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In Vitro Fertilization

We Are:
Surya P Kannan
Monu Varghese
Flora Philip
Bijily Thomas
Vincy Francis
Blessy Thomas
Elma Simon
Vanita Sharon

I.V.F.
In
Vitro
Fertilization
Test tube babies
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IVF
In vitrofertilisation (IVF) is a process by
which an egg is fertilised by sperm outside
the body: in vitro. IVF is a major treatment
for
infertility when
other
methods
of assisted reproductive technology have
failed.

Louise Brown, 1978

Dr Robert G Edwards, IVF


pioneer
I wanted to find out exactly who was in
charge, whether it was God Himself or
whether it was scientists in the laboratory.
And what did he conclude?
"It was us," he smiles triumphantly.

Today there are more than 3 million


IVF babies

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Success rate of IVF?


Success rates vary and are often
exaggerated
To attract more clients
Probably around 20-25% successful

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How much does it cost?


Average cost of total treatment
$10,000 - $25, 000 (American dollars)
Industrygenerates$2billionperyear.

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Let us Review

Femalereproductivesystem

Malereproductivesystem

NormalFertilization

IVF: In vitro
fertilization

In vitro: in glass

Fertilization: Ova + Sperm

Basic Principle of

Hormonal
treatment
Female
Harvest
theovum
MatureOva

Mixinatesttube
Motilesperms

Keepto
develop
embryo

Collectsemen

Natural
ejaculation

Male

Transfer
tomother

Hormonal Treatmen
Drugscurrentlyinuseinclude:
clomiphenecitrate(Clomid,Serophene)
humanmenopausalgonadotropin(hCG)
gonodotropinreleasinghormone(GnRH)analogcalled
leuprolide(Lupron)
Mostofthesedrugsmaybeusedaloneorina
combinationwithothers.

THE TECHNIQUE OF IVF


There are generally four major steps in the
process of IVF:
1. Collect eggs from the woman
2. Obtain sperm from the man
3. In the laboratory place eggs and sperm together
to allow for fertilization, to create embryos.
(ICSI-Intra-cytoplasmic sperm injection since
1990s.)
4. Transfer embryos into uterus of woman
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THE TECHNIQUE OF IVF

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1. Collect eggs from the woman


The woman is given drugs to hyperovulate (produce many eggs). The drugs
can cause side effects such as abdominal
pain, nausea etc.

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Egg Harvest
1. UltraSoundGuidedAspiration

2. Laproscopy

2. Obtain sperm from the man


Obtaining sperm
Sometimes donor sperm may be used

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3. In the laboratory place eggs and sperm


together to allow for fertilization, to create
embryos
Embryos are created in the laboratory (the
test tube) thus human fertilization occurs
apart from sexual intercourse and outside
the human body.

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4. Transfer embryos into uterus of


woman
Many embryos implanted in mothers womb
(usually 2-4) to increase chance of pregnancy.
Should too large a number of embryos start to
grow, the excess embryos are usually aborted
(called pregnancy reduction).

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Oocyteswith
granulosacells

"Naked"Oocyte

8-cellembryofortransfer

Blastocystfortransfer

Implantation

FourteenDaysafterInitialCellDivision

ViableFetus

AfterBirth

Alternates of IVF
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 mans sperm to fertilize there.
Zygote intrafallopian transfer (ZIFT): ZIFT is tubal
embryo transfer in which a womans eggs are taken
from her ovaries, fertilized in the laboratory, and put
back in the fallopian tubes rather than the uterus.

Alternates of IVF
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)

Alternates of IVF
ICSI
Standsforintracytoplasmicsperminjection.This
processisusedtoinjectasinglespermintoeachegg
beforethefertilizedeggsareputbackintothewoman's
body.Theproceduremaybeusedifthemalehasalow
spermcount.

