In vitro fertilisation

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in vitro fertilization ( IVF ) is a fertilization process in which eggs are combined with sperm outside the body, in vitro ("in a glass"). This process involves monitoring and stimulating the female ovulation process, removing the ovum or ovum (egg or egg) from the woman's ovaries and allowing the sperm to fertilize it in the liquid in the laboratory. The fertilized egg (zygote) undergoes embryo culture for 2-6 days, and then is transferred to the same female uterus or the other, in order to build a successful pregnancy.

IVF is a type of assisted reproductive technology used for the treatment of infertility and maternity substitutes, in which fertilized eggs are implanted into a replacement uterus, and genetically generated children are not associated with substitutes. Some countries prohibit or otherwise arrange the availability of IVF treatments, resulting in fertility tourism. Limitations on IVF availability include the cost and the age to bring a healthy pregnancy for the long term. IVF is mostly attempted if less invasive or expensive options have failed or are unlikely to work.

The birth of the first successful child after IVF treatment, Louise Brown, occurred in 1978. Louise Brown was born as a result of the natural cycle of IVF in which no stimulation was performed. This procedure takes place at Pondok Dr Kershaw Hospital (now Dr. Kershaw Hospital) in Royton, Oldham. Robert G. Edwards was awarded the Nobel Prize in Physiology or Medicine in 2010, a physiologist who co-developed the treatment along with Patrick Steptoe; Steptoe is not eligible for consideration because the Nobel Prize is not awarded posthumously. With egg donations and IVF, women who pass through their reproductive years, have an infertile male partner, have an idiopathic female fertility problem, or have reached menopause can still get pregnant. Adriana Iliescu holds the record as the oldest woman who gave birth using IVF and donated eggs, when she gave birth in 2004 at the age of 66, a record passed in 2006. After IVF treatment, some couples can become pregnant without any fertility. care. In 2012 it is estimated that five million children have been born worldwide using IVF and other assisted reproductive techniques.

Video In vitro fertilisation

Terminology

From Latin meaning "in glass", the term "in vitro" is used because of early biological experiments involving the planting of tissues outside the living organism from which they came, carried in glass containers such as glasses, test tubes, or petri dishes.

Currently, the scientific term "in vitro" is used to refer to any biological procedure performed outside the normally occurring organism, to distinguish it from the in vivo procedure, in which the tissue remains within the living organism where it is usually found. The daily term for babies conceived as a result of IVF, "baby test tube", refers to a tubular container of glass or plastic resin, called a reaction tube, commonly used in laboratory chemistry and laboratories biology. However, IVF is usually done in a more shallow container called a Petri dish. One IVF method, autologous endometrial coculture, is actually done on organic matter, but is still considered IVF.

Maps In vitro fertilisation

Medical use

IVF can be used to treat female infertility where it is due to problems with fallopian tubes, making in vivo fertilization difficult. It can also help male infertility, in cases where there are defects in sperm quality; in situations such as intracytoplasmic sperm injection (ICSI) may be used, in which sperm cells are injected directly into the egg. This is used when sperm have difficulty penetrating egg cells, and in this case sperm pair or donor can be used. ICSI is also used when the sperm count is very low. When indicated, the use of ICSI has been found to increase the success rate of IVF.

According to English abstract, IVF treatment is appropriate in cases of unexplained infertility for unmarried women after 2 years of unprotected intercourse on a regular basis.

Success rate

The success rate of IVF, the percentage of all IVF procedures that produce favorable outcomes. Depending on the type of calculation used, these results may represent the number of confirmed pregnancies, called pregnancy rates, or the number of live births, called live birth rates. The success rate depends on variable factors such as maternal age, infertility causes, embryo status, reproductive history and lifestyle factors.

Mother's Age: The younger IVF candidate is more likely to become pregnant. Women older than 41 are more likely to get pregnant with donor eggs.

Reproductive history: Women who had been pregnant before in many cases were more successful with IVF treatment than those who never became pregnant.

Due to advances in reproductive technology, the success rate of IVF is substantially higher today than it was a few years ago.

Live birthrate

The live birth rate is the percentage of all IVF cycles that lead to live births. This number does not include miscarriage or stillbirth and multiple births such as twins and triplets are counted as one pregnancy. A 2012 summary prepared by the Society for Reproductive Medicine that reports the average IVF success rate in the United States per age group using non-donor eggs compiles the following data:

In 2006, Canadian clinics reported a live birth rate of 27%. Birth rates in younger patients were slightly higher, with a success rate of 35.3% for those 21 and younger, the youngest group evaluated. The success rate for older patients is also lower and decreases with age, with age 37 years at 27.4% and no live births for those over 48 years old, the oldest group evaluated. Some clinics exceed this number, but it is impossible to determine whether it is due to superior technique or patient selection, as it may be possible to artificially increase the success rate by refusing to accept the most difficult patients or by directing them into the oocyte donation cycle (which is compiled separately ). Furthermore, the rate of pregnancy can be increased by placing some embryos with the risk of increasing the chance for multiples.

The live birth rate using donor eggs is also given by SART and includes all age groups using fresh eggs or diluted eggs.

Since not every IVF cycle begun will lead to oocyte retrieval or embryo transfer, the live birthrate report needs to determine the denominator, ie IVF cycle begun, IVF retrieval, or embryo transfer. The Society for Assisted Reproductive Technology (SART) summarizes the 2008-9 success rate for US clinics for a fresh embryo cycle that does not involve donor eggs and provides live birth rates at the age of expectant mothers, with a peak at 41.3% per cycle commencing. and 47.3% per embryo transfer for patients under 35 years.

IVF efforts in some cycles result in an increase in cumulative live birth rate. Depending on the demographic group, one study reported 45% to 53% for three trials, and 51% to 71% to 80% for six trials.

