tube baby (In vitro fertilization IVF) is a revolutionary
treatment for those couples who can't have a baby on their
own because of various types of infertility. First developed
by Drs. Patrick C. Steptoe and Robert G. Edwards of Great
Britain (where the first "test tube baby was born under their
care in 1978), the technique was devised for use in cases
of infertility when the woman's fallopian tubes are damaged
or the man's sperm count is low. It is also now used to enable
prospective parents with other reproductive problems (e.g.,
inability to produce eggs, poor sperm quality, or endometriosis)
to bear a child.
What is a Test Tube Baby?
A test tube baby is the term that refers to a child that is
conceived outside the woman's body. The process is referred
to as "in vitro" (outside the body) fertilization. Simply
put, eggs are removed from the mother's ovary and incubated
with sperm from the father. After fertilization, the "pre-embryos"are
allowed to divide 2-4 times (in a "test tube", hence the name)
and then returned to the mother's uterus where they can develop
normally. Through these procedures, women with otherwise untreatable
infertility problems have given birth to healthy babies.
In vitro fertilization IVF
During IVF, a physician collects ova from the woman at the
time of her ovulation, using a high-tech procedure called
laparoscopy. In the next step the man's sperms and woman's
egg are combined in a laboratory dish, where fertilization
occurs. The resulting embryo is then transferred to the woman's
uterus, for normal development in the uterus, or frozen for
later implantation. Eggs can also now be frozen and fertilized
later. The basic steps in an IVF treatment cycle are super
ovulation (stimulating the development of more than one egg
in a cycle), egg harvest, fertilization, embryo culture, and
embryo transfer. Even though conceived differently than most,
the baby does not look any different and, in fact, is no different
from other babies.
How is I.V.F. carried out?
During superovulation, drugs are used to induce the patient's
ovaries to grow several mature eggs rather than the single
egg that normally develops each month. The idea is that if
one has several follicles available for egg retrieval, then
if more than one egg is successfully fertilized and transferred
back into the uterus, the odds are greater that at least one
of them will successfully implant. The progress of the growth
of the follicles is closely monitored either by blood and
urine tests or by ultrasound measurement of the follicles.
Once the follicles are ready for ovulation, Human Chorionic
Gonadotropin (H.C.G) of 5,000 units is given. The eggs are
retrieved 33-36 hours following the H.C.G. injection.
There are two methods, which clinics may use for egg retrieval.
1. Ultrasound-guided aspiration.
In this method the ultrasound probe is inserted through the
vagina, which emits high-frequency sound waves, which are
translated into images of the pelvic organs and displayed
on a monitor, so that the mature follicles can be seen as
black bubbles on the screen. The doctor guides a needle through
the vagina into each mature follicle. The follicular fluid
containing the egg is then sucked out through the needle into
a test tube, and all the follicles are aspirated, one by one.
2. Laparoscopy. This is carried
out under general anesthetic. The eggs are retrieved from
their follicles using a very fine suction needle. However,
this method is rarely used today, because the vaginal-ultrasound
guided method is much quicker, easier and safer.
3. T.U.D.O.R. This stands for
Trans-vesical, Ultrasound Directed Oocyte Recovery. This is
an outpatient procedure performed under a local anesthetic.
In this method, a suction probe is guided by ultrasound control
through the bladder. This technique also has the advantage
of being able to retrieve eggs from an inaccessible ovary
even if it is covered by adhesions. The eggs are now incubated
for 4-24 hours in a specially prepared culture medium in order
to ensure that adequate maturation has occurred. 100,000-1,000,000
specially prepared progressively swimming sperms are then
added to the incubated eggs. Fertilisation takes place within
the next 24 hours. 2-3 days later the embryo transfer takes
place. This is a painless procedure and no anesthetic is required.
For whom is I.V.F. advisable
Candidates for I.V.F. are usually those women with irreparably
damaged tubes, endometriosis; immunological problems; unexplained
infertility and male factor infertility. I.V.F. can also be
the treatment of last resort in the case of problems like
oligospermia, major cervical mucus hostility factors and certain
cases of unexplained infertility.
A woman's age must be considered. Older women feel additional
pressure as they feel their biological clocks are ticking
and time is running out. However, there is no upper age limit
at which IVF should not be done, - and in fact, for older
women, it might represent their only chance of success. It's
not really the age of the woman, which is the limiting factor
- it's the quality of her eggs.
Patients who stand a very poor chance of success with IVF
include the following.
whose ovaries are failing. However, there is no upper age
limit at which IVF should not be done, and, infact, for
older women, it might represent their only chance of success.
It's not really the age of the woman, which is the limiting
factor; it's the quality of her eggs.
sperm count are very low. Again, IVF may be the only option
these men have to father their own biological child, and,
therefore, there is no " magic" number of sperm, which a
man must have before considering IVF for him.
a damaged uterus (for example, because of healed tuberculosis)
because the chance of successful implantation of the embryo
in the uterus becomes very poor.
Tips for greater
chances of I.V.F success
or alcohol use. Studies show both can result in lower pregnancy
rates and a greater risk of miscarriage.
No more than
two caffeinated beverages per day.
in diet or weight loss or fad diets during IVF cycle. A
healthy well balanced diet works best.
intercourse three to four days prior to egg retrieval and
following embryo replacement until pregnancy determination
may continue unless enlargement of your ovaries produces
- Avoid hot
tubs or saunas.
and cigarette smoking should be avoided for three months
prior to treatment and at all times during the ongoing IVF
treatment cycle to get the best results.
hot tubs and saunas is not recommended. Even a single episode
in the hot tub can adversely effect sperm function. Please
refrain from this for at least three months prior to treatment.
intercourse for at least three days, but not more than seven
days prior to collection of semen for egg collection and
than 100.4o one to two months prior to IVF treatment may
adversely affect sperm quality. Consult your doctor immediately.
is the cost of one IVF treatment cycle?
The cost of a single IVF treatment cycle
varies widely from approximately Rs 30,000 to more than Rs
75,000 depending on the program and the items included in
the fee. The number of treatment cycles needed to achieve
pregnancy will, of course, determine the final cost.
What is the success rate of I.V.F?
The success rate of pregnancy associated
with this treatment ranges between 15-30%. Therefore it is
also not advisable to go in for IVF treatment without trying
simpler treatment options first. IVF is a complex procedure
involving considerable personal and financial commitment,
so other treatments are usually recommended first.
GIFT stands for gamete intrafallopian transfer.
Specialists generally agree that pregnancy rates are higher
for GIFT than for IVF- in fact, GIFT is about twice as successful
as IVF. A gamete is a male or female sex cell - a sperm, or
an egg. During GIFT, sperm and eggs are mixed and injected
into one or both fallopian tubes. After the gametes have been
transferred, fertilization can take place in the fallopian
tube as it does in natural, unassisted reproduction. Once
fertilized, the embryo travels to the uterus by natural processes.
As in IVF, a GIFT treatment cycle begins with ovulation enhancement,
which is followed by egg harvest, usually by means of laparoscopy.
During this same laparoscopy procedure, which takes about
an hour, eggs are mixed with sperm and the gametes are transferred.