IN VITRO FERTILIZATION
INTRODUCTION
In vitro fertilization is a procedure where the joining of
egg and sperm takes place outside of the woman's body.
A woman may be given fertility drugs before this
procedure so that several eggs mature in the ovaries at
the same time. Eggs (ova) are removed from a woman's
ovaries using a long, thin needle.
Once the eggs are removed, they are mixed with
sperm in a laboratory dish or test tube. (This is where
the term test tube baby comes from.) 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.
DEFINITION
In vitro fertilisation is a process of fertilisation where
an egg is combined with sperm outside the body - in
vitro. The process involves monitoring and stimulating
a woman's ovulatory process, removing an ovum or
ova from the woman's ovaries and letting sperm
fertilise them in a liquid in a laboratory.
HISTORY OF IVF
•1977, the first IVF pregnancy in human and the birth of
louise brown.
•In India – Dr. Subhash mukhopadhyay ( 16 january 1931 –
19 june 1981 ) was a physician from Kolkata, India. Who
created the world’s second and India’s first child using in
vitro fertilisation, durga who was born 67 days after the IVF
baby in united kingdom.
INDICATION OF IVF
•Tubal disease- in women with blocked fallopion tubes, IVF
has largely replaced surgery as the treatment of choice.
• Endometriosis- patients with endometriosis, often have
tubal involvement and ovarian cysts (endometrioma).
•Ovulatory dysfunction- in patient with polycystic ovarian
disease (pcos) and other ovulatory problems .
•Age related infertility – azoospermia , oligozoospermia ,
asthenozoospermia, anti- sperm antibody etc.
•Preimplantation genetic testing (PGT)- genetic testing on
preimplantation embryos may be indicated for patients who
are at risk for genetic disorder such as cystic fibrosis and
thalassemia.
Contraindication
•IVF is contraindicated in patients with serious medical
illnesses or in patients in whom pregnancy is
dangerous.
ADVANTAGES OF IVF
•The fundamental advantage of IVF is that it allows a couple
to have their own biological child, rather than using a
donated egg or sperm.
•It’s more successful than other assisted-reproduction
techniques.
•In addition to being useful in cases of infertility related to the
Fallopian tubes.
• IVF is also indicated in cases of unexplained infertility, or
if there are minor problems with the man’s sperm.
•The procedure allows couples the option to screen
embryos for hereditary disease or chromosomal problems
if they wish to do so.
•IVF is appropriate for single women or same-sex couples.
DISADVANTAGES OF IVF
•IVF is not cheap, and is not always covered by
insurance/social security; and the costs of repeated
procedures can add up quickly.
Success rates for IVF vary widely depending on age and
medical condition. Overall, just over 25% of IVF cycles
that are begun result in a live birth.
•Possible side effects include complications from
stimulation of the ovaries to produce more eggs, as
well as the risk of ectopic pregnancy, which
happens when the embryo implants in the fallopian
tube – a condition that can become life-threatening
and require emergency surgery.
STEPS IN IVF (THE IVF CYCLE)
•Stimulating the ovaries – Super Ovulation
•Collecting the eggs – Egg Retrieval
•Fertilization of eggs – Insemination and Fertilization
•Embryo Culture
•Embryo Transfer
STIMULATING THE OVARIES
Hormones (Fertility Drugs) are usually given to stimulate
the ovaries to produce more than the usual one egg per
cycle. This is done to enable the collection of several
eggs.
The development of the eggs is monitored by blood tests
and Trans Vaginal Ultrasounds that ensure eggs are
collected at precisely the right time.
EGG RETRIEVAL
At the time of ovulation the eggs are collected. An ultrasound
probe is placed within the vagina while the woman is under light
sedation. The ultrasound monitor shows where the follicles are
within the ovaries. The needle is connected to a suction device,
which pulls the eggs and fluid out of each follicle, one at a time.
The procedure is repeated for the other ovary. The woman may
have some cramping after the procedure, but it usually goes
away within a day.
