This document summarizes factors that can affect in vitro fertilization (IVF) success rates based on an evidence-based review. It discusses patient preparation including hormonal and ultrasound screening, surgery for fibroids or endometriosis, vitamin supplementation, weight control, and screening for thrombophilia and immunological factors. It also discusses stimulation regimens, monitoring approaches, laboratory aspects such as sperm preparation and embryo culture conditions, embryo selection techniques, embryo transfer procedures, and ancillary treatments though some treatments like immunotherapy have no conclusive evidence of benefit. The overall goal is to optimize each step of the IVF process based on the best available evidence to improve pregnancy and live birth rates.
In-vitro fertilization (IVF) is a process by which oocytes are fertilized by sperm outside the women’s womb, in vitro. It still represents one of the most exciting modern scientific developments and continues to have a tremendous impact on
people's lives.
Here, we will discuss all about the embryo development inside the dish.
Also we discuss which embryo to choose for transferring into female's uterus.
In Vitro Fertilization (IVF) ovarian stimulation protocols - Assisted reprodu...Anu Test Tube Baby Centre
Presentation given in 2016 on protocols used for ovarian stimulation when undertaking in vitro fertilization (IVF) for management of infertility when using assisted reproductive technologies.
Intrauterine insemination versus fallopian tube sperm perfusion in non tubal ...Internet Medical Journal
Background: Controlled ovarian hyper stimulation (COH) combined with intrauterine insemination (IUI), using a volume of 0.5 mail of inseminate is commonly offered to couples with non tubal infertility. Another method is Fallopian tube sperm perfusion (FSP) which is based on a pressure injection of 4 ml of sperm suspension while attempting to seal the cervix to prevent semen reflux. This technique ensures the presence of higher sperm density in the fallopian tubes at the time of ovulation than standard IUI. The aim of this study was to compare the efficiency of IUI and FSP in the treatment of infertility.
Methods: 200 consecutive patients with infertility in 404 stimulated cycles were included in the study. Those randomized to standard IUI included 100 patients in 184 cycles [158 Clomiphene citrate/human menopausal gonadotrophin cycles and 26 Letrozole/FSH cycles exclusively for polycystic ovarian disease patients] (group A). Patients subjected to FSP included 100 patients in 220 cycles (193 Clomiphene citrate/human menopausal gonadotrophin cycles and 27 Letrozole/FSH cycles exclusively for polycystic ovarian disease patients] (group B). Swim up semen preparation technique was used in all cases. Insemination was performed in both groups 34-37 hours after hCG administration. Standard IUI was performed using 0.5 ml of inseminate. In FSP 4ml inseminate was used.
Results: In group A (184 IUI cycles in 100 patients), 22 clinical pregnancies (presence of gestational sac with fetal cardiac activity) occurred (11.95% per cycle over four cycles). In group B, (220 cycles of FSP in 100 patients), 48 clinical pregnancies occurred (21.81%per cycle over four cycles) and this difference was statistically significant (p<0.05).
Conclusions: For non-tubal sub fertility, the results indicate clear benefit for FSP (Fallopian tube sperm perfusion) over IUI (Intrauterine insemination).
Key Words: Intrauterine insemination, Fallopian tube sperm perfusion, Non-tubal infertility.
Authors: Dr. Col (Retd) G S Shekhawat, MD(Obst & Gyn) * (Corresponding. Author), Dr Priyanka S, MBBS+
In-vitro fertilization (IVF) is a process by which oocytes are fertilized by sperm outside the women’s womb, in vitro. It still represents one of the most exciting modern scientific developments and continues to have a tremendous impact on
people's lives.
Here, we will discuss all about the embryo development inside the dish.
Also we discuss which embryo to choose for transferring into female's uterus.
In Vitro Fertilization (IVF) ovarian stimulation protocols - Assisted reprodu...Anu Test Tube Baby Centre
Presentation given in 2016 on protocols used for ovarian stimulation when undertaking in vitro fertilization (IVF) for management of infertility when using assisted reproductive technologies.
