In vitro fertilisation, abbreviated henceforth as IVF, is an assisted

reproductive technique in which eggs from the woman’s ovaries are

removed, and then fertilised with the man’s sperm in a laboratory
procedure to create an embryo, which is then returned to the woman’s
uterus.
A woman may be given fertility drugs before this procedure so that several
eggs mature in the ovaries at the same time. Eggs are removed from a
woman's ovaries using a long, thin needle. The physician gains access to
the ovaries through laparoscopy or transvaginal insertion.
Once the eggs are removed, they are mixed with sperm in a test tube. The
eggs are monitored for several days. Once there is evidence that
fertilization has occurred, and the cells begin to divide, they are then
returned to the woman's uterus.

IVF and Infertility – Purpose of IVF.

1. Abnormal sperm production or function due to genetic and health

causes.
2. Problems with the delivery of sperm due to sexual problems.
3. Overexposure to certain environmental factors such as chemicals
and radiation
4. Ovulation disorders, which affect the release of eggs from the
ovaries.
5. Uterine or cervical abnormalities which obstruct the formation of the
embryo.
6. Fallopian tube damage or blockage which hinder the path of the
eggs.
7. Primary ovarian insufficiency (early menopause), when the ovaries
stop working and menstruation ends before age 40.

Key Terms

GIFT
Stands for gamete intrafallopian tube transfer. This is a process where
eggs are taken from a woman's ovaries, mixed with sperm, and then
deposited into the woman's fallopian tube.
ICSI
Stands for intracytoplasmic sperm injection. This process is used to inject a
single sperm into each egg before the fertilized eggs are put back into the
woman's body. The procedure may be used if the male has a low sperm
count.
ZIFT
Stands for zygote intrafallopian tube transfer. In this process of in vitro
fertilization, the eggs are fertilized in a laboratory dish and then placed in
the woman's fallopian tube.
PGD
Pre-implantation genetic diagnosis is the genetic profiling of embryos prior
to implantation
PGS/NGS
Pre-implantation genetic screening with next-generation sequencing.

Pros and Cons

 Age: Only ovulating women (usually below 35 years of age) can

expect certain success through IVF.
 Multiple births: Generally, in women who use IVF to establish a live
birth, about 63% are single babies, 32% are twins, and 5% are triplets
or more.
 Cost: IVF is a costly procedure that, in many cases, is not covered by
health insurance plans.
 Safety: Studies suggest that in vitro fertilization is safe. A study
covered nearly 1,000 children conceived through these methods in
five European countries and found that the children monitored from
birth to age 5 years, were as healthy as children conceived naturally.
 Circumvents reproductive medical conditions.
 Helps to prevent single gene disorders from being passed on to the
child via in vitro embryo PGD testing.
 Permits in vitro embryo testing to detect chromosomal deficiencies –
aneuploidy – an extra or missing chromosome through PGS/NGS
testing
  Allows couples to freeze their excess embryos for future Frozen
Embryo Transfers (FET) to assist in cost-effective future family
planning through embryo cryopreservation.
 Provides family planning options for the LGBTQ community using
donor eggs or donor sperm.
 IVF fertility medications cause discomfort and undesirable side
effects.
 IVF cycles require several follow-ups and appointments with
gynaecologists and embryologists.
 IVF procedure is considered unethical by many cultures.

Stages of IVF

 Prior to the IVF Procedure

 Egg Retrieval and Fertilization
 Embryo Transfer
 After Embryo Transfer

Pre-IVF

1. a transvaginal ultrasound of the ovaries and uterus.

2. When the treatment cycle begins, medications known as
gonadotrophins are given daily by injection to promote the maturation
of ovarian follicles containing eggs.
3. Blood tests are carried out to measure hormone levels.
4. When the follicles are mature, the woman administers an injection of
human chorionic gonadotrophin (hCG). It is critical for the success of
the procedure to take this injection at precisely the correct time to
stimulate ovulation.

Egg Retrieval and Fertilization

 1. The egg retrieval procedure is performed 34 to 36 hours after the
hCG injection is given.
2. fluid containing mature eggs from the follicles, which contains the
mature eggs is removed from the woman’s body.
3. Simultaneously, the man provides a semen sample. The sperms are
separated from the semen in the laboratory.
4. The active sperm are combined in the laboratory dish with the eggs.
This is the actual process of in vitro fertilization. In some cases, they
perform ICSI.
5. About 18 hours later, it is possible to determine if eggs have been
fertilized and they have begun to divide into embryos. They are
incubated and observed over the next 2 to 3 days or longer.

Embryo Transfer

1. The embryo transfer to the woman's uterus is typically scheduled 3 to

5 days after the egg retrieval, depending upon the maturation of the
embryos.
2. The number of embryos to be transferred will be decided jointly by
the doctor and the woman herself. This can vary from one embryo to
several.
3. During the procedure, the doctor transfers the embryos into the
woman's uterus through the cervix with a catheter.

Post-IVF

1. The woman is given the hormone progesterone, either as injections

or suppositories. Progesterone administration continues for the next 2
weeks.
2. A pregnancy test is scheduled for two weeks following the embryo
transfer. If implantation is successful (the egg or eggs attach to the
uterine wall and grow), the pregnancy test result should be positive.