Alternates of IVF
CryopreservationofOva,SpermandEmbryo

Risks
SuperovulationStimulatesEggDevelopment
OvarianHyperstimulationSyndrome(OHSS)

1. There may be a failure to recover an egg


because:
- follicles that contain mature eggs may not
develop in the treatment cycle
2. - ovulation has occurred before time of egg
recovery
- one or more eggs cannot be recovered
- pre-existing pelvic scarring and/or technical
difficulties prevent safe egg recovery
3. The eggs that are recovered may not be normal;

4. There may be insufficient semen to attempt fertilization


of the recovered eggs because the man is unable to
produce a semen specimen, because the specimen
contains an insufficient number of sperm to attempt
fertilization, because the laboratory is unable to
adequately process the specimen provided, or because
the option to use a donor sperm as a "backup" was
declined;
5. Fertilization of the eggs to form embryos may fail even
when the egg(s) and sperm are normal;
6. The embryos may not develop normally or may not
develop at all. Embryos that display any abnormal
development will not be transferred;

7. Embryo transfer into the uterus may be


difficult/impossible, or implantation(s) may not
occur after transfer, or the embryo(s) may not
grow or develop normally after implantation;
8. Any step in the IVF-ET process may be
complicated by unforeseen events, such as
hazardous or catastrophic weather, equipment
failure, laboratory conditions, infection, human
error and the like.

Normalresults
Success rates vary widely between clinics and between
physicians performing the procedure and implantation does
not guarantee pregnancy. Therefore, the procedure may
have to be repeated more than once to achieve pregnancy.
However, success rates have improved in recent years, up
from 20% in 1995 to 27% in 2001.

Abnormalresults
An ectopic or multiple pregnancy may abort spontaneously
or may require termination if the health of the mother is at
risk. The number of multiple pregnancies has decreased in
recent years as technical advances and professional
guidelines have led to implanting of fewer embryos per
attempt.

Ethics
Bypassingthenaturalmethodof
conception.
Thecreationoflifeinthelaboratory.
Fertilizationofmoreembryosthanwillbe
needed.
Discardingofexcessembryos.
Unnaturalenvironmentforembryos.
Useofuntestedtechnology.

Ethics
Notaffordableformany.
Misallocationofmedicalresources.
Creationofembryos,thenfreezingthem,and
keepingthem"inlimbo".
Exposureofembryostounnaturalsubstances.
Destructionofembryosinresearch.
Potentialtocreateembryosformedical
purposes.
Potentialtoselectembryos(PGD).

Ethics
Potentialtomodifyembryos.
Facilitationoftheideathatembryosare
commodities.
FinancialrewardsforIVFdoctorsdissuade
themfromrecommendingothermethodsto
couples.
Infertilityistreatedasadiseaseandnotasa
symptomofunderlying
medicalproblems.

Ethics
Separatingthetraditionalmother-father
model
Pregnancypastmenopause
Religious objections

Why religions are against this?

Why the Church says NO to IVF


1. Separation of the unitive-procreative
dimension of the conjugal act

The inseparable connection:


union and procreation
Religionss teaching on marriage and human procreation
affirms the inseparable connection, willed by God and
unable to be broken by man on his own initiative,
between the two meanings of the conjugal act: the
unitive meaning and the procreative meaning.
By safeguarding both these essential aspects, the unitive
and the procreative, the conjugal act preserves in its
fullness the sense of true mutual love and its ordination
toward man's exalted vocation to parenthood
Humanae Vitae 12

2. Massive destruction of human life


Currently the number of
embryos sacrificed, even
in the most technically
advanced centers of
artificial fertilization,
hovers above 80%.
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(Footnote 27, Dignitas Personae)

3.Thechildmustbeagiftnotaproduct
Thechildhastherighttobethefruitof
thespecificactoftheconjugalloveofhis
parents.

The child becomes a manufacturing


product and not a gift
A child cannot be desired or conceived
as the product of an intervention of
medical or biological techniques; that
would be equivalent to reducing him to an
object of scientific technology. Donum
Vitae II,B,4,c

Product

Genetic testing
A kind of quality control selection
Where is it going?
To create the perfect baby disease free,
blond hair, blue eyed, good footie player

Although the manner in which human


conception is achieved with IVF cannot be
approved, every child which comes into
the world must in any case be accepted as
a living gift of the divine Goodness and
must be brought up with love.
Donum Vitae II, B5

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You formed
my inmost being;
you knit me in my
mother's womb.
Fearfully and
wonderfully
made!
Psalm 139

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Thank you