Intrauterine insemination versus fallopian tube sperm perfusion in non tubal ...Internet Medical Journal
Background: Controlled ovarian hyper stimulation (COH) combined with intrauterine insemination (IUI), using a volume of 0.5 mail of inseminate is commonly offered to couples with non tubal infertility. Another method is Fallopian tube sperm perfusion (FSP) which is based on a pressure injection of 4 ml of sperm suspension while attempting to seal the cervix to prevent semen reflux. This technique ensures the presence of higher sperm density in the fallopian tubes at the time of ovulation than standard IUI. The aim of this study was to compare the efficiency of IUI and FSP in the treatment of infertility.
Methods: 200 consecutive patients with infertility in 404 stimulated cycles were included in the study. Those randomized to standard IUI included 100 patients in 184 cycles [158 Clomiphene citrate/human menopausal gonadotrophin cycles and 26 Letrozole/FSH cycles exclusively for polycystic ovarian disease patients] (group A). Patients subjected to FSP included 100 patients in 220 cycles (193 Clomiphene citrate/human menopausal gonadotrophin cycles and 27 Letrozole/FSH cycles exclusively for polycystic ovarian disease patients] (group B). Swim up semen preparation technique was used in all cases. Insemination was performed in both groups 34-37 hours after hCG administration. Standard IUI was performed using 0.5 ml of inseminate. In FSP 4ml inseminate was used.
Results: In group A (184 IUI cycles in 100 patients), 22 clinical pregnancies (presence of gestational sac with fetal cardiac activity) occurred (11.95% per cycle over four cycles). In group B, (220 cycles of FSP in 100 patients), 48 clinical pregnancies occurred (21.81%per cycle over four cycles) and this difference was statistically significant (p<0.05).
Conclusions: For non-tubal sub fertility, the results indicate clear benefit for FSP (Fallopian tube sperm perfusion) over IUI (Intrauterine insemination).
Key Words: Intrauterine insemination, Fallopian tube sperm perfusion, Non-tubal infertility.
Authors: Dr. Col (Retd) G S Shekhawat, MD(Obst & Gyn) * (Corresponding. Author), Dr Priyanka S, MBBS+
Indivisualization of Ovulation Induction - Dr Dhorepatil BharatiBharati Dhorepatil
IVF started to develop fast with the aim of maximizing pregnancy rates per cycle
Higher number of oocytes and thus more embryos
Use of unphysiological high doses of gonadotropins
Time consuming protocols
Higher costs
Patient discomfort
Higher risk of OHSS
Very high risk of multiple gestation
Optimal Timing of Oocyte Preincubation for Intra Cytoplasmic Sperm Injection ...theijes
IN Vitro Fertilization (IVF) i.e. fertilizing an oocyte with the sperm under in vitro condition is the most convincing option for treating infertility in the couples in which conception is not possible with conventional treatments. It is achieved either by co-culturing oocyte with sperms (conventional IVF) or by injecting single sperm in the cytoplasm of oocyte (Intra Cytoplasmic Sperm Injection - ICSI). The cultured embryos are then transferred from day2 to 4 (cleavage stage) or day 5 (blastocyst stage) in the uterus of the woman under treatment for implantation. The benefit of in vitro oocyte culture prior to insemination during conventional IVF has been demonstrated; however there are discrepancies about its advantage during ICSI procedure. We undertook this work to examine the effect of duration of pre-incubation on the rate of fertilization after ICSI. This work was carried out by making the retrospective analysis of data regarding oocyte pre incubation accumulated at Niramaya IVF Center during June 2010 to December 2015.ICSI cycles were categorized in to 5 different groups according to the duration of oocyte incubation period prior to ICSI as : Group I - oocytes not incubated, Group II - oocytes incubated between 1-3 hours, Group III- oocytes incubated between 3-5 hours, Group IV - oocytes incubated between 5-7 hours and Group V - oocytes incubated formore than 7 hours. It was observed that rate of fertilization varies with the duration of pre-incubation of oocyte prior to ICSI. We concluded that in vitro culture of oocyte for short duration prior to ICSI has beneficial impact on fertilization.
