In Vitro Fertilization-I.V.F

A British Woman Delivered First Baby By IVF - Louisa Brown

Developed By The Physiologist Robert G- Awarded The Nobel Prize in 2010!

What do we mean by In Vitro Fertilization?

Retrieval Of Eggs From Ovaries

Addition Of Sperm In Lab Dish To Make Fertilization

After Formation Of Embryo In

Lab Special Media

Transformation To Mother

Uterus

Idiopathic Causes

• Mainly after 2 years of unprotected intercourse with no obvious cause of infertility

Female Causes

• 1- Problems Of fallopian tubes obstruction, or salpingectomy due to ectopic pregnancy, or hydrosalpinx.

• Endometriosis. • Ovulation

problems.• Antibodies that

affects both eggs and sperms.

Male Causes

• Defects in sperm quantity and/or quality

• In-ability of the sperm to penetrate the cervical mucus

• No sperms seen in the semen fluid.

Genetic Diagnosis

• Pre implantation genetic diagnosis to rule out genetic disorders

Indications of In Vitro Fertilization - I.V.F

There Are 7 Steps For I.V.F Procedure

First step: Evaluation

Ovarian Follicles

Seminal fluid Blood Tests

Trans-Vaginal USFallopian Tube

US Scan - Uterus

US Scan - Ovaries

Second step: Ovulation Induction Producing many good

follicles to be Fertilized. Short or Long protocols: Is

done by daily injections of gonadotropins.

Regular monitoring by ultrasound scan is done.

Following the follicular development and adjust the dose of the injections accordingly,

After reaching certain size, the final maturation of those follicles is done by giving HCG.

Third step: Egg Retrieval (oocytes) Egg retrieval is done 34 to 37 hours

post HCG injection. This procedure is considered as minor

surgery. It is done under general anesthesia,

using ultrasound guide. It takes 15 to 20 minutes. Not more

than two hours are required for the patient to recover.

Then, the patient can leave the hospital. A needle is used to aspirate all the follicles.

The fluid is passed over to the embryologist, who identifies and separates the eggs.

Fourth step: Sperm and Egg Preparation The eggs are prepared and stripped from

the surrounding cells. At the same time, sperm preparation is

done using a special media. We need from 10,000-100,000 motile

sperm to be put beside each egg in a special dish, this is called traditional I.V.F.

It is different from intra-cytoplasmic sperm injection (ICSI, in which we need only one sperm to be injected in the cytoplasm of the egg)

Which is indicated in cases where sperm is present in the testes but the semen fluid does not contain sperm.

Fifth step: FertilizationAfter preparing the sperm, and the eggs are put in the same dish, in cases of failed fertilization we use ICSI procedure.

Sixth step: Blastocyst Day 5 Embryo

After 16 to 18 hours after the eggs, called zygotes, are fertilized,

They are cultured in special incubators to support division and development.

In this step, if the couple has a history of certain genetic disease and the gene that is causing that problem is identified, we may do pre-implantation genetic diagnosis.

Grading of the embryos is done using specific criteria.

Seventh Step: Embryo Transfer The Embryos are transferred into the uterus

after 2 to 5 days from the date of pick up. Depending on the quality and quantity of the

embryos. Using a special embryo transfer catheter. The patient is given drugs to help support the

implantation procedure. There is no need for a lengthy hospital stay

after the embryo transfer procedure (usually one hour is sufficient).

Residents of other countries can travel the next day if they wish.

Ovulation induction: Embryo transfer

• Ovarian hyperstimulation syndrome

• Lower abdominal pain.• Nausea and vomiting.• Oliguria.• Shortness of birth.• Accumulation of fluid in the

abdominal cavity.

Egg Retrieval

• Anesthesia complication.• Lower abdominal pain.• Mild vaginal Spotting as a

result of the needle used for the pick up.

• Intra-abdominal bleeding.• Genital tract infection.• Intestinal injury or bladder

injury in rare cases

IVF Procedure

• In Case of Success:• There is risk of multiple

pregnancies and its complications.

• Risk of miscarriage.• Ectopic pregnancy.• In case of failure:• There is risk of developing

depression for both members of the couple. Do not forget the financial burden.

Side Effects Of IVF

When to do the pregnancy test?

Two weeks post embryo transfer, if the blood tests give positive result. We can see the pregnancy sac one week after the blood test.

Women's age

• Less than 35 years old (41-43%). In our center, 65-70%.

• Between 35-37 years old (33-35%). In our center, 50- 55%.

• Between 38-40 years old (23-27%). In our center, 30-35%.

• After 41 years old (13-18%). In our center, 20-22%.

Other Statistics

• Repetition of four trials: success rate (70-80%).

• Repetition of after three trials: success rate (60-65%).

• If four embryos are transferred the percentage of success becomes 40%.

• If three embryo transfer the percentage 35%.

• If two embryo transfer the percentage 25%.

• One embryo carry 17% success rate.

Other Factors

• increasing the number of embryos transferred, the success rate increases

• risk of multiple pregnancies increases and miscarriage increases

• Quality of the eggs and sperm.

• Number and quality of embryos

What are the percentages of success?

Other factors that play a role in the success of I.V.F:Is there a genetic abnormality which will

decrease the rate of implantation?Is the endometrial lining of the uterus of good

quality, or not?What happens if ovulation occurs before the eggs are retrieved?In this case we have two choices:1 - Cancel the cycle and start again the following month.2 - Do intrauterine insemination, if possible.We must mention that 10 days post embryo transfer, you can do your normal daily activity. You can travel and have intercourse 2 weeks later.

Factors That Affects The Success Rate Regular cycle or not. Semen fluid analysis Sometimes AMH. Smoking. BMI (body mass index) and percent of

fat in the body Health of the tubes.

Technologies That Increase IVF Success rate

Assisted Hatching. Intracytoplasmic

morphologically selected sperm Injection – IMSI

Men And Women Guide to Preparing for IVF

Treating Failed In Vitro Fertilization