Pregnancy rate

Pregnancy rates can be defined in various ways. In the United States, pregnancy rates used by the Society for Assisted Reproductive Technology and the Centers for Disease Control (and appear in the table in the Success Rates section above) are based on the fetal heart movement observed on ultrasound examination.

A 2009 summary prepared by the Society for Reproductive Medicine includes the following data for the United States:

In 2006, Canadian clinics reported an average pregnancy rate of 35%. A French study estimated that 66% of patients starting IVF treatment eventually had children (40% during IVF treatment at the center and 26% after IVF termination). Achievement of having children after IVF termination is mainly due to adoption (46%) or spontaneous pregnancy (42%).

Predictors of success

The major potential factors affecting pregnancy rates (and live births) in IVF have been suggested to be maternal age, duration of infertility or subfertility, bFSH and oocyte count, all reflecting ovarian function. The optimal age of women is 23-39 years at the time of treatment.

Biomarkers affecting IVF pregnancy chances include:

• The number of antral follicles, with higher amounts gives a higher success rate.
• Anti-MÃÆ'¼llerian hormone levels, with higher rates indicate a higher likelihood of pregnancy, as well as live births after IVF, even after adjusting for age.
• The quality factor of semen for sperm providers.
• The degree of DNA fragmentation measured for example by Comet assay, advanced maternal age and semen quality.
• Women with specific ovarian FMR1 genotypes including het-norm/low have significantly lowered the likelihood of pregnancy in IVF.
• Progesterone elevation (PE) on the day of late maturation induction is associated with low pregnancy rates in the IVF cycle in women undergoing ovarian stimulation using GnRH analogues and gonadotropin. At this time, compared with a progesterone level below 0.8 ng/ml, levels between 0.8 and 1.1 ng/ml conferred a pregnancy odds ratio of about 0.8, and levels between 1.2 and 3.0 ng/ml gave the chance of a pregnancy ratio between 0.6 and 0.7. On the other hand, an increase in progesterone does not seem to provide a possible reduction in pregnancy in freeze-freezing and cycle with egg donations.
• Cell characteristics of the oophorus cumulus and granulosa membrane, which are easily aspirated during oocyte retrieval. These cells are closely related to oocytes and share the same microenvironment, and the level of expression of certain genes in these cells is associated with higher or lower pregnancy rates.
• An endometrial thickness (EMT) of less than 7 mm decreases the pregnancy rate with an odds ratio of about 0.4 compared with EMT greater than 7 mm. However, such low thickness is rare, and routine use of these parameters is considered to be unjustifiable.

Other determinants of IVF outcomes include:

• Smoking tobacco reduces the chances of IVF producing a live birth by 34% and increasing the risk of miscarriage of IVF by 30%.
• The body mass index (BMI) of more than 27 causes a 33% decrease in likelihood of having a live birth after the first cycle of IVF, compared with those with BMIs between 20 and 27. Also, obese pregnant women have high rates of miscarriage, diabetes gestational, hypertension, thromboembolism and problems during labor, and leads to an increased risk of fetal congenital abnormality. The ideal body mass index is 19-30.
• Salpingectomy or laparoscopic laparoscope occlusion prior to IVF treatment increases the chances for women with hydrosalping.
• Success with previous pregnancies and/or live births increases chances
• A low alcohol/caffeine intake improves the success rate
• Number of embryos transferred in the maintenance cycle
• Embryo quality
• Some studies also suggest that autoimmune diseases may also play a role in decreasing the success rate of IVF by impairing implantation of the right embryo after transfer.

Aspirin is sometimes prescribed for women with the aim of increasing the likelihood of conception by IVF, but by 2016 there is no evidence to suggest that it is safe and effective.

The 2013 review and meta-analysis of randomized acupuncture controlled trials as adjuvant therapy in IVF found no overall benefit, and concluded that the apparent benefit detected in a published trial subset in which the control group (which did not use acupuncture) was lower than average pregnancy rates require further study, because of the possibility of publication bias and other factors.

A Cochrane review came to the result that endometrial injuries done in the months before ovarian induction appear to increase both live birth rates and clinical pregnancy rates in IVF compared with no endometrial injury. There was no evidence of any difference between the groups in miscarriage, multiple pregnancy or bleeding rates. Evidence suggests that endometrial injury on the day of oocyte acquisition is associated with a lower live birth or an ongoing pregnancy rate.

For women, antioxidant intake (such as N-acetyl-cysteine, melatonin, vitamin A, vitamin C, vitamin E, folic acid, myo-inositol, zinc or selenium) has not been associated with significantly increased birth or clinical rates. pregnancy rate at IVF according to Cochrane review. The review found that oral antioxidants given to men in couples with unexplained male or subfertility factors may increase live birth rates, but more evidence is needed.

A Cochrane review in 2015 came to the result that there is no identifiable evidence regarding the influence of pre-conception lifestyle suggestions about the possible outcomes of live births.

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Complications

Many births

The major complication of IVF is the risk of multiple births. This is directly related to the practice of transferring many embryos to embryo transfer. Multiple births are associated with an increased risk of miscarriage, obstetrical complications, prematurity, and neonatal morbidity with potential long-term damage. Strict limits on the number of transferable embryos have been applied in some countries (eg England, Belgium) to reduce the risk of high-level (triplets or more), but not universally or acceptably followed. Spontaneous cleavage of the embryo in the uterus after transfer may occur, but this is rare and will lead to identical twins. A double-blind and randomized study followed an IVF pregnancy that resulted in 73 infants (33 boys and 40 girls) and reported that 8.7% of single infants and 54.2% of twins had birthweight & lt; 2,500 grams (5.5 pounds).

Recent evidence also suggests that single offspring after IVF have a higher risk for low birth weight due to unknown reasons.

