Introduction
In vitro fertilisation (IVF) or a test tube baby is one of the assisted reproductive techniques to help couples with infertility problems. When other reproductive technique failed to help the infertility couples, this IVF procedure which involved fertilisation of ovum and sperms outside of the human body will take place.
History
Research on the artificial insemination have started since 1909. However, only in 1965, a Britain scientist, Robert Edward work together with Howard and Georgeanna Jones who worked in IVF in America successfully fertilising the ovum in vitro. Edward have worked with Patrick Steptoe, a Gynecologist in Oldham, England, in order to make a successful human in vitro fertilisation. Steptoe introduce an abdominal laparoscopic surgery to retrieve the ovum.
In 1975, Edward and Steptoe succeed in producing a pregnancy from the in vitro fertilisation. However it was an ectopic pregnancy and results with abortion. Then, in 1977, Steptoe’s patients with blocked tube, Lesley Brown had undergone a surgery to retrieve the ovum. Two days later, the fertilised ovum developed to eight cells have been transferred back to Lesley’s uterus.
On December 1977, Lesley was pregnant with the transferred in vitro fertilised ovum. The test tube baby creates history when she was born in 25th July 1978 and named Louise Joy Brown.
Method
The treatment procedure started with ovarian stimulation to produce follicles. The ovarian hyperstimulation started with age dependent, protocol and the dosage of FSH (follicular stimulating hormone). FSH analogue are generally used under closed monitoring especially 10 days after the injections.
The egg retrieval procedure is performing usually 34 to 36 hours after the hCG (human chorionic gonadotropin) injection. The ovum is retrieved from the patient through the vagina with ultrasound guidance. The follicular fluid will be passed to the embryologist to identify the ovum.
In the lab, the semen is prepared for fertilisation and removing inactive cells and sperm. Sperm and oocyte(ovum) are incubated together for 1 to 4 hours in order for fertilisation to happen. Fertilised oocyte will be observed for the presence of pronuclei and transferred into culture dish for 48 hours until the embryo developed into six to eight cells embryo. A technique of single sperm injected into oocyte (ICSI) is done when male with low sperm count.
Embryo development after fertilisation will be observed until the embryo is transferred into the mother womb through vagina using a fine catheter. Embryologist will observe and documented cells number and percentage of fragmentation. Numbered of embryo transferred depend on the embryo quality, women’s age and other health factor.
Indication
IVF is indicated in female infertility in the women due to problems of the fallopian tube or unexplained infertility for women that have not conceived after 2 years of regular unprotected sexual intercourse.
Successful IVF requires healthy ovum, sperm that can fertilise and a uterus that can maintain a pregnancy. Only after the less expensive (IUI) option has failed, then IVF is suggested to be attempted.
In the case of male infertility, where there is a defect in sperm quality, low count of sperm, difficult in penetrating the egg, ICSI may be used. The use of ICSI procedure has been found to increase the success rates of in-vitro
Complication in IVF Procedure
- Multiple birth
Multiple pregnancies is the major risk of IVF due to the multiple number of embryo transfer. Multiple pregnancies are related to increased risk of pregnancy loss, obstetrical complications, prematurity and neonatal morbidity with the potential for long term damage.
- Birth defect
There is no significant link between birth defect and other fertility treatment like IVF. However there are factors that can affect birth defects, such as mother’s age, race, genetic and environment that influence the development of disorders.
Success rate
The main potential factors that influence pregnancy (and live birth) rates in IVF have been suggested to be maternal age. The optimal woman’s age is 23–42 years at time of treatment.
- Pregnancy
Success rates per age group of the IVF patients are higher in those below 35 years old with 35 % to 45 % successful rates. It decreases as the age of women increased.
- Live Birth
Birth rates in younger patients were slightly higher, with a success rate of 30 % to 35.3 % for those 21 and younger, the youngest group evaluated. Success rates for older patients were also lower and decrease with age, with 37-year-olds at 20 % to 27.4 % and no live births for those older than 48, the oldest group evaluated.
Failure factor
- Stress
Stress might not influence IVF outcome, but it is possible that the experience of IVF or infertility can result in stress that leads to depression
- Others factor
There are many factors affect the chances and outcome in IVF. Such as; semen quality, DNA fragmentation level, tobacco smoking, and body mass index (BMI) not normal that might lead to miscarriage, gestational diabetes, hypertension, thromboembolism and problems during delivery. The quality of embryo and number of embryo transferred also affect the IVF outcome.
| Last Reviewed | : | 22 October 2014 |
| Writer / Translator | : | Siti Norfaizah bt. Wagiman |
| Accreditor | : | Krishnan a/l Kanniah |
