In-vitro fertilisation is an Assisted Reproduction Technology (ART) process whereby eggs are harvested from the woman, after hormonal stimulation of the ovaries, and then fertilised manually in a laboratory by combining the egg with the partner’s sperm. The embryo is then transferred to the uterus. An IVF treatment is required in cases where the fallopian tubes are blocked or damaged, there is decreased sperm count or sperm mobility, there is a history of genetic disorder, when the woman has uterine fibroids, ovulation disorders, have had their fallopian tubes removed and other such reasons causing infertility. Sometimes, if there is a problem with the sperm, an Intra-Cytoplasmic Sperm Injection (ICSI) is used along with IVF treatment to further increase the chances of conception. Intra cytoplasmic sperm injection is an in vitro fertilization procedure in which a single sperm cell is injected directly into the cytoplasm of an egg. ICSI involves the direct injection of a single sperm into each egg, under microscopic control.
Intrauterine insemination or IUI is a fertility treatment procedure where a catheter is used to place washed, concentrated sperm into the uterus, near the time of ovulation in order to facilitate fertilisation. The main idea of an IUI treatment is to increase the number of sperm that make it to the fallopian tubes, thereby increasing the chances of fertilisation. The procedure is less invasive and also less expensive when compared to IVF. Sometimes doctors prescribe minimal medication to stimulate the ovaries and prepare the uterus prior to the insemination. This helps enhance the chances of success. IUI is a treatment option for couples who have unexplained infertility or very mild factors preventing natural pregnancy. Some reasons for couples to opt for IUI are low sperm count or mobility, the presence of cervical scar tissue from previous procedures, ejaculation dysfunction and a hostile cervical condition. IUI can be highly successful when the recommended 4-6 cycles are done. However, IUIs have a lower success rate than IVF procedures.
Earlier, IVF treatment involved transfer of embryos on the 3rd day after egg collection. In cases where many good quality embryos are available on day 3, it may be difficult to decide which are the best ones to put back, and in these circumstances we can now give couples the possibility of opting for blastocyst culture and transfer. In this treatment, the embryos are allowed to grow in the laboratory until they are 5 days old. The appearance of the embryo changes each day, so instead of a group of 6 to 8 cells as seen on day 3, it accumulates fluid in the centre of the embryo and those cells which are going to form the baby (the inner cell mass) fuse together at the side of the embryo. The remaining cells go towards forming the placenta. The blastocyst is a much more advanced structure than the 3-day-old embryo and the real advantage of transferring blastocysts is the high live birth rate associated with blastocyst transfer. Although many couples wish to undergo blastocyst transfer, it can only be used in those patients who have several high quality embryos on day 3 after egg collection and so although we can take a decision in principle to perform transfer on day 5 we can only take the final decision on day 3. For women who wish to get pregnant but are keen to avoid a twin pregnancy, a single embryo transfer using a blastocyst will give them the highest chance.
PGD is a procedure used prior to implantation to help identify genetic defects within embryos. PGD is used to improve the chance of a successful IVF pregnancy in couples where prior IVF failures have remained unexplained. It also prevents the transmission of single gene disorders in a family and achieve a healthy pregnancy. The embryos used in PGD are usually created during the process of In Vitro Fertilization (IVF). PGD is performed in the female of embryo biopsy and identifies which embryos are not at increased risk of developing the disease. PGD testing helps couple to build a healthy family, if there is a risk of inheritance or genetic disorder. PGD is done before the pregnancy is established and helps avoid tough decisions and situations. Using PGD to select the best embryos is clearly superior to traditional methods of selection. Miscarriage rates following PGD are far less than with standard IVF. Once we have the genetic information about each embryo available, we are able to sit down with each couple prior to the embryo transfer, discuss the genetic health of each embryo, explain how the genetic information has improved the chances for pregnancy success compared to their prior unsuccessful attempts at IVF elsewhere, and make a determination about the return of the now "known to be normal" embryos to the mother to be.
This procedure is increasingly being used to detect numerical chromosomal abnormalities in embryos to improve implantation rates after IVF. The main indications for the use of PGS in IVF treatments include advanced maternal age, repeated implantation failure, and recurrent pregnancy loss. The success of PGS is highly dependent on technical competence, embryo culture quality, and the presence of mosaicism in preimplantation embryos. PGS is a technique for testing whether embryos have any problems with their chromosomes, which is thought to be the most common reason IVF treatment fails. PGS is performed on a small embryo biopsy prior to transfer and identifies which embryos are chromosomally normal. Chromosomally normal embryos are the most likely to develop to term and to be born as a healthy baby. PGS testing helps IVF physicians and patients decide which embryos to transfer. This technology is specially developed for analysis of only a few cells or even a single cell as is required for preimplantation genetic testing.
Embryo freezing is relatively a new technique, which is used as a part of the IVF treatment. Embryo freezing offers the opportunity for couples to conceive more than once from a single IVF procedure. During the IVF procedure, fertility drugs are recommended by doctors to stimulate the production of eggs. This usually results in more eggs than required. A couple can choose to store their embryos for future use, should they decide to conceive again without again going through the ovum pick up, and In-Vitro Fertilisation steps of the process. If they later decide not to use the embryos, they may elect to donate them to other couples. The success rate of pregnancy using the frozen embryos is similar or slightly lower than that using the fresh embryo. The process of embryo freezing is very simple. The unused embryos are frozen and stored in the tank of liquid nitrogen at -196° Celsius. During the freezing process, a liquid called cryoprotectant is added to protect the embryos. It is not necessary that all embryos will survive the thawing process. Therefore, for the next cycle, your doctor will advise you to have more embryos thawed than needed to be transferred. Normally, embryos can be stored for 10 years and after this it’s storage will depend on the woman’s medical circumstances and her partner or sperm donor’s medical status.