Sex ratio distortion

Several types of IVF, specifically ICSI (first applied in 1991) and blastocyst transfer (first applied in 1984) have been shown to cause distortion in the sex ratio at birth. ICSI causes female births to be slightly more (51.3% female) while blastocyst transfers lead to more boys (56.1% of men) being born. Standard IVF performed on the second or third day leads to a normal sex ratio.

Epigenetic modifications caused by extensive culture lead to more female embryonic deaths have been theorized as the reason why blastocyst transfer leads to higher male sex ratios, but adding retinoic acid to culture can bring this ratio back to normal.

Spread of infectious diseases

By washing sperm, the risk that chronic diseases in men who provide sperm will infect women or children can be brought to a negligible level.

In men with hepatitis B, the American Society for Reproductive Medicine Practice Committee recommends that sperm leaching is not required in IVF to prevent transmission, unless the female partner has not been vaccinated effectively. In women with hepatitis B, the risk of vertical transmission during IVF is no different from the risk in spontaneous conception. However, there is insufficient evidence to suggest that ICSI procedures are safe in women with hepatitis B due to vertical transmission to offspring.

Regarding the potential spread of HIV/AIDS, the Japanese government banned the use of IVF procedures for couples in which both partners were infected with HIV. Despite the fact that the previous ethical committee allowed Ogikubo, Tokyo Hospital, located in Tokyo, to use IVF for partners with HIV, Japan's Ministry of Health, Labor and Welfare decided to block the practice. Hideji Hanabusa, vice president of Ogikubo Hospital, stated that along with his colleagues, he successfully developed a method that allows scientists to remove HIV from sperm.

Other risks to egg provider/retrievers

The risk of ovarian stimulation is the development of ovarian hyperstimulation syndrome, especially if hCG is used to induce late oocyte maturation. This produces a swollen and painful ovary. It occurs in 30% of patients. Mild cases can be treated with over-the-counter drugs and cases can be resolved in the absence of pregnancy. In moderate cases, the ovaries swell and fluid accumulates in the abdominal cavity and may have symptoms of heartburn, gas, nausea or loss of appetite. In severe cases, the patient experiences excessive abdominal pain, nausea, vomiting and will result in hospitalization.

During the taking of eggs, there is a small chance of bleeding, infection, and damage to surrounding structures such as the intestines and the bladder (transvaginal ultrasound aspiration) and difficulty breathing, chest infections, allergic reactions to drugs, or nerve damage (laproscopy).

Ectopic pregnancies can also occur if a fertilized egg develops outside the uterus, usually in the fallopian tube and requires immediate fetal destruction.

IVF does not appear to be associated with an increased risk of cervical cancer, or with ovarian cancer or endometrial cancer when neutralizing the confounding of infertility itself. It also does not seem to provide an increased risk for breast cancer.

Regardless of the outcomes of pregnancy, IVF treatment usually causes stress for the patient. Neuroticism and the use of coping escapist strategies are associated with higher difficulty levels, while the presence of social support has a deleterious effect. Negative pregnancy tests after IVF are associated with an increased risk of depression in women, but not with an increased risk of developing anxiety disorders. Pregnancy test results do not seem to be a risk factor for depression or anxiety among men.

Birth defects

A review in 2013 came to the result that infants resulting from IVF (with or without ICSI) had a relative risk of birth defects 1.32 (95% confidence interval 1.24 to 1.42) than naturally conceived infants. In 2008, a data analysis from the National Birth Defect Study in the US found that certain birth defects were significantly more common in babies conceived through IVF, especially septal heart defects, cleft lip with or without palate cleft, esophageal atresia, and anorectal. atresia; the mechanism of causality is not clear. However, in a population cohort study of 308,974 births (with 6163 using assisted reproductive technology and following children from birth to age five), the researchers found: "The increased risk of birth defects associated with IVF is no longer significant after adjustment for parental factors.. "Parental factors include known independent risks for birth defects such as maternal age, smoking status, etc. Multivariate correction did not remove the significance of the birth defect relationship and ICSI (the corrected odds ratio of 1.57), although the authors speculated that the underlying male infertility factor (to be associated with ICSI use) may contribute to this observation and can not correct this confounder. The authors also found that a history of infertility increases its own risk in the absence of treatment (odds ratio 1.29), consistent with the Danish national registry study and "... implies a patient factor in this increased risk." The authors of the Danish national registry study speculate: "... our results indicate that the increased prevalence of congenital malformations reported in single pregnancies born after assisted reproductive technology is partly due to underlying infertility or determining factors."

Other risks to her offspring

If underlying infertility is associated with abnormalities in spermatogenesis, it makes sense, but it is too early to check that male offspring are at higher risk for sperm abnormalities.

IVF does not seem to present any risk associated with cognitive development, school performance, social functioning, and behavior. In addition, IVF babies are known to be securely attached to their parents as those who are naturally conceived, and IVF adolescents are also tailored to those who have been naturally conceived.

Limited long-term follow-up data suggest that IVF may be associated with increased incidence of hypertension, fasting glucose disorder, increased total body fat composition, advancing bone age, subclinical thyroid disorders, early adult clinical depression and alcoholic binge. However, it is unknown whether this potential relationship is due to IVF procedures themselves, by adverse obstetric outcomes associated with IVF, by the genetic origin of children or by unknown causes associated with IVF. Increased embryo manipulation during IVF results in a more distorted growth curve of the fetus, but birth weight does not seem to be a reliable marker of fetal stress.

IVF, including ICSI, was associated with an increased risk of recording disorders (including Prader-Willi syndrome and Angelman syndrome), with an odds ratio of 3.7 (95% confidence interval 1.4 to 9.7).

The incidence associated with cerebral palsy and associated IVF development of nerves is believed to be associated with a lowering of prematurity and low birth weight. Similarly, the incidence of autism and associated deficits of IVF are believed to be associated with maternal and obstetric confounding factors.

