This document provides an overview of IVF and ICSI procedures. It discusses that IVF involves fertilizing eggs with sperm in a lab dish, then transferring embryos into the uterus. ICSI is used for severe male factor infertility and involves injecting a single sperm into each egg. Both aim to increase the chances of fertilization. The document outlines the steps of ovarian stimulation, egg retrieval, sperm preparation, fertilization, embryo culture, and embryo transfer.

1. An overview of IVF/ICSI
DR.RENUKADEVI
SENIOR EMBRYOLOGIST
ARC International Fertility & Research
Centre

2. INFERTILITY?

3. OVERVIEW OF INFERTILITY
• Definition: 1 year of well-timed, unprotected
intercourse without a pregnancy
• 10-15% of population is infertile
• 15-20 % of couples have unexplained
infertility (work-up is negative)

4. CAUSES OF INFERTILITY

6. Assisted Reproductive Techniques (ART)
Any treatment that deals with “means of conception other
than vaginal intercourse” is termed as ART.
NICE guideline 2013
 IUI – Intra Uterine Insemination (Husband /
Donor)
 IVF + ET – In Vitro Fertilization + Embryo transfer
 ICSI – Intra Cytoplasmic Sperm Injection

7. IUI
• Injection of washed prepared sperms into
the uterine cavity through a fine catheter
during pre-ovulatory phase in a natural
or stimulated cycle.
• Although pregnancy may not occur as quickly, a policy of initial
treatment by IUI will probably save 20% of couples from moving
onto IVF
• After 3-4 cycles of failed IUI treatment, patients should be
encouraged to opt for IVF

8. Indications for Intra Uterine Insemination
(IUI)
- At least one Fallopian tube must be normal and
patent
- Mild male infertility
- Unexplained infertility
- Ovulatory dysfunction, PCOS
- Mild endometriosis
- Cervical factors
- Coital problems
- Immunological factors
- HIV, HBs Ag infection
- Donor Sperm

9. SPERM PREPARATION

10. Intrauterine Insemination (IUI)
Goal is to Maximize the Chance of Fertilization
• Increase Number of Eggs
• Position Sperm Closer to Eggs

11. I.V.F.
In
Vitro
Fertilization
“Test tube babies”

12. Indication for IVF
I. IVF as first line infertility treatment
- Tubal pathology (severe, non-repairable)
- Donor Oocyte
- Genetic Surrogacy
- PGD (Possibility of genetically transmitted disease)
- Fertility preservation in cancer patients
- Where ICSI is indicated (Azoospermia)
II. IVF following failed cycles of IUI
- Usually up to six cycles of IUI with controlled
ovarian stimulation are recommended, but there
are situations where couples should move to IVF
earlier.

13. IVF and ET
• In Vitro Fertilization (IVF) and Embryo Transfer (ET) are the basic ART
for all related technology. These include:
- Intra Cytoplasmic Sperm Injection (ICSI)
- Assisted hatching
- Pre-implantation Genetic Diagnosis (PGD)
- Cryopreservation
- Donor oocyte IVF programs
- Donor embryo (genetic surrogacy)
- Intracytoplasmic Morphologically selected
Sperm Injection (IMSI)
- And many more

14. Various steps of an IVF treatment cycle
Pre IVF work-up Ovarian stimulation Monitoring
Preparation of
sperms
Oocyte retrieval
Embryo transfer Luteal Support
Ovulation induction
In Vitro Fertilization

15. EGG RETRIEVAL

16. SPERM PREPARATION

17. CONVENTIONAL -I.V.F.
• Simply put IVF is adding a man's sperm to his
female partners eggs in the laboratory to
produce embryos. In vitro fertilization is an
option for many couples who cannot conceive
through conventional therapies. These
embryos are put back into the female
partner's uterus (womb) after 3 to 5 days of
being in the incubator.

18. CONVENTIONAL -I.V.F.

19. IN VITRO EMBRYO
DEVELOPMENT
COC at the time of
retrieval
M II oocyte with a PB
(Mature)
2 PN embryo
4 cell embryo 8 cell embryo Fully grown blastocyst

20. Intra cytoplasmic Sperm Injection
(ICSI)
• Unprecedented
successful development
of ART which has
revolutionized the
management of severe
male infertility.
• The procedure involves
the direct injection of a
single sperm into the
egg cytoplasm

21. INDICATIONS FOR ICSI
• Sperm completely absent from the ejaculate
(azoospermia)
• Sperm present in low concentrations (oligospermia).
• Poor sperm motility (asthenospermia)
• Poor sperm morphology (teratospermia)
• Sperm retrieved by surgical techniques (for example
TESA, TESE)
• If pre-implantation genetic diagnosis (PGD) is being used
to screen embryos for a specific genetic disorder
• History of fertilization failure in conventional IVF
attempts

22. ICSI

23. IN VITRO EMBRYO
DEVELOPMENT
COC at the time of
retrieval
M II oocyte with a PB
(Mature)
2 PN embryo
4 cell embryo 8 cell embryo Fully grown blastocyst

24. EMBRYO TRANSFER

25. HOW MANY EMBRYOS ARE
TRANSFERRED?
• Related to age and embryo quality
– <35 = 2
– 35-37 = 2-3
– 38-40 = 3-4
– >40 = up to 5
– For patients with 2 or more failed IVF cycles, or a poor
prognosis, can add more based on clinical judgment

26. EMBRYO
TRANSFER

27. EMBRYONIC DEVELOPMENT