In Vitro Fertilisation

1. In Vitro FertilisationIn Vitro FertilisationIn Vitro FertilisationIn Vitro FertilisationTrivaini Patel, Tom Lewis & Umar Hussain
Department of Biosciences and Chemistry, Faculty of Health and Wellbeing, Sheffield
Hallam University. Sheffield S1 1WB, United Kingdom
References: 9. Sunkara, S., La Marca, A., Seed, P., & Khalaf, Y. (2015). Increased risk of preterm birth and low birthweight with very high number of oocytes following IVF: an analysis of
1. Casper, R., Haas, J., Hsieh, T.-B., Bassil, R., & Mehta, C. (2017). Recent advances in in vitro fertilization. F1000Research, 6, 1616. http://doi.org/10.12688/f1000research.11701.1 65 868 singleton live birth outcomes. Human Reproduction, 30(6), 1473-1480. http://dx.doi.org/10.1093/humrep/dev076
2. Gy, Y., Liu, G, H., Belmonte, J, C, I. (2012) Gametogenesis in a dish. Cell research, 1422-1425. Doi:10.1038/cr.2012.84 10. Piñón, R. (2002). Biology of Human reproduction. California: University Science Books.
3. Suter, S, M. (2016). In Vitro Gametogenesis. Just another way to have a baby? Journal of law and biosciences, 87-119. http://doi.org.10.1093/jlb/lsv057 11. Wang. J, Sauer. M.V. (2006). IVF: a review of 3 decades of clinical innovation and technological advancement. The Clin Risk Manaq. 2(4):335-364. Retrieved
4. Van der Ven , K., Montag, M., & van der Ven, H. (2008) Polar body diagnosis- A step in the right direction? Deutsches Arzteblatt International, 10(11), 190-196. http://doi.org/10.3238/arztebl.2008.0190 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1936357/
5. The free dictionary (2007) retrieved from: http://medical-dictionary.thefreedictionary.com%2Foogenes 12. Dr Hicks, R (2016). Fertility Health Centre - IVF costs & access. Retrieved from: https://www.webmd.boots.com/fertility/ivf-costs-and-access
6. Cohlen, B., Bijkerk, A., Van der Poel, S., & Ombelet, W. (2018). IUI: review and systematic assessment of the evidence that supports global recommendations. Human Reproduction Update. http://dx.doi.org/10.1093/humupd/dmx041 13. Human Fertilisation & Embryology authority. 2016. New statistics, retrieved from https://www.hfea.gov.uk/about-us/new-statistics/
7. Karen Gill, M. (2018). In-vitro fertilization (IVF): Procedure, success rate, and risks. Medical News Today. Retrieved 18 February 2018, from https://www.medicalnewstoday.com/articles/262798.php 14. Bing. Y, Ouellette. RJ (2009) Fertilsation in Vitro. Methods Mol Biol. 550:251-66. DOI: 10.1007/978-1-60327-009-0_16
8. Klemetti, R., Sevón, T., Gissler, M., & Hemminki, E. (2005). Complications of IVF and ovulation induction. Human Reproduction, 20(12), 3293-3300. http://dx.doi.org/10.1093/humrep/dei253 15.Healthwise, 2015, IVF for Infertility. Retrieved from: https://www.webmd.com/infertility-and-reproduction/in-vitro-fertilization-for-infertility
Introduction to IVF
In vitro fertilisation (IVF) is an assisted reproduction technique (ART) where human
oocytes are fertilised outside of the body (Bing & Ouellette, 2009), developed by
Steptoe & Edwards in 1978 (Piñón, 2002). Lesley Brown was a patient with 9 years
primary infertility secondary to tubal occlusion and underwent the first successful
procedure at Oldham General Hospital, England (Wang & Sauer, 2002). At this time
IVF was completely experimental, moreover previous attempts had resulted in
miscarriage and ectopic pregnancies. Lesley Brown had a single egg fertilised and
the embryo transfer resulted in the first live birth from IVF as daughter Louise
Brown was born in July 1978 (Wang & Sauer, 2002)
Since the development and original introduction of IVF in 1978 millions of
procedures have been performed and babies born worldwide. In 2015 281,438 IVF
babies born in the UK compared to a reduced 186,372 IVF babies in 2010 according
to Human Fertilisation & Embryology Authority, HFEA.
The development and application of IVF and other ARTs is one of the main growth
industries in human reproductive biology and the main alternative for many cases
of infertility in males and females (Piñón, 2002). Modifications of IVF have been
developed, as a result increasing the applicability of IVF to different types of
infertility e.g. gamete intrafallopian transfer (GIFT), using IVF protocol however
oocytes and spermatozoa are transferred directly into uterine tubes for fertilisation
to occur (Piñón, 2002).
In most procedures, 3-4 embryos are transferred in order to increase the probability
of establishing pregnancy to 29-32% from 9% with 1 embryo (Piñón, 2002).
Transferring more embryos does not significantly improve the chances of
establishing pregnancy however it does increase the chance of multiple
pregnancies, moreover carrying significant risks for mother and fetuses.