Overall, IVF does not lead to an increased risk of cancer in children. Studies have shown a decreased risk of certain cancers and increased risk of others including hepatoblastoma retinoblastoma and rhabdomyosarcoma.

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Method

Theoretically, IVF can be done by collecting the contents of the oviduct or female uterus after natural ovulation, mixing it with sperm, and reentering the fertilized egg into the uterus. However, without additional techniques, the possibility of pregnancy will be very small. Additional techniques routinely used in IVF include ovarian hyperstimulation to produce multiple eggs or transvaginal oocyte preparations that are guided ultrasonically directly from the ovaries; after which the egg and sperm cells are prepared, as well as the culture and selection of embryos produced before the embryo is transferred to the uterus.

Ovarian hyperstimulation

Ovarian hyperstimulation is a stimulation to induce the development of multiple ovarian follicles. This should start with the predicted response by eg. age, number of antral follicles and levels of the anti-MÃÆ'¼llerian hormone. Predictions generated from eg. bad or hyper-responsive to ovarian hyperstimulation determines protocol and doses for ovarian hyperstimulation.

Ovarian hyperstimulation also includes suppression of spontaneous ovulation, in which two main methods are available: Using the GnRH agonist protocol (usually longer) or GnRH antagonist protocol (usually shorter). In the GnRH agonist protocol the standard length of the day when hyperstimulation treatment begins and the expected day of oocyte retrieval can then be chosen to adjust to personal choice, while in the GnRH antagonist protocol it must be adjusted to the spontaneous onset of the previous menstruation. On the other hand, the GnRH antagonist protocol has a lower risk of ovarian hyperstimulation syndrome (OHSS), which is a life-threatening complication.

For ovarian hyperstimulation itself, gonadotropin injections (usually analogue FSH) are generally used under close monitoring. Such monitoring often checks estradiol levels and, by way of gynecological ultrasound, follicle growth. Usually about 10 days of injections will be required.

Natural IVF

There are several methods called natural IVF cycles :

• IVF does not use drugs for ovarian hyperstimulation, while medication for ovulation suppression can still be used.
• IVF uses ovarian hyperstimulation, including gonadotropin, but with the GnRH antagonist protocol so that the cycle begins with the natural mechanism.
• Transfer of frozen embryo; IVF uses ovarian hyperstimulation, followed by cryopreservation of the embryo, followed by embryo transfer in later, natural, cycle.

IVF using no cure for ovarian hyperstimulation is the method for the Louise Brown concept. This method can be successfully used when women want to avoid the use of ovary-stimulating drugs with associated side effects. HFEA estimates live birth rate to about 1.3% per IVF cycle using no hyperstimulation medication for women aged between 40-42.

Light IVF is a method in which small doses of ovarian stimulant drugs are used for short duration during a woman's natural cycle that aims to produce 2-7 eggs and create healthy embryos. This method seems to be an advance in the field to reduce complications and side effects for women and is aimed at quality, and not the quantity of eggs and embryos. One study comparing mild treatment (mild ovarian stimulation with a combination of GnRH antagonists combined with single embryo transfer) to standard treatment (stimulation with the old GnRH agonist protocol and transfer of two embryos) came to the result that a cumulative proportion of pregnancies that resulted in the term live birth after 1 year was 43.4% with mild treatment and 44.7% with standard treatment. Light IVF can be cheaper than conventional IVF and with a significantly reduced risk of multiple pregnancies and OHSS.

Acceleration of final maturation

When the ovarian follicle has reached a certain level of development, late oocyte maturation induction is performed, generally by injection of human chorionic gonadotropin (hCG). Generally, this is known as a "trigger shot." hCG acts as a luteinising hormone analog, and ovulation will occur between 38 and 40 hours after a single HCG injection, but egg-taking is done usually between 34 and 36 hours after hCG injection, ie, just before the follicle will break. This is useful for scheduling egg-taking procedures when the egg is fully cooked. HCG injections provide the risk of ovarian hyperstimulation syndrome. Using a GnRH agonist instead of hCG eliminates most of the risk of ovarian hyperstimulation syndrome, but with a decreased delivery rate if the embryo is moved fresh. For this reason, many centers will freeze all oocytes or embryos after agonist triggers.

Egg retrieval

Eggs are taken from patients using a transvaginal technique called transvaginal oocyte removal, involving an ultrasound needle that punctures the vaginal wall to reach the ovaries. Through this needle follicle it can be aspirated, and follicular fluid is passed to the embryologist to identify the ovum. It is common to throw between ten and thirty eggs. The retrieval procedure usually takes between 20 and 40 minutes, depending on the number of mature follicles, and is usually done with conscious sedation or general anesthesia.

Preparation of eggs and sperm

In the laboratory, the identified eggs are stripped from nearby cells and prepared for fertilization. Selection of oocytes can be done before fertilization to select eggs with the optimal chance of successful pregnancy. Meanwhile, the semen is prepared for fertilization by disposing of inactive cells and semen in a process called sperm washing. If semen is being supplied by a sperm donor, it is usually prepared for treatment before it is frozen and quarantined, and it will be melted ready for use.

Co-incubation

Sperm and eggs are incubated together with a ratio of about 75,000: 1 in culture medium for actual fertilization to occur. A review in 2013 showed that this incubation duration of about 1 to 4 hours resulted in a much higher pregnancy rate of 16 to 24 hours. In most cases, the egg will be fertilized during co-incubation and will show two pronucleus. In certain situations, such as low sperm count or motility, one sperm can be injected directly into the egg using intracytoplasmic sperm injection (ICSI). The fertilized egg is passed to a special growth medium and left for about 48 hours until the egg is made up of six to eight cells.

In intrafallopian gamete transfer, the egg is removed from the woman and placed in one of the fallopian tubes, along with the male sperm. This allows conception to take place inside a woman's body. Therefore, this variation is actually in vivo fertilization, not in vitro.

