IVF is the process of fertilization by extracting eggs, retrieving a sperm sample, and then manually combining an egg and sperm in a laboratory dish. The embryo(s) is then transferred to the uterus. Other forms of ART include gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT).

1. IVF
A blessing to infertile couples
Krupasindhu Dinda
Department of biotechnology
Ravenshaw University

2. Contents
Introduction
History
Infertility
Why IVF?
Steps in IVF
How can we improve the success rate
ethics
references

3. INTRODUCTION
• In Vitro Fertilization (IVF) is a process of fertilization, where egg
is combined with sperm outside the body(In Vitro).
• From the ancient time “Infertility” was considered as a divine
punishment.
• IVf becomes a blessings for the infertile couples.

4. Welter Heape(1855-1929)
He transferred a in-
vivo fertilized egg
from one rabbit to
another (in 1890)

5. He successfully
conduct IVF in rabbit
M.C. Chang(1959)

6. • In 1977 the first IVF pregnancy in human was reported.
• In 1978 world’s first “test tube baby” took birth in England.
• R.G. Edwards got noble prize in “physiology and medicine” for the
development of IVF in 2010.
R.G. Edwards (2010) 25th July 1978 41 years Louise

7. Kanupriya Agarwal (DURGA) DR. Subhash Mukhopadhyay

9. FSH
(+)
FSH=Follicle Stimulating Hormone
Physiology
E2
(-)
E2=Estradiol
Developing follicle

10. Infertility
• Definition: 1 year of well-timed,
unprotected intercourse without a
pregnancy
• 10-14% of population is infertile in
India(27.5 million couples)
• 15-20 % of couples have unexplained
infertility (work-up is negative)

11. Causes of Infertility
Male factors
40%
Female factors
40%
10%
Both
10%
Unidentified

12. Women are
born with
their
lifetime egg
supply
• 4 million at
20 weeks
gestation
• 400,000 at
birth
100,000
eggs left at
time of
puberty
Fertility
initially
declines at
age 27
Significant
decline at
age 37-38
Rare
pregnancies
after age 44
Female Age

13. Female Infertility factors
Ovary
Tubes
Uterus
Cervix
Hormones

14. Abnormality
in sperm
production
Abnormality
in sperm
function
Obstruction
in the ductal
system
Low sperm
count in
semen (less
than 15
million /ml )
Causes of Male
Infertility

16. How many
Sperm are
needed for
fertilization?
• Natural conception
• 20,000,000
• Intra-uterine insemination
• 1,000,000
• In-vitro fertilization (IVF)
• 10,000
• Intra-cytoplasmic sperm
injection (ICSI)
• 1

17. Infertility Treatments
Improve Timing
of Intercourse
• Clomiphene citrate (Clomid) + IUI
• FSH + IUI
Intrauterine
insemination
(IUI)
In Vitro
Fertilization (IVF)

18. Who Needs IVF?
Failed other treatments
Tubal damage
Significant male factor
Absent uterus
Carriers of genetic diseases
Cancer patients
Non-traditional Lifestyles

19. Hormonal
treatment
Female
Harvest
the ovum
Mix in a test tube
Natural
ejaculation
Collect semen
Mature Ova
Motile sperms
Keep to
develop
embryo
Transfer
to mother
Male
Steps of IVF

20. FSH
(+)
FSH=Follicle Stimulating Hormone
How Does Clomid Work To Increase
Egg Number?
E2
(-)
E2=Estradiol
Developing follicle
Clomid

22. Conventional IVF
ICSI

23. EMBRYO (DAY 1 ) 4 CELLED STAGE (DAY 2) 8 CELLED STAGE(DAY 3)
• The eggs remain in the incubator for up to 6 more days after the
fertilization.
• The sign of a fertilization is seen in next day.
• The day 5 after the egg retrieval the normal embryos reach blastocyst
stage and the embryo now has 16 or more cells with an inner fluid
filled cavity.

24. Assisted hatching
• Assisted hatching is done by making a
small slot in the zona pellucida which is a
protective protein coat around the
embryo.
• After which it can be transfer to womb of
patient for implantation.

26. 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
This must be a consensus decision done between a
couple and medical team ,they will advice as per
available embryo quality and the recommended
guidelines.

