IVF: Introduction, Steps involved in IVF, First Test Tube Baby, Cryopreservation, Surrogacy, Significance of IVF, Practice Problems, and FAQs

We love our parents, through them we came to this most beautiful world. Parents and children together make a family. But in your neighbourhood, you might have heard that there are couples who don’t have kids. There may be various reasons for this. Some couples overcome this situation by adoption. Yes it is a good thing. In this way they give better living conditions for an orphan. But certain people opt in vitro fertilisation or IVF. 

Adoption is a legal process during which a couple can legally adopt a child even though the parent and child are not related by blood. In vitro fertilisation or a test-tube baby is a technique by which a couple can get a baby and both the parents and baby are related by blood here.

You know, for the IVF technique, the couple need to undergo a series of procedures. But do you know what are the various steps involved in this technique? or How successful is it? Let’s try to find out the answers for all the above questions. So let’s take a deep dive into the details of IVF technique and understand how it solves the problem of infertility to some extent through this article. 

Table of contents

• Introduction
• Steps involved in IVF
• First test-tube baby
• Cryopreservation
• Surrogacy
• Significance of IVF
• Practice Problems
• FAQs

Introduction

IVF or in vitro fertilisation is a type of assisted reproductive technology (ART) in which sperm and an egg are fertilised outside the human body. This method is used by infertile couples to achieve pregnancy. In this process, gametes are retrieved from a couple or donors and fertilised in lab conditions. The fertilised egg, which is now known as an embryo, is implanted inside the uterus a few days (around 3 – 5 days) after fertilisation. When this embryo embeds itself in the uterine wall, pregnancy results. IVF is also known as a test tube baby program. 

Reasons for choosing IVF

IVF is normally chosen by people for a variety of reasons as follows:

• Due to infertility problems
• Due to a pre-existing medical condition. For example, due to azoospermia condition in males that means lacking sperms in the semen. 
• Some people will try IVF if other fertility treatments haven't worked for them. For example, artificial insemination. 
• Some are beyond the optimum age of the pregnancy. 
• IVF is considered as an additional reproductive option especially for the same-sex couples or individuals (gays and lesbians) who want to become parents on their own. 

Steps involved in IVF

IVF is a type of assisted reproductive technology (ART). This indicates that specific medical procedures are performed in this technique to aid a woman in getting pregnant. When other, less expensive reproductive treatments haven't worked, this one is typically tried. It involves the following steps:

• Superovulation
• Gamete retrieval
• Insemination and fertilisation
• Embryo culture
• Embryo transfer
• Pregnancy
   

Superovulation or controlled ovarian hyperstimulation

This is the first step of IVF. During this process, medicines or fertility drugs are injected into the female’s body to boost egg production. Normally, a healthy woman produces one egg in a menstrual cycle. The hormonal treatment of ovaries produces several mature ova in one cycle and this process is known as superovulation. It is achieved normally by eliminating the inhibitory mechanism of the dominant follicle or by promoting the development of subordinate follicles using follicle-stimulating gonadotropins.

The rapid secretion of luteinising hormone leads to the maximum level during the mid of the cycle and this is known as LH surge. It induces rupture of the Graafian follicle and thereby the release of an ovum (ovulation). 

The woman will undergo routine transvaginal ultrasounds to evaluate her ovaries during this phase, as well as blood tests to determine her hormone levels. When eggs are prepared for final maturation, a ‘trigger shot’ is administered to complete their maturity in preparation for egg retrieval. A trigger injection is administered precisely 36 hours before the period allotted for egg retrieval.

Gamete retrieval

During this step, sperm and ova are extracted from the donor. 

Retrieval of egg

Once the hormone therapy has assisted in the development of multiple mature eggs, the doctor harvests the ova using a minimally invasive technique called transvaginal oocyte retrieval. During this technique, a thin needle is inserted under sonographic guidance through the vaginal wall. This enters the ovaries and extracts a number of mature ova either from the mother or from the donor female.

Retrieval of sperms

The doctor harvests sperm from the male (father or donor) in the form of semen, either through ejaculation or using collection condoms. The collection condom enables the sperm to be obtained through sexual activity in order to maintain sperm viability and motility. There is another option to obtain sperm from the male if any obstruction occurs that prevents normal ejaculation. This method is known as the surgical method. In this case the sperm is extracted from the epididymis instead of the testes. IVF facilities typically prefer to work with fresh rather than frozen gametes and hence the gamete retrieval takes place on the same day.

Insemination and fertilisation

When eggs and sperm are placed together, the mixing occurs between these two structures, and the process is known as insemination. Both the egg and the sperm are stored in controlled conditions in a chamber after this, so that the sperm swims and fertilises the egg after a few hours of insemination. This is considered traditional fertilisation. 

The fertilisation can also be done artificially if there is a low chance of natural fertilisation and then the technique is known as intra cytoplasmic sperm injection (ICSI).