Why we need to predict?
Hormone defects may cause severe neurological, metabolic or cardiovascular consequences and lead to the early onset of osteoporosis
Psychological Depression
Low levels of self esteem and Life satisfaction
Sexual Dysfunction
Ridge IVF is palce for Infertility Treatment in Delhi/NCR with team of best Infertility Specialist. Female infertility treatment Delhi, male infertility treatment Delhi, Infertility Specialist in Delhi, In Vitro Fertility, IVF Doctors Delhi, IVF Specialist Delhi, infertility hospital Delhi.Our Clinic is North India's leading chain of fertility centers providing comprehensive male and female infertility treatment "
We provide a wide variety of infertility treatments, from basic infertility care to advanced infertility treatment at our state of the art centers in india. We have three tertiary care infertifilty treatment centers in India, conveniently located in North and South Delhi.
Ovarian reserve tests provide an indirect measure of the cohort of recruitable antral follicles present in the FSH window at the beginning of each menstrual cycle..Functional Ovarian Reserve
This presentation consist brief introduction about the IVF (In-vitro fertilization) in humans.
There are more than 15 slides which gives you basic study about the history of IVF, causes of IVF, basic steps involved in IVF process, ethical issues and etc.
Hope it will help you and make you easy to understand the IVF.
Indivisualization of Ovulation Induction - Dr Dhorepatil BharatiBharati Dhorepatil
IVF started to develop fast with the aim of maximizing pregnancy rates per cycle
Higher number of oocytes and thus more embryos
Use of unphysiological high doses of gonadotropins
Time consuming protocols
Higher costs
Patient discomfort
Higher risk of OHSS
Very high risk of multiple gestation
Optimal Timing of Oocyte Preincubation for Intra Cytoplasmic Sperm Injection ...theijes
IN Vitro Fertilization (IVF) i.e. fertilizing an oocyte with the sperm under in vitro condition is the most convincing option for treating infertility in the couples in which conception is not possible with conventional treatments. It is achieved either by co-culturing oocyte with sperms (conventional IVF) or by injecting single sperm in the cytoplasm of oocyte (Intra Cytoplasmic Sperm Injection - ICSI). The cultured embryos are then transferred from day2 to 4 (cleavage stage) or day 5 (blastocyst stage) in the uterus of the woman under treatment for implantation. The benefit of in vitro oocyte culture prior to insemination during conventional IVF has been demonstrated; however there are discrepancies about its advantage during ICSI procedure. We undertook this work to examine the effect of duration of pre-incubation on the rate of fertilization after ICSI. This work was carried out by making the retrospective analysis of data regarding oocyte pre incubation accumulated at Niramaya IVF Center during June 2010 to December 2015.ICSI cycles were categorized in to 5 different groups according to the duration of oocyte incubation period prior to ICSI as : Group I - oocytes not incubated, Group II - oocytes incubated between 1-3 hours, Group III- oocytes incubated between 3-5 hours, Group IV - oocytes incubated between 5-7 hours and Group V - oocytes incubated formore than 7 hours. It was observed that rate of fertilization varies with the duration of pre-incubation of oocyte prior to ICSI. We concluded that in vitro culture of oocyte for short duration prior to ICSI has beneficial impact on fertilization.
Why we need to predict?
Hormone defects may cause severe neurological, metabolic or cardiovascular consequences and lead to the early onset of osteoporosis
Psychological Depression
Low levels of self esteem and Life satisfaction
Sexual Dysfunction
Ridge IVF is palce for Infertility Treatment in Delhi/NCR with team of best Infertility Specialist. Female infertility treatment Delhi, male infertility treatment Delhi, Infertility Specialist in Delhi, In Vitro Fertility, IVF Doctors Delhi, IVF Specialist Delhi, infertility hospital Delhi.Our Clinic is North India's leading chain of fertility centers providing comprehensive male and female infertility treatment "
We provide a wide variety of infertility treatments, from basic infertility care to advanced infertility treatment at our state of the art centers in india. We have three tertiary care infertifilty treatment centers in India, conveniently located in North and South Delhi.