Culture embryo

The main period of embryonic culture is to the division stage (day 2 to 4 after co-incubation) or blastocyst stage (fifth or sixth day after co-incubation). Embryonic cultures up to the blastocyst stage provide a significant increase in live birth rate per embryo transfer, but also confer fewer embryo available for embryo transfer and cryopreservation, so that the cumulative clinical pregnancy rate increases with transfer of cleavage stage. Transfer of the second day instead of the third day after conception has no difference in live birth rate. There is a higher likelihood of premature birth (odds ratio 1.3) and congenital anomalies (odds ratio 1.3) among births from embryos cultured to the blastocyst stage compared with the cleavage stage.

Embryo options

The laboratory has developed assessment methods to assess the quality of the ovaries and embryos. To optimize pregnancy rates, there is significant evidence that a morphological assessment system is the best strategy for embryo selection. Since 2009 where the first time-lapse microscopy system for IVF was approved for clinical use, the morphokinetic assessment system has been shown to increase to further pregnancy rates. However, when all types of time-lapse embryo imaging devices, with or without a morphokinetic assessment system, were compared with conventional embryo assessment for IVF, there was not sufficient evidence of differences in live birth, pregnancy, stillbirth or miscarriage to choose between them.

Embryo transfer

The amount to be transferred depends on the amount available, the age of the woman and other health and diagnostic factors. In countries such as Canada, UK, Australia and New Zealand, up to two embryos are transferred except under unusual circumstances. In the UK and according to HFEA regulations, a woman over 40 may have up to three embryos transferred, whereas in the United States, there is no legal limit on the number of embryos that can be transferred, even though medical associations have provided practice guidelines. Most clinics and regulatory agencies try to minimize the risk of multiple pregnancies, so it is not uncommon for some embryos to be implanted if multiple embryos are transferred. The embryo is transferred to the patient's uterus through a thin plastic catheter, which penetrates the vagina and cervix. Some embryos may be passed to the uterus to increase the likelihood of implantation and pregnancy.

Adjuvant treatment

Luteal support is the administration of drugs, generally progesterone, progestin, hCG, or GnRH agonists, and often with estradiol, to improve the success rate of early implantation and embryogenesis, thus complementing and/or supporting corpus luteum function. A Cochrane review found that hCG or progesterone given during the luteal phase may be associated with higher live birth rates or ongoing pregnancies, but the evidence is not conclusive. Co-treatment with GnRH agonists appears to increase yield, by RD live birth rate from 16% (95% confidence interval 10 to 22%).

On the other hand, growth hormone or aspirin as an adjunctive drug in IVF has no evidence of overall benefit.

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Expansion

There are various extensions or additional techniques that can be applied in IVF, which are not usually required for the IVF procedure itself, but are almost impossible or technically difficult to do without simultaneously performing IVF methods.

Preimplantation genetic screening or diagnosis

Preimplantation genetic screening (PGS) or preimplantation genetic diagnosis (PGD) has been suggested to be used in IVF to select embryos that seem to have the greatest chance of successful pregnancy. However, a systematic review and meta-analysis of existing randomized controlled trials came to the result that there was no evidence of beneficial effects of PGS by biopsy of the cleavage stage as measured by live birth rate. In contrast, for women of advanced maternal age, PGS with phase biopsy of the hemispheres significantly decreased the live birth rate. Technical weaknesses, such as invasive biopsy, and non-representative samples due to mosaicism are the main factors underlying PGS inefficiency.

However, as an IVF expansion, patients who may benefit from PGS/PGD include:

• Couples who have a family history of inherited diseases
• Couples who want assertiveness of sex before birth. It can be used to diagnose monogenic disorders with sexual intercourse. This can potentially be used for sex selection, in which the fetus is aborted if having unwanted sex.
• Couples who already have children with incurable diseases and need a compatible cell from a healthy second child to heal the former, produce a "rescue brother" who fits the sick child in the HLA type.

PGS screens for temporary chromosomal abnormalities while PGD diagnoses specific molecular defects of inherited disease. In PGS and PGD, individual cells of pre-embryo, or trophectoderm cells should be biopsied from the blastocyst, analyzed during the IVF process. Before pre-embryo transfer back to a woman's womb, one or two cells are removed from the pre-embryo (8-cell stage), or preferably from the blastocyst. These cells are then evaluated for normality. Usually within one to two days, after completion of the evaluation, only the normal pre-embryo is sent back to the woman's uterus. Alternatively, the blastocyst may be pre-prescribed via vitrification and transferred later in the uterus. In addition, PGS can significantly reduce the risk of multiple pregnancies because fewer embryos, ideally only one, are required for implantation.

Cryopreservation

Cryopreservation may be performed as cryopreservation of oocytes prior to fertilization, or as cryopreservation of the embryo after fertilization.

The Rand Consulting Group estimated that there were 400,000 frozen embryos in the United States in 2006. The advantage is that patients who fail to get pregnant can get pregnant using the embryo without having to go through the full IVF cycle. Or, if pregnancy occurs, they can return later for pregnancy again. Oocytes or spare embryos resulting from fertility treatments may be used to donate oocytes or embryo donors to women or other couples, and embryos can be created, frozen and stored specifically for transfers and donations using donor eggs and sperm. Also, cryopreservation of oocytes can be used for women who tend to lose their ovarian reserves as they undergo chemotherapy.

By 2017, many centers have adopted cryopreservation of embryos as their primary IVF therapy, and do little or no fresh embryo transfer. The two main reasons for this are better endometrial reception when embryos are transferred in cycles without exposure to ovarian stimulation as well as the ability to store embryos while awaiting pre-implantation genetic testing results.

The results of using cryopreserved embryos were uniformly positive without an increase in birth defects or developmental abnormalities.

