ivf - what everyone needs to know about ivf

Download IVF - what everyone needs to know about IVF

Post on 23-Aug-2014

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This is a presentation I gave at Hyderabad on New Biology and Society, at the National Conference for Science Communicators

TRANSCRIPT

  • Dr Aniruddha Malpani, MD www.DrMalpani.com
  • Egg plus sperm = baby !
  • Traditional approach
    • Important and urgent for the patient
    • However, most doctors take a wait and watch approach
    • Often , patients get fed up and frustrated and drop out of treatment
    • This is a shame !
  • Need to change !
    • Patients are getting married at an older age
    • Time is running out as the biological clock ticks on
    • We now have effective technology to help them !
  • IVF cycle
    • 4 basic steps
    • 1. Superovulation
    • 2. Egg collection
    • 3. In vitro fertilisation
    • 4. Embryo transfer
    • Only 6 visits to the clinic
    • Day care basis no hospitalisation needed
  • IVF cycle 1. Superovulation
    • 1. With HMG ( gonadotropins)
    • Natural hormones
    • Newer recombinant preparations much more expensive, but no better
    • 2. Downregulation with Buserelin ( GnRH)
    • 3. GnRH antagonists to prevent LH surge
    • 4. Low cost clomiphene plus HMG
  • IVF cycle Superovulation
    • Monitor follicular growth ( ovarian response)
    • Vaginal ultrasound scans
    • Day 3, 10, 12, 14
    • Rarely need to measure blood estradiol
    • levels !
  • IVF cycle
    • 2. Egg collection
    • Vaginal ultrasound guidance
    • Non-surgical
  • IVF cycle
    • 3. Insemination
    • Sperm added to egg in the incubator
    • Kept in vitro in conditions which mimic in vivo conditions
    • The incubator is the heart of the IVF lab
  • IVF cycle
    • 4. Embryo transfer
    • Non-surgical
    • Number of embryos ?
    • When to transfer ? Day 2 or 3 or 5
  • IVF cycle
    • No need for bed rest you cannot cough the embryo out !
    • Still a matter of luck !
    • Not the patients fault if she doesnt conceive
    • She cannot reject the embryo !
  • Risks of IVF
    • No pregnancy
    • Multiple pregnancy
    • Ectopic pregnancy
    • OHSS ovarian hyperstimulation syndrome. Managed conservatively
  • Limitations of IVF
    • Few medical risks
    • Major risks are
      • Financial
      • Emotional
  • Advanced fertilisation techniques
    • Intracytoplasmic Sperm Injection(ICSI)
    • Assisted Hatching
    • Blastocyst transfer
    • Preimplantation Genetic Diagnosis (PGD)
  • ICSI
    • Microinjection ( Intracytoplasmic sperm injection)
    • One egg + one sperm = one embryo !
    • Can use testicular sperm even from men with testicular failure ( with high FSH levels and small testes)
  • Blastocyst transfer
    • Culture in vitro to Day 5 allows improved selection of viable embryos
    • Advantage of blastocyst transfer is that the number of embryos transferred can be reduced without risking a decline in pregnancy rates . This helps to reduce the risk of multiple pregnancy .
  • Freezing - cryopreservation
  • Vitrification
    • Can store and preserve
      • Sperm
      • Embryos
      • Eggs
      • Ovarian tissue
  • The promise of ART
    • We can help any couple to have a baby, no matter what their medical problem !
    • Third party reproduction
      • Embryo adoption
      • Donor eggs
      • Surrogate uterus
  • PGD the newest ART
    • PGD marries genetic technology and IVF technology
    • The newest patient is the embryo !
  • Procedure for preimplantation genetic diagnosis
    • 1. IVF cycle
    • 2. 8-cell embryo at Day 3
    • 3. Biopsy embryo ( micromanipulator)
    • 4. Fix blastomere
    • 5. Study genetic composition of blastomere using genetic probes ( FISH)
    • 6. Transfer selected embryos into uterus
  • Signal interpretation
    • Evaluate slides with a fluorescence microscope.
    • Locate nucleus using DAPI filter
    • Interpret signals
    • Probe will bind to specific chromosome only
    • Pink = Y ( Spectrum Orange)
    • Green = X ( Spectrum Green)
  • Normal blastomere
  • Trisomy 21
  • Comparative Genomic Hybridisation
  • PCR
  • Indications for preimplantation genetic diagnosis
    • 1. Sex linked genetic disorders Hemophilia Duchenne muscular dystrophy
    • 2. Chromosomal disorders Downs syndrome ( Trisomy 21)
  • Indications for preimplantation genetic diagnosis
    • 3. Single gene diseases ( using PCR) Thalassemia
    • 4. Older women doing IVF Screen embryos for aneuploidy
    • 5. Recurrent pregnancy loss because of chromosomal anomalies
  • Cloning
    • Reproductive cloning
    • Therapeutic cloning
  • Embryonic stem cells
    • Can change the face of medicine
    • Very promising future
    • Lots of research still needs to be done
    • Indian can be a leading center in this field
    • Collaboration between IVF clinics and basic research labs
  • Weve come a long way, baby !
  • Playing God ?
    • When does life begin? What are the rights of an embryo? Can human embryos be used for harvesting embryonic stem cell lines ? Should cloning be allowed ?
    • Vexed issues and since they deal with creating human life, these debates generate more heat than light !
  • Should embryo research be banned ?
    • Banning research ends up stopping scientific progress
    • We are not mad scientists trying to play God
    • We are doctors trying
    • to do the best for our patients
  • ART is a medical success story !
    • However, advances in IVF have come with government guidelines and laws
    • The purpose of these guidelines is to ensure that these technologies are used safely and responsibly
    • How well do these guidelines work ? What purpose do really serve ?
  • Human Fertilisation and Embryology Authority (HFEA) Act, UK
    • Protect the welfare of the child
    • Theory - It should be the parent(s) of the child who should be empowered to make the best decisions for their child
    • Practice - An impersonal government body without a heart or a soul makes these decisions, claiming that they are acting in the interests of the child.
  • UK v/s US
    • Interestingly, the US has not found it necessary to pass a federal law to regulate IVF
    • And they are doing fine thank you very much !
  • Doctors v/s politicians
    • Is it better to allow doctors to make medical decisions ( as is done in the USA) ?
    • Or to have legal hurdles, as is the practice in many European countries ?
    • Who can