Ovarian reserve tests provide an indirect measure of the cohort of recruitable antral follicles present in the FSH window at the beginning of each menstrual cycle..Functional Ovarian Reserve
This presentation consist brief introduction about the IVF (In-vitro fertilization) in humans.
There are more than 15 slides which gives you basic study about the history of IVF, causes of IVF, basic steps involved in IVF process, ethical issues and etc.
Hope it will help you and make you easy to understand the IVF.
Human rights begin with child rights. These
rights are: 1. Subsistence rights 2. Development rights 3.
Protection rights 4. Participation rights. A Child is defined as a
every human being below the age of 18 years. In India, many of
these feeble hands, instead of carrying books are often bruise in
factories of pan, bidi, cigarettes (21%), construction (17%),
domestic workers (15%), spinning & weaving (11%), apart from
brick kilns (7%) dhabas (6%) auto workers (4%) ,paddy-fields
and football making etc. Punjab has an alarmingly low under-5
sex ratio(846:1000) and the lowest sex ratio at birth(832:1000). It
also has 1,77,268 child laborers. Among all reported feticides,
56% are registered in Madhya Pradesh, Chattisgarh and Punjab.
Crime against children saw a 24% increase; from 26,694 cases in
2010 to 33,098 cases in 2011. Rape cases increased by 30%,
feticide by 19% while buying of girls for prostitution declined by
65%. There is an increase of 10.5% in juvenile crimes from
2010(22,740) to 2011(25,125). As a result of such forced labor,
children are often subjected to malnutrition, impaired vision,
deformities and easy victims of deadly diseases like Tb, Cancer
and AIDS.
Ovarian reserve refers to the reproductive potential left within a woman's two ovaries based on number and quality of eggs. Diminished ovarian reserve is the loss of normal reproductive potential in the ovaries due to a lower count or quality of the remaining eggs
this presentation highlights the principles of uterine and ovarian transplantation. It explores the past and examines the current status for uterine and ovarian factor infertility.
Role of Multivitamins & Antioxidants in Managing Male Infertility Sujoy Dasgupta
Dr Sujoy Dasgupta was invited to deliver a talk on "Role of Multivitamins & Antioxidants in Managing Male Infertility " in a CME organized by Agartala Obstetric and Gynaecological Society and ArEx Laboratory held at Agartala on 8 July 2023
1. Gab Kovacs
International Medical Director, Monash IVF
Hawthorn Victoria, Australia
Declared speakers fees from MSD and Bayer; being a stakeholder in Monash IVF, ISIS
FERTILITY ACT
2. L1: In vitro fertilization and factors affecting success
Professor Gab Kovacs AM,
International Medical Director,
Monash IVF
3.
4.
5.
6.
7. How to improve your ART
success rates?
• Based on an “Evidence Based Review”
• 48 Chapters- each written by a leading expert
• Written in late 2010
• Published by Cambridge University Press
8. Possible factors
• Patient preparation
• Stimulation Regimens
• Monitoring
• Laboratory aspects
• Embryo transfer
• Ancillary treatment
10. Patient preparation (1)- Hormonal
screening and Ultrasound
• AMH-
– predicts ovarian response
– Warns of likely OHSS
– Can be measured any time in cycle
• Thyroid screening
• Pelvic ultrasound
– Antral follicle count (AFC)
– Uterine abnormalities- fibroids, polyps, senechiae
11. Patient preparation (2)- surgery
• Hysteroscopy- If pathology suspected
• Fibroids-
– Submucous – Definite
– Intramural- Maybe
– Subserous- no
• Laparoscopy- not routinely
– If hydrosalpinges present
• Salpingectomy and tubal occlusion performed prior to
the IVF treatment improve subsequent pregnancy
rates
– Endometrioma/ Dermoids
• May be beneficial to remove
12. Patient preparation (3)-
Vitamins and other nutrients
• There is evidence on the effects of folic acid
and iodine supplementation preconception
and during pregnancy.