Other expansions

• Injection of intrasitoplasmic sperm ( ICSI ) is where one sperm is injected directly into the egg. Its primary use as an IVF extension is to overcome male infertility problems, although it may also be used where eggs are not easily penetrated by sperm, and sometimes simultaneously with sperm donors. Can be used in teratozoospermia, because once the egg is fertilized, abnormal sperm morphology does not seem to affect the development of blastocyst or blastocyst morphology.
• Additional methods of embryo profile creation. For example, methods appear in making a comprehensive analysis to the entire genome, transcript, proteom and metabolom that can be used to assess embryos by comparing patterns with those previously found between embryos in successful and unsuccessful pregnancies.
• Assisted zone hatching (AZH) can be done just before the embryo is transferred to the uterus. A small opening is made in the outer layer surrounding the egg to help the embryo hatch and help the process of growing embryo implantation.
• In egg donations and embryo donations, the embryos produced after fertilization are inserted into other women than those that deliver the eggs. It is a resource for women without eggs due to surgery, chemotherapy, or genetic causes; or with poor egg quality, IVF cycles that were previously unsuccessful or advanced maternal age. In the egg donor process, the egg is taken from the donor ovary, fertilized in the laboratory with the sperm from the receiving partner, and the resulting healthy embryo is returned to the recipient's uterus.
• In oocyte selection, an oocyte with an optimal likelihood of live birth can be selected. It can also be used as a preimplantation genetic screening tool.
• Embryo separation can be used for twins to increase the number of available embryos.
• The transfer of the cytoplasm is where the cytoplasm of the donor egg is injected into the egg with the mitochondria being compromised. The resulting egg is then fertilized with sperm and implanted in the uterus, usually from the woman who provides the receiving egg and the nuclear DNA. Cytoplasmic transfer is created to help women who experience infertility due to lack or mitochondrial damage, which is contained in the cytoplasm of the ovum.

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Embry or leftover

There may be residual or egg embryos from the IVF procedure if the woman they originally created has successfully brought one or more pregnancies for an extended period of time. With the consent of a woman or spouse, this can be donated to help women or other couples as third-party reproductive tools.

In embryo donations, these additional embryos are given to other couples or women to be transferred with the aim of producing a successful pregnancy. The resulting child is regarded as the daughter carrying it and giving birth, and not the child of the donor, just as with egg donations or sperm donations.

Typically, genetic parents donate eggs to a fertility clinic or where they are preserved with cryopreservation oocytes or cryopreservation of the embryo until carriers are found for them. Usually the process of matching the embryo with the prospective parent is done by the agency itself, at that time the clinic transfers the ownership of the embryo to the prospective parent.

In the United States, women who want to become embryonic recipients undergo infectious disease tests required by the US Food and Drug Administration (FDA), and reproductive tests to determine the best placement locations and cycle times before actual embryo transfer takes place. The number of screenings that the embryo has undergone is highly dependent on clinics and IVF processes of genetic parents. The embryo receiver may choose to have its own embryologist perform further testing.

Another alternative to donating unused embryos is to destroy them (or burn them at a time when pregnancy is highly unlikely), keep them frozen indefinitely, or donate them for use in research (which causes their disability). The individual's moral view of discarding the remaining embryo may depend on the personal view at the beginning of the human personality and the future definition and/or future value of the candidate and on the value assigned to the fundamental research question. Some people believe the remaining embryo donations for research are a good alternative to getting rid of embryos when patients receive the right, truthful and clear information about research projects, procedures and scientific values.

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History

In 1977, Steptoe and Edwards succeeded in a pioneering conception that resulted in the birth of the world's first baby contained by IVF, Louise Brown on July 25, 1978, at Oldham General Hospital, Greater Manchester, UK.

The successful birth of a second successful tube baby occurred in India just 67 days after Louise Brown was born. The girl named Durga was conceived in vitro using Subhash Mukhopadhyay method, a doctor and researcher from Kolkata.

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Ethics

Mixed-plus

In some cases, laboratory mixing (incorrectly identified gametes, incorrect embryonic transfer) has occurred, leading to legal action against IVF providers and complex paternity clothing. An example is the case of a woman in California who received another partner's embryo and was informed of this error after the birth of her son. This has caused many individual authorities and clinics to apply procedures to minimize the risk of such mix-ups. The HFEA, for example, requires a clinic to use a double witness system, the identity of the specimen is examined by two people at any point at which the specimen is transferred. Alternatively, technology solutions get help, to reduce labor costs from manual double testimony, and to reduce risk with RFID tags with unique numbers that can be identified by readers connected to the computer. The computer tracks specimens throughout the process and marks the embryologist if an unsuitable specimen is identified. Although the use of RFID tracking has been expanded in the United States, it has not yet been widely adopted. However, in other cases there is no mixture of embryos or gametes, but the intentional use of embryos from other couples or gamete donors, without the consent of parents, either: receptors or donors. Some of these cases take legal and judicial courses.

Preimplantation or screening diagnosis

Another concern is that people will filter in or out for certain traits, using a preimplantation (PGD) genetic diagnosis or a preimplantation genetic screening. For example, deaf English couples, Tom and Paula Lichy, have petitioned to make deaf babies using IVF. Some medical ethicists are very critical of this approach. Jacob M. Appel writes that "deliberately destroying a blind or deaf embryo can prevent future suffering, while a policy that allows deaf or blind parents to vote for because such traits will deliberately be much more troublesome. "

This convincing conception of genes has created the concept of Baby Designer. Currently, PGD can change some physical and health attributes, and projections for future PGD forces in its ability to create ideal human beings have raised many ethical issues. Projections for social reactions include changing the field of athletics, creating human weapons, and exchanging autonomy over one's life course for pre-design. Also, with a limited view of the future, it is difficult to alter the genetic make-up of humans without knowing full impact. For example, through gene therapy, laboratories are able to make mice lose weight, but the long-term effects of gene manipulation lead to fears of toxic production and too much weight loss. To prevent some of these problems from emerging, scientists are working to stabilize the entire process to make it safer before applying higher gene modifications to human embryos in IVF.

