Test Tube Baby- IVF

Looks can be deceptive. It is not always that a healthy person is sexually healthy. People get married to have a child. But when they cannot have children, their relationship becomes one devoid of happiness. In-Vitro Fertilization (IVF) or test tube baby can be the ultimate for those couple.

In-Vitro Fertilization (IVF) or test tube baby involves removing ovum/egg from a woman, fertilizing it with sperm in the laboratory and then transferring the fertilized ovum or the embryo into the uterus after a few days.

Not being able to have children is due to infertility. Infertility is the inability to conceive and become pregnant after 12 months of regular unprotected sex at the time of ovulation.

If the lady does not get pregnant after a year of effort, it is likely that the man, the woman, or both the partners are infertile.

History

Louise Brown is the first human test tube baby who was born on July 25, 1978, in England under Dr. Steptoe and Edwards.

In India, Durga was the first and world’s second human test tube baby who was born in October 1978 at Kolkata under Dr. Subash Mukhopadhyay.

Initially the IVF was developed to deal with the problem of the fallopian tube. But it turned out to be successful in many other infertility situations. Like for man who have very poor semen quality and women who are not producing ova of their own.

Indian context

“Like any other country, in India, infertility is affecting around 15% of the couples who are trying to get pregnant. In a month, if 50 couples come to me, around 15 of them suffer from male factor infertility. The rest 35 couples, out of which 50% would be women who have blocked fallopian tube and 50% would be women who have crossed her pregnancy age or egg quality is not good,” said Dr. Rohit Gutgutia, IVF Consultant.

Process of IVF

For IVF to be successful it requires healthy ova, sperm that can fertilise and a uterus, which can maintain pregnancy.

The process of IVF involves six steps

1.      Administering stimulants to the woman to produce ova

2.      Taking out the ova/eggs

3.      Taking the husband’s semen

4.      Fertilizing the ovum outside the body

5.      Putting the embryo inside the uterus and

6.      Checking whether she is pregnant or not

1.      Administering stimulants to the woman to produce ova

“We want to develop as many as 10 to 12 eggs in an IVF cycle with hormonal injections. These injections are started from a fixed period of a cycle. This could be the second or third day of the menstrual cycle. These injections are called FSH- Follicle Stimulating Hormone or HMG-Human Menopause Gonadotropins. They are administered at the same time everyday to help us develop more than one follicle in a naturally ovulating lady. The process is known as controlled ovarian hyper stimulation. The purpose of is to stimulate the growth of many good eggs in a particular month. The patient is also administered other injections to ensure that she does not ovulate on her own. Third, once ovulation starts, we conduct serial ultra sound tests to see if the eggs are growing properly. Once the eggs reach maturity size, that is, around 18mm follicular diameter, we are sure that the patient has matured eggs. Then she is administrated the final injection HCG- Human Chronic Gonodotropins,” explains Dr. Rohit

Administering stimulants to the patient

“After 35 hours of HCG injection, we perform the ovum pick up surgery. Ovum pick up takes place in an operation theatre. The patient is kept under general anesthesia during the surgery,” said Dr. Monam.   

2.                  Taking out the ova/eggs

The eggs are retrieved from the patient using a transvaginal technique involving an ultrasound-guided needle piercing the vaginal wall to reach the ovaries. 

It is aspirated and collected in the tube. This follicular fluid is handed to the IVF laboratory to identify the eggs. The follicles are aspirated from both right and left ovaries.  The retrieval procedure takes about 10 to 20 minutes.

Collecting follicular fluid a tube

The follicles are taken to the laminar air flow, where the temperature is maintained at 37⁰C which are analysed under microscope to identify the ozcytes or ova.

The ovam is kept in the petri dish. It contains the media, which was in the ovary. The ova are kept in the incubator. The temperature is maintained at of 37⁰C, which is just equal to that of our body or of the uterus.

Ovam in a petri dish

3.      Taking the husband’s semen

“The husband or the man is asked to give semen in the laboratory. The seminal plasma, prostate galantine and the occasional puss cell are eliminated through a sperm wash technique.We centrifuge the semen sample and remove the dead sperms. Thus we have both the male and female gametes in the laboratory,” said Dr. Rohit.   

