the eggs to form embryos may fail even when the egg(s) and spermare normal;

6. The embryos may not develop normally or may not develop at all. Embryos thatdisplay any abnormal development will not be transferred;

7. Embryo transfer into the uterus may be difficult/impossible, or implantation(s) maynot occur after transfer, or the embryo(s) may not grow or develop normally afterimplantation;

8. Any step in the IVF-ET process may be complicated by unforeseen events, such ashazardous or catastrophic weather, equipment failure, laboratory conditions,infection, human error and the like.

Normal results

Success rates vary widely between clinics and between physicians performing theprocedure and implantation does not guarantee pregnancy. Therefore, the proceduremay have to be repeated more than once to achieve pregnancy. However, success rateshave improved in recent years, up from 20% in 1995 to 27% in 2001.

Abnormal results

An ectopic or multiple pregnancy may abort spontaneously or may require termination ifthe health of the mother is at risk. The number of multiple pregnancies has decreased inrecent years as technical advances and professional guidelines have led to implanting offewer embryos per attempt.

Normal results

Success rates vary widely between clinics and between physicians performing theprocedure and implantation does not guarantee pregnancy. Therefore, the proceduremay have to be repeated more than once to achieve pregnancy. However, success rateshave improved in recent years, up from 20% in 1995 to 27% in 2001.

Abnormal results

An ectopic or multiple pregnancy may abort spontaneously or may require termination ifthe health of the mother is at risk. The number of multiple pregnancies has decreased inrecent years as technical advances and professional guidelines have led to implanting offewer embryos per attempt.

• Bypassing the natural method of conception.• The creation of life in the laboratory.• Fertilization of more embryos than will be needed.• Discarding of excess embryos.• Unnatural environment for embryos.• Use of untested technology.• Not affordable for many.• Misallocation of medical resources.• Creation of embryos, then freezing them, and keeping them "in limbo".• Exposure of embryos to unnatural substances.• Destruction of embryos in research.• Potential to create embryos for medical purposes.• Potential to select embryos (PGD).• Potential to modify embryos.• Facilitation of the idea that embryos are commodities.• Financial rewards for IVF doctors dissuade them from recommendingother methods to couples.• Infertility is treated as a disease and not as a symptom of underlyingmedical problems.

Ethics

• Bypassing the natural method of conception.• The creation of life in the laboratory.• Fertilization of more embryos than will be needed.• Discarding of excess embryos.• Unnatural environment for embryos.• Use of untested technology.• Not affordable for many.• Misallocation of medical resources.• Creation of embryos, then freezing them, and keeping them "in limbo".• Exposure of embryos to unnatural substances.• Destruction of embryos in research.• Potential to create embryos for medical purposes.• Potential to select embryos (PGD).• Potential to modify embryos.• Facilitation of the idea that embryos are commodities.• Financial rewards for IVF doctors dissuade them from recommendingother methods to couples.• Infertility is treated as a disease and not as a symptom of underlyingmedical problems.

Separating the traditional mother-father model

Pregnancy past menopause

Religious objections

Thank you