Industrial profit passion

Many people do not oppose the practice of IVF itself (ie creating a pregnancy through "artificial" means) but are very critical of the current state of the industry. Such people argue that industry has now become a multibillion dollar industry, widely unregulated and prone to serious violations in the practitioners' desire to make a profit. For example, in 2008, a California doctor transferred 12 embryos to a woman who gave birth to twin-eight babies (see Suleman octuplets). It has made international news, and has led to accusations that many doctors are willing to endanger the health and even the lives of women seriously to earn money. Robert Winston, professor of fertility studies at Imperial College London, has called the industry "corrupt" and "greedy" saying that "One of the big problems facing us in healthcare is IVF has become a massive commercial industry," and that "What has happened, of course, is money that destroys all this technology ", and accuses authorities of failing to protect spouses from exploitation" Regulatory authorities have done consistently bad jobs.This does not prevent the exploitation of women, it does not extinguish very well information for couples , it's an unlimited number of unscientific treatments that people can access ". The IVF industry can be seen as an example of what social scientists describe as an increasing trend toward the development of market-driven health, medicine and the human body.

As science evolves, industry is increasingly driven by money in which researchers and innovators enter the battle over patents and intellectual property rights. The copyright clause in the US Constitution protects the rights of innovators for their respective jobs in an effort to promote scientific progress. In essence, this legitimate protection gives incentives to innovators by giving them a temporary monopoly over their own work. In the IVF industry, it is very expensive for patients, patents are at risk even higher prices for patients to accept the procedure because they also have to cover the cost of protected work. For example, the 23andMe company has patented a process used to calculate the probability of genetic inheritance. Although this innovation can help many people, the company still has the sole right to run it and therefore has no economic competition. The lack of economic competition leads to higher product prices.

The industry has been accused of making unscientific claims, and distorting facts related to infertility, particularly through over-claims of how general infertility in society, in an effort to get as many couples as possible and as soon as possible to attempt treatment (rather than trying to conceive naturally for time which is longer). It risks eliminating infertility from its social context and reducing experience to simple biological damage, which can not only be handled through bio-medical procedures, but must be treated by them.. Indeed, there are serious concerns about the excessive use of care, for example Dr. Sami David, a fertility specialist and one of the early pioneers of IVF care, has expressed disappointment over the current state of the industry, and says many procedures are unnecessary; He said: "This is the first choice of treatment rather than the last option.When it first opened in the late 1970s, the early 80s, it was meant to be the last resort.Now it is the first attempt.I think it's injustice to women. thinking it could endanger women in the long run. "IVF thus raises ethical concerns about the misuse of bio-medical facts to 'sell' corrective procedures and treatments for conditions deviating from the ideal built from 'healthy' or 'normal' bodies ie, and men with an inherited reproductive system produce offspring.

Pregnancy after menopause

Although menopause is a natural barrier to further conception, IVF has enabled women to become pregnant in their fifties and sixties. Women whose uterus has been properly prepared receive embryos derived from egg donor eggs. Therefore, although these women have no genetic relationship with children, they have an emotional connection through pregnancy and childbirth. In many cases the child's genetic father is a female partner. Even after menopause, the uterus is fully capable of doing the pregnancy.

Allowing women to get pregnant through natural time can be a factor of overpopulation problems. Through PGD, children born through IVF will have a higher life expectancy rate because of the disease being eliminated. Thus increasing the number of women capable of childbearing increases the rate of population growth, while IVF in IVF decreases mortality, resulting in an increase in population.

same-sex couples, single and unmarried parents

A 2009 statement from ASRM found no persuasive evidence that children were harmed or harmed solely because of being raised by single parents, unmarried parents, or homosexual parents. It does not support restricting access to assisted reproductive technologies on the basis of marital status or the prospective parental sexual orientation.

Ethical issues include reproductive rights, hereditary welfare, non-discrimination against unmarried individuals, homosexuality, and professional autonomy.

A recent controversy in California focuses on the question of whether doctors opposing same-sex relationships should be asked to do IVF for lesbian couples. Guadalupe T. Benitez, a San Diego lesbian medical assistant, sued doctors Christine Brody and Douglas Fenton from the North Coast Women's Medical Treatment Group after Brody told him that he had "a religious-based objection to treat him and the homosexuals in general to help them. " Imagine children with artificial insemination, "and Fenton refused to authorize recipe refills for Clomid's fertility drugs on the same basis.The Californian Medical Association initially sided with Brody and Fenton, but his case, the Northern Coast Women's Medical Treatment Group v. The Court of Appeal, unanimously by the California State Supreme Court in favor of Benitez on August 19, 2008.

IVF is increasingly being used to allow lesbians and other LGBT couples to share in the reproductive process through a technique called IVF reciprocity. Eggs from one pair are used to create embryos carried by other couples through pregnancy.

Nadya Suleman came to international attention after twelve embryos were implanted, eight of them survived, producing eight newborns added to the family of six children. The Medical Board of California seeks to have fertility doctor Michael Kamrava, who treats Suleman, revoked his license. State officials alleged that Suleman's procedure was evidence of unreasonable judgment, substandard treatment, and a lack of attention to the eight children he would conceive and six he had struggled to raise. On June 1, 2011, the Medical Council issued a decree that Kamrava medical license was revoked effective July 1, 2011.

Anonymous donors

Some of the children borne by IVF use an anonymous donor report of the problem because they do not know about their donor parents as well as the genetic relatives they may have and their family history.

Alana Stewart, who was conceived using donor sperm, started an online forum for donor children called AnonymousUS in 2010. The forum welcomes the point of view of anyone involved in the IVF process. Olivia Pratten, a Canadian-funded donor, sued the province of British Columbia for access to records about the identity of her baby's father in 2008. "I am not a treatment, I am a person, and the records are mine," Pratten said. In May 2012, the court ruled in favor of Pratten, agreeing that the law at that time discriminated against donor children and made anonymous sperm and donated eggs in British Columbia illegally.

