This is the most widely practiced assisted conception procedure in the world and in simple terms means fertilizing the

eggs outside the body and transferring the resulting embryos in the uterus for implantation.

INDICATION OF IVF-ET

Female factors1) Bilateral tubal obstruction2) Severe Endometriosis

Male Factors

1) Severe oligozoospermia

2) Oligoasthenozoospermia

3) Psychological dysfunction etc

4) Azoospermia- testicular sperm

Unexplained Causes:

STEPS OF IVF-ET

1) Ovulation induction

2) Egg retrieval

3) Sperm preparation and fertilization

4) Embryo transfer

female ovum cellsoviduct

uterinecavity

ca.24 h

ca.24 h

malespermatospore

stimulatedovary

A) Self Oocytes

B) Donor Oocytes

- POF

- Poor Response

- Unexplained long term infertility

B. IN VITRO FERTILIZATION (IVF)

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PROTOCOL USED

OVULATION INDUCTION

- Long / short protocol. In the long protocol, treatment is started on days 21 of previous cycle. GnRH agonist is started on

day 21 to down regulate the ovary.

- The goal is to stimulate the ovaries to produce several follicles. In the

normal cycle only one egg is mature and ovulates. The various drugs used are:

1) GnRH antagonist

2) Human Menopausal gonadotropins (HMG)

3) Purified follicle stimulation hormone (FSH)

4) Recombinant FSH

The response is monitored by the frequent ultrasound and frequent blood levels of estrogens. The aim is

to achieve between 5-10 folicles of 15-18 mm size. When this is achieved HCG in the dose of 5000 to

10000 IU is administered by intramuscular injection. The eggs pick up is done about 32-35 hours after

HCG injection.

SUCCESS

The reported pregnancy rate

foetal malformation as compared to normal conception.

in an IVF-ET procedure is 40% and take home baby rate is 30-35% per cycle. There is no increase in the rate of

EGG RETRIEVAL

It is done under anaesthesia using intravenous pentothal with the help of a vaginal ultrasound.

There is no cut or operation. Under the guidance, the needle is inserted into the follicle. The follicles

are aspirated and the aspirate is examined in the lab for the eggs. This is a day care procedure and

the patient is sent after 2-3 hours. One may experience some vaginal spotting or pain in abdomen,

which subsides on its own. Complications from the procedures is < 1%.

SPERM INSEMINATIONThe eggs are placed in the incubator for 4-6 hours and are then inseminated with motile sperms that have been prepared by washing techniques.

EMBRYO TRANSFER

Embryo takes between 24-48 hours to develop. Between 24 and 72 hours after fertilization the

embryo is ready to be replaced into the uterus. Patients are advised to rest for about 4 hours

and after going home to rest for 3-4 days. Progesterone support is given and blood test is done

14 days after the ET procedure. This can be in the form of injection or a vaginal or oral tablets.

HCG is also used to supplement progesterone in cases where there is no ovarian

hyperstimulation.

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