Men’s semen

“After the centrifugation, we keep it in the incubator for swim up. Only the motile sperms are able to swim up and we take their count. The non-motile sperms are left below,” said Sinjini

4.      Fertilizing the ovum outside the body

On an average 50 to 60 thousand of good sperms are put together to fertilize an egg. After 14 to 18 hrs, one of the sperm penetrates the zona of the ovum and it gets fertilized.

In some case, when the sperm count is very low or difficult to penetrate the egg, a donor's sperm may be used or a single sperm is injected directly into the egg using ICSI (Intracytoplasmic Sperm Injection).

5.      Putting the embryo inside the uterus

The temperature in the incubator and the growth of an embryo is properly monitored. Once the embryo has grown to 4 to 8 cells level, the best embryo is implanted in the uterus with the help of a very thin plastic catheter on the third day from the day of pick up.

6.      Checking whether she is pregnant or not

 “After restoring the embryo in the uterus, we prescribe the patient medicine and advice to maintain the correct endometrial levels so that the embryo finds it easy to grow. After fifteen days we generally conduct a hormonal test to see if the embryo has implanted or not. Once the embryo has implanted successfully, we call the patient again after fifteen days to see if the embryo is implanted within the uterine cavity and to check whether the embryo is growing well or not,” said Dr. Rohit.

Success figure

The success rate may vary from clinic to clinic. However the society of Assisted Reproductive technologies (SART) reported that appromimate likelihood of IVF cycles resulting in a live birth is:

Women under 35 years 41 to 43%

Women between 35 nd 37 years 33 to 36%

Women between 38 and 40 years 23 to 27%

Women more than 41 years 13 to 18%

Causes

Infertility is caused by a number of reasons such as stress, smoking, substance abuse, alcohol, malnutrition, obesity, bicycling, sexual issue, genetic factors, physical abnormality and so on.

Nowadays most workingwomen are putting off marriage till they are 30. At this age their fertility decline fast. Also professional stress and strain often result in premature menopause, which prevent them from conceiving normally.

Medical advancement

It is said that women lose around two eggs an hour. A woman at the age of 16 has 400,000 eggs, but by the age of 46 there will be virtually none left. But medical advances have made possible for even women who have reached menopause to have children.

It has been reported that scientists have found a protein, which they believe, could be developed into a pill or an injection to extend the life of women’s ova.

But the greatest concern over the IVF procedure has been whether it increases the risk for birth defects.

“Initially when IVF was propounded people were thinking it might give rise to lot of unnaturally unhealthy babies and there were a few reports also. But subsequently it was proved that this babies were more to do with advance age of the patients who are undergoing IVF rather than the procedure of IVF. Dr. Rohit

Self-awareness

One just cannot rely on technology and keep letting biology to work against individuals.

Infertility affects around 15% of the population. So there needs to be a way to prevent it rather than cure it after it has happened. The way to do this would be for women to be more conscious of regular menstrual cycle. If she has irregular or delayed cycle, too many hair follicles on her body, unnatural distribution of hair, family history of diabetes or obesity, she should start consulting the doctor as soon as they are spotted. This could prevent a condition called Polycystic ovarian syndrome which, if treated at the right time, prevents infertility in future.

Other reasons of infirmity in female could be pelvic inflammable disease or tuberculosis. The only way to prevent these is to remain hygienic, stay away from dirty water and to treat urinary infection as soon they occur. If these simple measures are followed, most of the women who find it hard to conceive now would be alright.

As regards male infertility, man who are exposed to high temperature for a long duration of their work hours tend to have lower sperm counts. Man who are attracted to smoking, coffee, cold drinks are have lower than the usual counts. So they should give them up and apply a cold wash to the testis twice a day, stay away from heated environment as much as they can.

Patient testimonial

At the time of delivery one of my children weighed just 700 gram and the other weighed 735 grams. According to the doctor they had not even 1 % chance to survive. Nonetheless, they tried their best and god blessed us.  Now the kids are doing very well. There is no harm in going for IVF. The babies are born absolutely normal. There is nothing unnatural about it,” said Punam Konodia a mother of an IVF twin.  

Courtesy EMMRC Kolkata

You can watch my documentary on Test Tube Baby.