The success rate of procedures differs and is dependent on many factors including
the skill and experience of clinicians and whether eggs used were frozen, however
the success rate has improved since the original introduction (Bing & Ouellette,
2009) (Piñón, 2002). Success rates for frozen embryo transfers are increasing and
the difference between fresh and frozen pregnancy and birth rates is smaller.
To get IVF, patients can pay themselves or see if they are eligible for treatment on
the NHS however availability of this varies on location in the UK. Prices can vary
from clinic to clinic but the average cost of one IVF cycle including drugs, fertility
tests and consultations can be £5000.
Following the first live birth in 1978, innovations in IVF and ARTs have allowed infertile couples to have children. Major technological advances have led to greater efficiency and success, expanded accessibility of IVF, and moreover
innovations and refinements have introduced modifications e.g. gamete intrafallopian transfer(GIFT) furthermore resulting in greater success rates.
Treatments for infertility such as IVF are being modified and improved with new research and technology. This means the risks associated with this type of treatment has reduced over time and therefore it is likely to be a more viable treatment
option. This will allow more families the chance to have a child if they were unable to do so.
Figure 2. Diagram to show the
standard procedure of IVF and embryo
transfer. (Piñón, 2002)
Oocytes are collected from woman after
artificial stimulation of follicular
development by FSH. Oocytes mixed
with sperm from male and fertilised. The
zygote is cultured in a culture dish
through cleavage and the morula stage
until development to early blastocyst
stage. The blastocyst is transplanted
into the uterus of the female, whose
endometrium has been primed with
oestrogen and progesterone for
implantation. (Piñón, 2002)
RESEARCHAND DEVELOPMENTSIN IVFRESEARCHAND DEVELOPMENTSIN IVFRESEARCHAND DEVELOPMENTSIN IVFRESEARCHAND DEVELOPMENTSIN IVF
USEOF POLARBODIESUSEOF POLARBODIESUSEOF POLARBODIESUSEOF POLARBODIES
IN VITRO GAMETOGENESIS:
The process of in vitro gametogenesis is where
offspring are produced in the absence of gametes
formed by gonads.
In 2016 a scientist in Japan revealed the birth of
mice from egg’s made from human skin cells. The
adult skin cells are reprogrammed to behave like
pluripotent stem cells which are stimulated to grow
into gametes. These gametes can form an embryo
and subsequently be implanted into an adult womb
(Suter, 2016).
PROS:
● No surgery required
● Same sex couples can have a
biological child
● Babies for those with no gametes
● Can help the 10-15% of the
reproductive aged population that
are infertile (Gu & Liu, 2012)
CONS:
● Access to others genetic
information without
consent
● Embryo- farming
concerns
● Devalues human life
1) Polar body diagnosis (PBG) has been
used in the past a diagnose genetic
disorders in oocytes (Van Der Ven,
Montag & Van der Ven, 2008).
2) More recently, scientist have been
exploring the possibilities of using polar
bodies to increase quantity of egg cells
collected in IVF. This requires a second
female required to donate eggs and
incorporate new DNA from the polar
body.
Figure 4: A diagram to show
the process of oogenesis and
demonstrate where polar
bodies are synthesised
(thefreedictionary.com,
2007).
Methods
The most common amongst the
treatment options are IVF treatment.
IVF treatment for women involves the
control of the menstrual cycle.
Medication is given to the patient for a
set amount of time. After this the patient
will be given hormones known as FSH
(Follicle stimulating hormone) to help
increase the amount of eggs that the
ovaries can produce. The patient will be
checked on a regular basis to ensure
that everything in on track and that
there are no side effects for the patient.
The next phase is that the eggs are
collected from the patient by inserting a
needle that will enter through the vagina
and into the ovaries, the eggs are then
fertilised with the partner's sperm or a
donor's sperm. The next step is to
transport the embryo into the patient by
a small tube, known as a catheter this is
then inserted in through the vagina. The
embryo is able to then embed itself and
carry on with the stages of
pregnancy.(Karen Gill, 2018)
Treatment
There are many different types of
infertility treatments from surgery
to medication. One of these
method is Intrauterine insemination
(IUI), which involves placing the
donated sperm into the uterus to
aid fertilisation(Cohlen, Bijkerk,
Van der poel & Ombelet, 2018).
Alongside this, in vitro fertilisation
(IVF), the most common treatment,
is used by removing the egg from
the patient and mixing the sperm
to produce an embryo. The
embryo will be placed back in to
the patient to continue with the
stages of pregnancy.
Risks
● Multiple births
● Miscarriages
● Ovarian
hyperstimulation
syndrome (Klemetti,
Sevon, Gissler and
Hemminki, 2005)
● Low body weight
● Preterm births (Sunkara,
La Marca, Seed and
Khalaf, 2015)
Figure 1. Percentage IVF birth rate (green) and percentage IVF
multiple birth rate (blue). (HFEA)
Overall, birth rates is showing a continued increase. An
explanation of this is due to the types of treatment now available
and the opportunity for older women to seek using IVF. In 2015
ages 35-44 of female patients made up for 54.4% of the total
treatments (HFEA).
Multiple birth rate is showing a continued decline as a result of
clinics implementing focussed multiple birth reduction strategies.