• In order to understand what happens in an IVF cycle, it is important to understand what happens in a normal menstrual cycle first.
• A gland in the brain releases the ‘Follicle Stimulating Hormone’ (FSH) which causes the follicle (the sac containing the egg) to grow until
eventually it can be seen as a black circle on an ultrasound scan
• In a normal cycle only one follicle and one egg develops
• When the follicle becomes mature, a second hormone called ‘Luteinizing Hormone’ (LH) is released from the gland in the brain
• This hormone triggers the egg to be released from the follicle and this is called ‘Ovulation’
• The follicle produces a hormone called ‘oestrogen’ which develops the lining of the womb which is called the ‘endometrium’
• After ovulation the follicle is called the ‘corpus luteum’.
• This produces another hormone called ‘progesterone’ which further develops the lining of the womb for implantation
• The tube picks up the egg and if sexual intercourse has occurred the sperm will swim up through the neck of the womb called the ’cervix’ and
through the uterus into the fallopian tubes to fertilise the egg
• The embryo will then travel to the uterus and implant if it has a good potential for development
Female reproductive system
What is IVF(Assisted Reproductive Technology
• In vitro fertilisation (IVF) literally means ‘fertilisation in glass’ giving
us the familiar term ‘test tube baby’.
• During the IVF process, eggs are removed from the ovaries and
fertilised with sperm in the laboratory. The fertilised egg (embryo) is
later placed in the woman’s womb.
• In vitro fertilization (IVF) is a fertility procedure which first
succeeded as recently as 1978 by Dr. Edwards ( an embryologist) and
Dr. Steptoe ( a gynecologist) in England. Since then the technology
has been further refined and developed by physicians and
embryologists, with over 20,000 babies born worldwide.
Reason for infertility
Tubes are blocked or damaged
Sperm do not swim well
Sperm are too few in number
The lining of the womb is affected
Ovaries do not produce eggs
Quality of eggs is compromised
Basic Principle of IVF
Mix in a test tube
Modifications in an IVF or ICSI cycle
• Why do we need to make changes?
We need more than one egg in the cycle
Not all eggs fertilise or grow
Not all embryos have a good potential for development
We want to transfer 1-3 embryos for a good success rate
We do not want the gland in the brain to become confused in treatment
IVF CYCLE PROTOCOL
Suppression of the natural cycle
To switch off the gland in the brain so that it does not interfere in treatment
Hormone injections to produce multiple eggs
Ovulation trigger or HCG injection
Hormonal support after the embryo transfer
Stage 1:Suppression of the natural cycle
Oral Contraceptive Pill
Prostap once a month injection
Buserelin daily injection
Nafarelin three times a day nasal spray
headaches, hot flushes, night sweats, mood-swings, prolonged
period or second bleeding
Stage 2: Stimulation of the Ovary
Dose of stimulation is adjusted for:
Reserve of eggs in the Ovary (hormone levels and scan findings)
Weight or Body Mass Index
Past history (infections, cyst removal)
Presence or absence of PCOS
Types:Menopur, Merional, Puregon,Gonal-F, Fostimon
All are subcutaneous injections
Events after Egg Collection
Insemination of Eggs or Sperm injection into the
Observation of growth
Selection of embryos for transfer
Stage 5: Intracytoplasmic Sperm
• During the process of ICSI, an embryologist isolates a
sperm cell, draws it up into a microscopic needle and
injects it inside an egg using a high power microscope.
• Once mature eggs have been retrieved, the sperm and eggs are
placed together in the laboratory and incubated in a
meticulously prepared culture medium at a temperature
identical to that of the woman’s body.
Early day 2
Late day 2
Stage 6: Embryo Transfer
• Embryo transfer is not a painful
procedure and can be performed
• Usually up to three embryos are
placed together in a catheter ( a
tubular instrument) and
transferred, via the vagina, into
Success rate of IVF
• Varies from programme to programme.
• It is dependent upon correct diagnosis of patient, and age.
• Pregnancy rate is in the range of 25-30% per oocyte retrieval.
• The take home is about 15-20% per procedure.
Limitation of IVF
• Genetic defect in oocytes.
• Genetic defect in fertilizing sperm.
• Environmental mutagenesis.
• Inadequate supply of nutrients and hormones.
• Exposure to toxic agents and free radicals.