IVF Centre Dehradun, Uttarakhand, INDIA

IVF-ET (TEST TUBE BABY)

INTRODUCTION

Birth of Louise brown in 1978 via IVF-ET has brought revolution for treating infertility. More than 5 lakh (500,000) babies have been delivered globally with various assisted reproductive techniques (ART and treating infertile couples with ART has become a part of regular treatment globally.

INDICATIONS

• TUBAL PATHOLOGY
• ENDOMETRIOSIS
• MALE INFERTILITY
• IDIOPATHIC INFERTILITY
• IMMUNOLOGIC INFERTILITY/CERVICAL FACTOR
• HORMONAL DISTURBANCES

INVESTGATIONS

• TB PCR On Menstrual blood
• HORMONAL PROFILE
1. sLH, sFSH, sTSH, sE2, sProlactin,
2. sDHEAS, sTesto, AMH, Insulin
• HSG, DIAG LAP AND HYST
• HSA, AND C/S
1. ROUTINE INVESTIGATIONS

PATIENT SELECTION

Both partners should be healthy and maternal contraindication to pregnancy should be excluded. Age of female partner is very important, women over 40 years of age usually have a poor prognosis in comparison to their young counter parts.

PROCEDURE

Ovarian stimulation - Long term down regulation with gonadotropin releasing hormone (GnRH) agonist followed by stimulation with gonadotropins (urinary or recombinant) is the standard protocol for controlled ovarian hyperstimulation. The aim is to develop 10-12 mature follicles. Follicular monitoring is done with the help of transvaginal sonography, serial Estradiol (E2), sLH and progesterone estimation. When 3 or more follicles are >18 mm in their mean diameter,hCG is administered at a dose – 5000 to 10000 IU to effect final maturation of oocyte. Ovarian stimulation with gonadotropins followed by GnRH antagonist (cetrorelix orgainerelix) and hCG is successfully used for ovarian stimulation in various ART procedure with equally good results.

MONITORING OF FOLLICULAR GROWTH
• Begins from Day 3 of the cycle
• Regular monitoring by TVS & blood estradiol &progesterone levels
• Mean diameter of follicles about 18 mm &serum E2 levels
• Showing Signs of plateauing

FOLLICULAR MONITORING



OOCYTE RETREIVAL - Oocyte recovery is undertaken 34-36 hoursposthCG injection. Procedure is done under USG guidance and anesthesia. The follicles are punctured with aspiration needle under biopsy guard and USG guidance with controlled pressure is maintained via an aspiration pump. Follicles are seen collapsing and the follicular fluid is collected with cumulus corona complexes (COC's) in test tubes, which are immediately shifted to adjacent laboratory under strict temperature control and aseptic conditions.

OOCYTE INSEMINATION AND CULTURE - Embryologist identifies the corona cumulus complexes form the fluid and immediately shifts them into culture plates/dishes. These plates are then kept in 6% CO2 incubators. After 3-4 hours of incubation these COC's are inseminated with washed/processedmale partner's sperm. Signs of fertilization are checked after post 18-20 hours of insemination. These embryos are then further cultured in different media for 3-6 days until they achieve blastocyst stage. 1-2 embryos are transferred with the help of embryo transfer catheter into uterine cavity. Saini IVF promotes the use of single embryo transfer technique (SET), however each and every case is different and very patient specific. SET is carried out to further protect the fetus from development abnormalities such as small for gestational age (SGA) and other forms of disorders common with multiple gestations.

LUTEAL PHASE SUPPORT - Luteal support is started with progesterone (intra muscular/vaginal/rectal routes) from the day of oocyte retrieval for 2-3 weeks. Pregnancy test is preformed after 12-14 days of retrieval. PREGNANCY OUTCOME 25% - 40% is the success rate per cycle with improved culture conditions.

EMBRYO CRYO PRESERVATION - Extra embryos resulting from multi follicular stimulation are frozen at different stages (zygote to blastocyst). Specific freezing and thawing protocols for vitrificationare followed.

PREGNANCY FOLLOWING ART - Serial hCG measurement titre 12-14 Days after retrieval. Transvaginal Sonography after 4-5 weeks of pregnancy. Clinical Pregnancy rate in IVF-ET with blastocyst transfers is around 35-40%. 1% IVF pregnancies are ectopic.