IVF is an artificial embryo development in laboratory condition and embryo is injected to mother for fetus development.

1. Invitro fertilization(IVF) in humans
MEIKANDAN C
B.Sc.Biotechnology
Kongu arts andscience college
Erode

3. Why IVF ?
• Female Infertility
▫ Hormone issue
▫ Obesity
▫ Ovulation reduction
▫ Advanced age of women
▫ Follopian tude
damage/blocked
▫ Abnormal menstrual cycle
▫ Endometriosis
• Male infertility
▫ Smoking
▫ Alcohol
▫ Certain illicit drugs
▫ Over weight
▫ Past & present infection
▫ Exposed to toxins
▫ Over heat of testicles
▫ Sperm mobility 60%
▫ Lower no.of sperm count

4. MEDICATION FOR IVF TREATMENT
• Sucess IVF depands on growing several eggs
• Done through injection of natural hormones
• Sometimes overies respond too strong-
sometimes not enough

5. GoNODOTROPINS
• Natural hormone – overies to grow oocytes @ 8
or more days
• Skin or direct into muscle
• Risk – headache , fewer, etc
• Sometimes – lower no. Of eggs available,
medication may not help.
• There may very few / no egg in egg retrivel
proceture or cancelled before ERP

6. GnRH- Antagonists
• Ganirelix acetate or cetrorelix acetate
• Prevent premature ovulation

7. hCG
• Human chorionic gonotropins
• Help eggs to become mature &ready to harvest

8. Progesterone , estradial (somecase)
• produced normally by ovaries after ovulation
• Some women after ERP ovaries not produced
enough
• Adding for getting pregnant and stay pregnant
• Intramuscular injection / also suppository
directly vagina – 3 times /day after ERP –
continue for some weeks after become pregnant
• Side effects- depression,sleepingness / allergy
rare

9. Oral contraceptive pills
• Birth control pills
• Dr.advised this for 2-4 weeks before hormone
stimulating injection
• Slow down hormone production to schedule
treatment cycle
• Risk- bloodclots/rare stoke
• Growth hormone- embryo quality- daily
injection

10. Testosterone or DHEA
• Womens had @ low 1/10-1/20 of men
• +ve impact on fertility rate in women with poor
responce t IVF cycle
• Use improves quality & no. Of oocytes as well as
the no. Of embryo
• 12.5mg 1-2 month prior to stimulation
Clomid or Letrozole
Coenzyme Q10- improve egg quality

11. Transveginal Oocyte( egg) Retrievel
• Eggs are removed from overy with needle under
Ultrasound guidence placed into vagina
• Needle attached to ultrasound
• Guiding to ovaries Dr. Will draw out fluid,
eggs,egg supporting cells
• Rare – ovaries cannot reached through vagina-
egg removed through belly by leparoscope
• Anesthesis – reduce/eliminate pain

13. Risks of egg retrievel
• Infection
▫ Vagina – bacteria – transformed to pelvis or
ovaries through needle + infection to nearby organ
▫ Infection are very rare (<0.1%)
▫ Severe- surgery – removal of infected tissue
▫ Antibiotics used before ERP to help reduce chance
of infection

14. • Bleeding
▫ Needle passes through vaginal wall &into ovaries ,
both of these contain blood vessiels – small
amount of blood loss while retriving
▫ Risk – bleeding is rare- major bleeding require
surgery to stop , results in removal of ovary
▫ Does not notice - death

15. • Trauma
▫ Ultra sound, nearby organ damage-
intestines,appendix,bladder,ureters,overy
▫ Some case damaged organ removed through
surgery
• Anesthesia
▫ Use for removal of eggs - cause allergy , low
BP,nausea/vomiting/ somerare –death
• Failure-
▫ No eggs found @ERP /egg not normal or poor
quality

16. IVF – Embryo culture
• After ERP – transformed to embryology lab &
kept in growth condition
• Egg placed in small dish or tubes containing
culture medium – special fluid to support
develpment of embryo
• Fluid is made to resemble condition like in
follopian tube & uterus
• Eggs placed in incubator , which keep
temp,humidity,gas,light @ right levels

17. • 3-4 hours after retrieved , sperm are placed in
media with egg
• In some individual sperm are injected through
ICSI(intracytoplamic sperm injection)
• Eggs then return to incubator where they remain
to grow
• Inspected @intervals of nexr few days to check
progarms

19. • Day 1: This is the day that the eggs and sperm come
together, and we can check for signs of fertilization.
At this stage, the normally fertilized egg is still a
single cell with 2 nuclei, called 2PN or zygote.
• Day 2: Normal embryos will divide into 2 to 4 cells
• Day 3: Normally developing embryos will continue
to divide 4 to 8 cells.
• Day 4: The cells of the embryo begin to merge to
form a solid ball of cells called morula (like a
mulberry).
• Day 5: Normal embryos now have 100 cells or more,
and are called blastocysts. It has an inner fluid-filled
cavity and a small cluster of cells on the inside called
the inner cell mass.

21. • It is important that many eggs &embryos are
abnormal
• Means some egg without fertilize, some not
divide @normal size ,some embryo stop growing
• Even embryo grow normally in lab but may not
get pregnant
• Some embryo genetical abnormality- testing
possible PST but not routinely done
• Best are transfered using look under microscope

22. • We take great care of all eggs , embryos sperm
in lab but many reasons why pregnancy not
happen with IVF
• Eggs may fail to fertilze
• 1 or more eggs to fertilize abnormally leads to
abnormal no. of chromosomes in embryo. These
cannot transfered
• Fertilized eggs may fall apart before dividing
into embryo or embryo may not develop
normally
• Rare- eggs/embryo harmed by bacteria @ lab

23. • Lab equipment failure, poweroff- leads to
destruction of eggs/embryo
• Quality control – running test lab contition are
best , can help embryo grow
• System in lab frequently checked to optimal
• Some times immature or abnormal eggs , or
embryo that have not developed normally can be
used for quality control check before discarded

24. Embryo transfer
• After few days of development , embryo transfer
takes place
• One or more embryo transfer to uterus using
thin tube (catheter)
• Ultrasound – catheter
• Confirm placement to cervix& into uterus
• Some rare risk- infection, loss of
embryo(s),damage to embryo

25. • Not all embryo become pregnancies & not all
pregnancies are normal / grow in correct place-
tubal pregnancies

28. • No. Of embryos tranfered is very important
decision
• Woman age and quality of embryo affects both
the chance of pregnancy as well as chance for
multiple embryo to implant
• If multiple embryo implant, multiple pregnancy
(twins, triplets,or more) ‘ll result
• In some cases, embryo can split to 2 (identical
twins) after transfer
• Before transfer, discuss with doctor

29. Hormonal support of uterine lining
• For pregancy to )occur, the embryo(s) must
attached to lining of uterus- IMPLANTATION
• Implantation has better chance of happening if
you take extra progesterone hormone

30. Risks to women
• Ovarian hyperstimulation syndrone(OHSS)
• CANCER
• Risks of pregnancy

32. Risks to baby
• IVF babies may be at a slightly higher risk for
birth defect /genetic defect
• IVF has a greater chance of multiple
pregnancy,even when only one embryo transfer
• A multiple pregnancy is the greatest risk to your
baby when using IVF

33. BIRTH DEFECT
• The risk of birth defects through normal birth is
about 4.4 %, and it is about 3% for severe birth
defects. In IVF babies, the risk for any birth
defect is about 5.3%, while the risk for a severe
birth defect is about 3.7%. Most of the increased
risk with IVF seems to be due to older mothers
and to having infertility. No higher risk is seen in
frozen embryo or donor egg cycles.