In Vitro Fertilization - I.V.F

1
In Vitro Fertilization-I.V.F
2
A British Woman Delivered First Baby By IVF -
Louisa Brown
Developed By The Physiologist Robert G- Awarded
The Nobel Prize in 2010!
3
What do we mean by In Vitro Fertilization?
4
Indications of In Vitro Fertilization - I.V.F
5
There Are 7 Steps For I.V.F Procedure
6
Blood Tests
Seminal fluid
Trans-Vaginal US
Fallopian Tube
US Scan - Uterus
Ovarian Follicles
First step Evaluation
US Scan - Ovaries
7
Second step Ovulation Induction

• Producing many good follicles to be Fertilized.
• Short or Long protocols Is done by daily
  injections of gonadotropins.
• Regular monitoring by ultrasound scan is done.
• Following the follicular development and adjust
  the dose of the injections accordingly,
• After reaching certain size, the final maturation
  of those follicles is done by giving HCG.

8
Third step Egg Retrieval (oocytes)

• Egg retrieval is done 34 to 37 hours post HCG
  injection.
• This procedure is considered as minor surgery.
• It is done under general anesthesia, using
  ultrasound guide.
• It takes 15 to 20 minutes. Not more than two
  hours are required for the patient to recover.
• Then, the patient can leave the hospital. A
  needle is used to aspirate all the follicles.
• The fluid is passed over to the embryologist, who
  identifies and separates the eggs.

9
Fourth step Sperm and Egg Preparation

• The eggs are prepared and stripped from the
  surrounding cells.
• At the same time, sperm preparation is done using
  a special media.
• We need from 10,000-100,000 motile sperm to be
  put beside each egg in a special dish, this is
  called traditional I.V.F.
• It is different from intra-cytoplasmic sperm
  injection (ICSI, in which we need only one sperm
  to be injected in the cytoplasm of the egg)
• Which is indicated in cases where sperm is
  present in the testes but the semen fluid does
  not contain sperm.

10
Fifth step Fertilization
After preparing the sperm, and the eggs are put
in the same dish, in cases of failed
fertilization we use ICSI procedure.
11
Sixth step Blastocyst Day 5 Embryo

• After 16 to 18 hours after the eggs, called
  zygotes, are fertilized,
• They are cultured in special incubators to
  support division and development.
• In this step, if the couple has a history of
  certain genetic disease and the gene that is
  causing that problem is identified, we may do
  pre-implantation genetic diagnosis.
• Grading of the embryos is done using specific
  criteria.

12
Seventh Step Embryo Transfer

• The Embryos are transferred into the uterus after
  2 to 5 days from the date of pick up.
• Depending on the quality and quantity of the
  embryos.
• Using a special embryo transfer catheter.
• The patient is given drugs to help support the
  implantation procedure.
• There is no need for a lengthy hospital stay
  after the embryo transfer procedure (usually one
  hour is sufficient).
• Residents of other countries can travel the next
  day if they wish.
•  

13
Side Effects Of IVF
14
When to do the pregnancy test?
Two weeks post embryo transfer, if the blood
tests give positive result. We can see the
pregnancy sac one week after the blood test.
15
What are the percentages of success?
16

• Other factors that play a role in the success of
  I.V.F
• Is there a genetic abnormality which will
  decrease the rate of implantation?
• Is the endometrial lining of the uterus of good
  quality, or not?

What happens if ovulation occurs before the eggs
are retrieved? In this case we have two
choices 1 - Cancel the cycle and start again the
following month. 2 - Do intrauterine
insemination, if possible. We must mention that
10 days post embryo transfer, you can do your
normal daily activity. You can travel and have
intercourse 2 weeks later.
17
Factors That Affects The Success Rate

• Regular cycle or not.
• Semen fluid analysis
• Sometimes AMH.
• Smoking.
• BMI (body mass index) and percent of fat in the
  body
• Health of the tubes.

18
Technologies That Increase IVF Success rate

• Assisted Hatching.
• Intracytoplasmic morphologically selected sperm
  Injection IMSI
• Men And Women Guide to Preparing for IVF
• Treating Failed In Vitro Fertilization

19
(No Transcript)