• There is limited evidence as to the effect of
other micronutrients on improving pregnancy
rates and obstetric outcomes.
13. Patient Preparation (4) Weight
control
• Thinness and obesity have a negative impact
on reproduction.
• Not just for getting pregnant but staying
pregnant and having a healthy child.
• Weight control and/or reduction will improve
chances of success
14. Patient preparation (5)-
Thrombophilia screening
• Haematological- suggested tests:
– Protein C, Protein S
– Antithrombin
– Lupus anticoagulant
– Anti Cardiolipinis
– Factor 5 Leyden
– Prothrombin Gene mutation
– Fasting homocysteine
– Full Blood Examination /platelet count
16. Patient preparation (7)
Immunological Screening :NK
Cells
• NK cells are lymphocytes with a CD3-CD56+ phenotypic profile
• produce cytokines (IFN-γ, TNF-β, IL-10, and GM-CSF).
• Can be tested in Blood or Endometrium-
– What is “normal”
• treatment with immune therapy (on an empirical basis) is not
necessarily confined to women with high NK cells
• No conclusive evidence for any benefit
17. Conclusion: Immunological/
Thrombophilia
• No good evidence that these factors are
significant
• No definite evidence that treatment of any of
these factors improves outcomes
• (steroids, anticoagulants, albumin, intralipid)
18. Patient Preparation (7)- Metformin in
PCOS
• The current evidence would support the use
of metformin as an adjunct to IVF treatment
– particularly in the context of the long agonist
protocol.
– as adjunct to the short antagonist protocol
requires further clarification.
• metformin may not necessarily improve the
„take home baby rate‟ but reduces the
incidence of moderate-severe OHSS
20. Stimulation Regimens
• No significant difference between Agonist and
Antagonist
• Marginal benefits for hMG vs rFSH
• Pretreatment with OC
– Benefits exceed disadvantages
21. Stimulation regimens- poor
responders
• DHEA-
• Limited evidence that DHEA may improve
oocyte numbers ?quality
• LH addback-
• Maybe some subgroups
• Growth Hormone
• Some evidence for benefit. RCT in progress
22. Rationale for using LH “add-back”
• FSH and LH both secreted in natural ovulatory cycle
• During natural menstrual cycles, FSH levels initially rise and
then, primarily under the influence of oestradiol, decline,
whereas LH is secreted in pulses, rising during the mid
follicular phase of the cycle.
• With the use of
– rFSH
– Agonist/antagonist protocols, levels of LH very low (<1.2IU/L)
23. Summary- role of LH addback
• In women with HH, it is generally accepted that LH supplementation is
needed for normal, healthy follicular development and oocyte
maturation.
• In a general population of normogonadotrophic women undergoing ART,
irrespective of whether a GnRH agonist or GnRH antagonist is co-
administered, the addition of r-hLH to treatment protocols does not
appear to provide any additional benefits.
• Subgroups of normogonadotrophic women who may receive benefit
from r-hLH supplementation for IVF and ICSI include the following:
– women aged ≥35 years and
– women who are hyporesponsive to FSH.
The latter group of women may be further identified by specific genetic
biomarkers that are currently being investigated.
25. Monitoring
• optimized by adopting an individualized, patient-
centred approach to COH.
• selection of
– appropriate COH protocol,
– close monitoring of follicle growth and serum E2 levels,
– adjustment of gonadotrophin dose to avoid hyper-response,
– individualized timing of hCG injection.