27. Embryo transfer

28. Pregnancy test
A blood test is done to
detect pregnancy by
measuring the hCG
level in the blood.
Pregnancy detection kit
can be used to detect
pregnancy.

29. What happens to other embryos?

30. Side effects of fertility drugs
Headache
breast tenderness
upset stomach
hot flashes
mood swings
ovarian hyperstimulation syndrome (OHSS)

32. How can we improve IVF success rate
1. Endometrial thickness
2. Endometrial scratching
3. Duration of embryo transfer
4. Position of embryo transfer

33. 18.1
24.6 25.5
33.7
0
5
10
15
20
25
30
35
40
endometrial thickness
LBR%
LBR decreases with Endometrial
thickness
5-5.9
6-6.9
7-7.9
>_8
Al-Ghamdi et al., 2008
Clinical pregnancy and live birth rates decrease for each
millimeter of endometrial thickness below 8mm in fresh IVF
cycles and below 7mm for frozen–thaw IVF cycles. Nevertheless,
viable pregnancy rates remain reasonably acceptable in patients
with an endometrial thickness between 4 and 6mm.

34. How much it costs?
• The average cost for one in vitro fertilization (IVF) cycle is
$12,000 in USA
• The IVF Cost in India (including all surgical and diagnostic procedures, test
and treatments) normally ranges between 1 to 1.25 Lakh per cycle

35. Gamete intrafallopian transfer (GIFT): GIFT is similar to IVF. It is used when a
woman has at least one normal fallopian tube. Eggs are placed in this tube
along with a man’s sperm to fertilize there.
Zygote intrafallopian transfer (ZIFT): ZIFT is tubal embryo transfer in which a
woman’s eggs are taken from her ovaries, fertilized in the laboratory, and put
back in the fallopian tubes rather than the uterus.
Assisted fertilization techniques when not enough sperm are available or sperm
quality is not sufficient to fertilize include the following:
• Partial zona dissection
• Subzonal sperm injection
• Intracytoplasmic sperm injection
• Embryo cryopreservation (frozen fertilized egg and sperm)
Other forms of ART

36. The Ethics of In Vitro Fertilization
• Biologically, a human embryo is a living human being at
its earliest stage of development. The embryo is
dependent on a woman for nurture and life, but it is a
genetically distinct organism, different from both the egg
and sperm that it grew from, and it needs nothing more
than nourishment to grow into a recognizable human
being — a point on which both science and Christianity
agree.
• Therefore, some argue that the destruction of embryos in
the IVF process requires the destruction of human life in
order to create human life.

37. Ethical Questions
At what point should embryos be considered to
have human rights? Is "creating", discarding,
freezing, or manipulating them right?
Should single women be allowed access to IVF
in order to have children? Is there a need for a
father? Should homosexual male or female
couples be allowed access to IVF treatment in
order to have children?

38. How long should embryos be allowed to be frozen?
If they go past that time should they be destroyed?
Should frozen embryos be destroyed if patients
stop paying the storage fees?

39. References
1. Al-Ghamdi A, Coskun S, Al-Hassan S, Al-Rejjal R, Awartani K. The correlation
between endometrial thickness and outcome of in vitro fertilization and embryo
transfer (IVF-ET) outcome. Reprod Biol Endocrinol 2008; 6:37.
2. Abou-Setta AM, Mansour RT, Al-Inany HG, Aboulghar MM, Aboulghar MA, Serour
GI. Among women undergoing embryo transfer, is the probability of pregnancy
and live birth improved with ultrasound guidance over clinical touch alone? A
systemic review and meta-analysis of prospective randomized trials. Fertil Steril.
2007;88:333–41.
3. Buckett WM. A review and meta-analysis of prospective trials comparing different
catheters used for embryo transfer. Fertil Steril. 2006;85:728–34.
4. Singh SS, Suen MW. Surgery for endometriosis: beyond medical therapies. Fertil
Steril 2017;107:549-54.
5. Gunby J, Daya S. Assisted reproductive technologies (ART) in Canada: 2001 results
from the Canadian ART Register. Fertil Steril 2005; 84(3): 590-599

40. Thank you