In the UK, Sweden, Norway, Germany, Italy, New Zealand, and some Australian states, donors are not paid and can not be anonymous.

In 2000, a website called Donor Sibling Registry was created to help biological children with public donors connect with each other.

In 2012, a documentary entitled Anonymous Father's Day was released which focuses on the donor children it contains.

Unwanted embryo

During the selection and transfer phase, many embryos can be disposed for the sake of others. This choice can be based on criteria such as genetic or gender abnormalities. One of the earliest cases of specialized gene selection through IVF was the Collins family case in the 1990s, which chose the sex of their child. Ethical issues remain unresolved because there is no consensus in science, religion, and philosophy about when a human embryo should be recognized as a person. For those who believe that this is at conception, IVF becomes a moral question when some eggs are fertilized, developed, and few are chosen for implantation.

If IVF involves the fertilization of only one egg, or at least just the amount to be implanted, then this will not be a problem. However, this has the opportunity to increase costs dramatically because only a few eggs can be tried at a time. As a result, the couple must decide what to do with this extra embryo. Depending on their view of the humanity of the embryo or the possibility the couple will want to try to have more children, this couple has several options to deal with this additional embryo. Couples may choose to keep them frozen, donate them to other infertile couples, dilute them, or donate them for medical research. Keeping them frozen requires money, donating them does not ensure they will survive, liquefying them makes them imperfect soon, and the results of medical research in terminating their employment. In the field of medical research, couples do not need to be told what embryo will be used, and as a result, some can be used in stem cell research, a field deemed to have ethical problems.

Religious response

The Catholic Church opposes all types of assisted reproductive technology and artificial contraception, insisting that they separate the purpose of procreation of marital sex from the purpose of uniting a married couple. The Catholic Church allows the use of small amounts of reproductive technology and contraceptive methods such as natural family planning, which involve ovulation time charts. The Church allows another form of reproductive technology that allows conception to occur from normative sexual relationships, such as fertility lubricants. Pope Benedict XVI has publicly reiterated the Catholic Church's rejection of in vitro fertilization, claiming that it replaces love between husband and wife.

The Catechism of the Catholic Church claims that the laws of nature teach that reproduction has an "inseparable connection" to the married couple's sexual relations. In addition, the church opposes IVF because it can lead to the disposal of embryos; in Catholicism, the embryo is seen as an individual with a soul to be treated as a person. The Catholic Church maintains that not objectively evil becomes infertile, and supports adoption as an option for couples who still want to have children.

Hindu people welcome IVF as a reward for those who can not bear children and have declared doctors associated with IVF to do Have as there are some characters who are claimed to be born without intercourse, especially Karna and five Pandavas.

Regarding the response to the Islamic IVF, the conclusions of ART's Gad El-Hak Ali Gad El-Hak's fatwa include:

• IVF eggs from a wife with her husband's sperm and removal of the fertilized egg back to the wife's womb are permitted, provided the procedure is indicated for medical reasons and performed by a specialist.
• Since marriage is a contract between a wife and a husband during their marriage span, no third party should interfere with the function of sexual marriage and procreation. This means that third-party donors are unacceptable, whether they provide sperm, eggs, embryos, or uterus. The use of a third party is equivalent to adultery , or adultery.

In the Orthodox Jewish community this concept is debated because there is little precedent in the textual sources of traditional Jewish law. Regarding the law of sexuality, religious challenges include masturbation (which can be thought of as "waste of seed"), laws related to sexual activity and menstruation (niddah) and special laws on sexual relations. The main additional problem is establishing paternity and lineage. For naturally conceived infants, the identity of the father is determined by the legal presumption (chazakah) of legitimacy: rov bi'ot achar ha'baal - female sexual relationships are assumed with her husband. Regarding IVF children, this assumption does not exist and like Rabbi Eliezer Waldenberg (among others) requires an outside supervisor to identify father positively. The Reformation of Judaism has generally approved IVF.

Society and culture

Many people in sub-Saharan Africa choose to raise their children to infertile women. IVF allows these infertile women to have their own children, which impose new ideals on a culture in which raising children is seen as natural and culturally important. Many infertile women are able to gain more respect in their community by caring for children from other mothers, and this may be lost if they choose to use IVF instead. Because IVF is considered unnatural, it can even inhibit their societal position as opposed to making them equal to a fertile woman. It is also economically advantageous for infertile women to raise foster children because it gives these children greater ability to access resources that are important to their development and also foster the development of their communities at large. If IVF becomes more popular without declining birth rates, there may be larger family homes with fewer options to send their newborn children. This may lead to an increase in orphaned children and/or a decrease in resources for children from extended families. This will eventually hamper the growth of children and society.

src: media.npr.org

Emotional engagement

Studies have shown that IVF mothers show greater emotional involvement with their children, and they enjoy mothers more than mothers with natural concepts. Similarly, studies have shown that IVF fathers express more warmth and emotional involvement than fathers with adoption and natural conception and enjoy more dad roles. Some IVF parents become too involved with their children.

src: www.drroshisatija.com

Men and IVF

Research has shown that men mostly see themselves as 'passive' contributors because they are 'less physically involved' in IVF care. Nevertheless, many men feel depressed after seeing the amount of hormonal injections and ongoing physical intervention in their female partner. Fertility is found to be a significant factor in men's perception of masculinity, encouraging many people to keep their care secret. In cases where men do share that he and his partner undergo IVF, they are reported to have been ridiculed, especially by other men, although some people consider this to be an affirmation of support and friendship. For others, this causes a feeling of social isolation. Compared with women, men show fewer declines in health m

Source of the article : Wikipedia