• This approach to IVF can
– improve oocyte and embryo quality, pregnancy and implantation rates,
– minimizes the risk of OHSS
26. Monitoring
• No evidence that intensive monitoring gives
better results than a “minimalist” approach
28. Laboratory aspects
–Sperm preparation and selection
–Culture media and culture of embryos
–Extended culture
–Embryo selection
• Metabolomics
• Morphokinetics
–Assisted hatching
–PGD
29. Laboratory aspects
–Sperm preparation and selection
–Culture media and culture of embryos
–Extended culture
–Embryo selection
• Metabolomics
• Morphokinetics
–Assisted hatching
–PGD
30. Sperm preparation
• Only use ICSI if indicated
• Use most viable, motile, functional
spermatozoa- IMSI Feldberg
• Discontinuous gradient centrifugation or a
new electrophoretic approach
• Select least damaged DNA containing
31. Laboratory aspects
–Sperm preparation and selection
–Culture media and culture of embryos
–Extended culture
–Metabolomics
–morphokinetics
–Assisted hatching
–PGD
32. Addition of Co-factors
• Has the potential to improve the development of
zygotes to the blastocyst stage
• Might mimic the autocrine and paracrine factors
• Perhaps the use of microfluidic culture systems
would be more applicable
• Much research and controlled studies are required
before these co factors can be routinely used
33. Laboratory aspects
–Sperm preparation and selection
–Culture media and culture of embryos
–Extended culture
–Embryo selection
• Metabolomics
• Morphokinetics
–Assisted hatching
–PGD
34. Embryo Transfer- cleavage or
blastocyst
• When laboratory conditions are not ideal, then it
would be more appropriate to place the embryos
into the uterus sooner than later.
• The available literature indicate that embryo
transfer on day 5 is associated with better
outcomes
• Day 5 ET the preferred option with increasing move
to single embryo transfer
35. Laboratory aspects
–Sperm preparation and selection
–Culture media and culture of embryos
–Extended culture
–Embryo selection
• Metabolomics
• Morphokinetics
–Assisted hatching
–PGD
36. Metabolomics-
• a non-invasive assessment of embryo culture media
to aid in the prediction of embryo viability.
• determine more subtle embryo characteristics
• rapid metabolic or metabolomic assessment tool will
be part of the routine procedure used to select an
embryo for transfer.
37. • Theory: the differences between viable and sub-viable
embryos are reflected by metabolism activity.
• Take a small sample of the culture medium where the
embryo has been growing, and measure amino acids, etc.
38. • Eg: glucose, pyruvate, amino amino acids.
• Currently several methods being trialled to
measure these molecules. Most popular is
Near Infrared Spectoscopy (NIR).
• Expected time-frame for commercial
availability: 1-2 years.
39. Laboratory aspects
–Sperm preparation and selection
–Culture media and culture of embryos
–Extended culture
–Embryo selection
• Metabolomics
• Morphokinetics
–Assisted hatching
–PGD
43. Could time-lapse embryo imaging
reduce the need for biopsy and
PGS?
Swain JE. J Assist Reprod Genet. 2013 Jul 11.
Multiple morphologic endpoint assessments
and developmental timings and refinement
of modeling systems may improve the
predictive ability to determine embryonic
aneuploidy.
44. Possible factors
• Patient preparation
• Stimulation Regimens
• Monitoring
• Laboratory aspects
• Embryo transfer
• Ancillary treatment
45. Embryo transfer
• Dummy transfer beneficial
• Position-mid fundus
• Ultrasound monitoring
• Catheter soft but malleable
• Bed rest- no help
• Intercourse may help
48. Immunological/ Thrombophilia
• The best randomized controlled trials do not
support the use of heparin and aspirin in aPL
positive patients with IVF failure.
49. Hormone Supplements
• On the basis of the currently best available
evidence:
• The addition of E2 supplementation in the
luteal phase does not improve IVF outcomes in
long protocol/antagonist cycles.
– excluding antagonist trigger
50. Prednisolone
• Normal IVF patients do not significantly
improve their chances of pregnancy when
subjected to additional glucocorticoid
treatment in the IVF cycle.
• In patients who present a previous
autoimmune pathology and in whom it does
seem that corticoid treatment might be
beneficial.