FERTILIZATION OF EGG
On the day of egg collection, the male partner provides a
sample of semen. As a precautionary measure a semen
sample of the husband is taken at the onset of stimulation
and Cryopreserved. In a standard IVF treatment, the semen
and best quality eggs are placed together in an
environmentally controlled chamber. This process of mixing
the egg and sperm is called insemination. The sperm
usually enters (fertilizes) an egg a few hours after
insemination.
EMBRYO CULTURE
When the fertilized egg divides, it becomes an embryo. An
embryologist will regularly check the embryo to make sure it is
growing properly. Within about 3-5 days, a normal embryo has
several cells that are actively dividing.
Couples who have a high risk of passing a genetic (hereditary)
disorder to a child may consider Pre-Implantation Genetic
Diagnosis (PGD). The procedure is done about 3 -4 days after
fertilization. Laboratory scientists remove a single cell from each
embryo and screen the material for specific genetic disorders. PGD
can help doctors decide which embryos to implant, which
decreases the chance of passing a disorder onto a child.
EMBRYO TRANSFER
Once the embryos have grown to a predetermined size, one
to a maximum of three embryo’s will be transferred back to
the woman’s womb 3 – 5 days after egg retrieval and
fertilization. This procedure involves passing a very fine
plastic tube (catheter) through the cervix and into the
uterine cavity under ultrasound guidance. Pregnancy results
if an embryo implants in the lining of the womb and is able
to grow successfully.
PREGNANCY TEST
Two weeks after the transfer, blood is taken and tested to
determine if the woman is pregnant.
COMPLICATION OF IVF
•Multiple births-
A pregnancy with multiple fetuses carries a higher risk of early labor
and low birth weight than pregnancy with a single fetus does.
•Premature delivery and low birth weight –
Research suggests that IVF slightly increases the risk that the baby
will be born early or with a low birth weight .
• Ovarian hyperstimulation syndrome-
Use of injectable fertility drugs, such as human chorionic gonadotropin
(HCG), to induce ovulation can cause ovarian hyperstimulation syndrome,
• Miscarriage-
The rate of miscarriage for women who conceive using IVF with fresh
embryos is similar to that of women who conceive naturally — about 15%
to 25% — but the rate increases with maternal age.
• Egg-retrieval procedure complications-
Use of an aspirating needle to collect eggs could possibly cause bleeding,
infection or damage to the bowel, bladder or a blood vessel. Risks are also
associated with sedation and general anesthesia, if used.
• Ectopic pregnancy-
About 2% to 5% of women who use IVF will have an ectopic pregnancy —
when the fertilized egg implants outside the uterus, usually in a fallopian
tube.
•Birth defects-
The age of the mother is the primary risk factor in the development of birth defects,
no matter how the child is conceived. More research is needed to determine whether
babies conceived using IVF might be at increased risk of certain birth defects.
•Cancer-
Although some early studies suggested there may be a link between certain
medications used to stimulate egg growth and the development of a specific type
of ovarian tumor, more-recent studies do not support these findings. There does
not appear to be a significantly increased risk of breast, endometrial, cervical or
ovarian cancer after IVF.
•Stress-
Use of IVF can be financially, physically and emotionally draining. Support from
counselors, family and friends can help you and your partner through the ups and
downs of infertility treatment.
NURSING ROLE IN IVF
•Nurse bears an extensive background in the fertility industry.
•Nurses have access to the information and the latest research
in a field that is ever charging.
•They can provide informed, medical, timely support so that
options and decisions are not overwhelming.
•They are a complement and an integral part of client care.
•Provide support for patients emotional well being.
•Assist patients with the strains of infertility and ART.
•IVF nurse are bright, intelligent, and commpassionate .
•Play a major role in ovulation induction programs.
•The nurse takes the client through the whole IVF
treatment process step by step.
•She will repeat everything that she has told to make
sure that the client understands everything that is going
on.
•Check blood test and ultrasound appintments.
•She will be the client’s first port of call if anything goes
wrong during the treatment.
•The nurses offers the soluation and advice when unusal
things happen during the treatment process.
•They will recognize when client is close to breaking
point and arrange to meet a conselor if need be.