Intra cytoplasmic sperm injection (ICSI)

It is known as artificial fertilisation during which sperm is directly injected into the ovum. A tiny needle is used in this process which is called a micropipette. The technique of ICSI can be done in case of low sperm count, low sperm motility, and when there is a higher concentration of immobile sperm. 

Embryo culture

An embryo is formed when a fertilised egg divides. The embryo will be monitored by laboratory personnel on a regular basis to ensure normal growth. It is a must for an embryo to overcome all the complications to become a suitable one for transfer. Approximately, 50% of the fertilised embryos develop to the blastocyst stage because this stage is most suitable for implantation. The remaining 50% fail to develop and therefore, are discarded. After about five days, a typical embryo has numerous cells that are actively dividing. 

Preimplantation genetic diagnosis (PGD)

Preimplantation genetic diagnosis (PGD) is a technique advised for couples who are at a high risk of spreading genetic (hereditary) disorders to their unborn child. This procedure is commonly done after three to five days of fertilisation. From each embryo, a single cell or cells are removed by laboratory researchers who then check the sample for particular genetic diseases. PGD can assist parents in selecting the embryos for implantation. By doing this, the likelihood of transferring a disorder to a child is reduced.

Embryo transfer

During this process, the embryo is placed within the female genital system for further development. It is an invasive procedure. This can be done in two ways as follows:

• Zygote intra fallopian transfer (ZIFT)
• Intra uterine transfer (IUT)

Zygote intra fallopian transfer

It is a type of process in which a fertilised egg is directly transferred into the fallopian tubes artificially. This procedure is also known as tubal embryo transfer (TET). Through a laparoscopic procedure, the fertilised eggs are injected through a catheter that has been inserted deep inside the fallopian tube. After that, the zygote descends into the fallopian tube and implants itself on the uterine wall. There is about a 32 - 36% chance of success in a healthy young woman. With the help of this procedure, the zygote can only be transferred up to the 8 blastomeres stage.

Intra uterine transfer

Intra uterine transfer of the zygote can be done in those situations in which there is a blockage in the fallopian tubes. This prevents the normal fertilisation of sperm and egg. To overcome this problem, the zygote of more than 8 blastomeres stage is transferred directly to the uterus. Here, the zygote gets implanted in the uterus wall. The success rate of IUT in a healthy young female is 32 - 46%.

Pregnancy

When the embryo embeds itself in the uterus lining, pregnancy results. About nine to 14 days following embryo transfer, the doctor will perform a blood test to confirm the pregnancy. It is possible to implant more than one embryo at once, which may result in twins, triplets, or more. The precise number of embryos transferred is a complicated matter that depends on a variety of elements, particularly the age of the woman. 

The same procedures are followed if donor eggs are being used. The egg donor will finish the egg retrieval and ovarian stimulation procedures. The embryo is given to the individual who will carry the pregnancy after fertilisation has occurred.

First test-tube baby

Louise Joy Brown, the first child born through a test tube, was born on July 25, 1978, in Oldham, Lancashire, England. This method was developed by Dr. Robert Edwards and Dr. Patrick Steptoe. In 2010, Dr. Robert Edwards got the Nobel Prize for this achievement.

First test tube baby in India

In India, the first test tube baby born was Kumari Harsha, born on August 6, 1986, in Mumbai. Dr. Indira Hinduja deserves the honour of having produced India's first test tube baby. On the contrary, some people claimed that the world’s second and India’s first test tube baby was born in Kolkata on October 3, 1978. Her name was Durga previously but now her name is Kanupriya Agarwal. Dr. Subhas Mukhopadhyay was the medical professional in charge of this innovative project.

Cryopreservation

Cryopreservation is the process of preserving live cells, tissues, and other biological samples by placing them in a deep freezer at extremely low temperatures. The sample is typically stored at -196°C in liquid nitrogen in this technique. All of a cell's biological functions cease at such low temperatures, resulting in cell death. Cells can withstand freezing and thawing due to cryopreservation.

The viability of gametes is retained but the viability of sperm is reduced in cryopreservation as compared with the non frozen sperm. Therefore, the cryopreserved sperms are delivered using intracytoplasmic sperm injection. 

Surrogacy

Surrogacy is an arrangement when a woman (the surrogate mother) consents to carry a child for a couple, which is frequently supported by a legal agreement. The intended parent or parents receive custody and guardianship of the child once it is born from the surrogate mother. The intended or commissioning parents are the ones who choose to use a surrogate to carry their child.

In gestational surrogacy, the embryo is put in the surrogate's uterus via in vitro fertilisation after the intended mother's egg or a donor egg is fertilised with the intended father's sperm or donor sperm.

Significance of IVF

The following are the major significances of IVF

• It helps in achieving a successful pregnancy and a baby. 
• IVF can make it a reality for people who would be unable to have a baby.
• For women with problems like blocked or damaged fallopian tubes, IVFis the best possibility of having a child by using their own eggs.
• It is used to treat infertility.
• It is a good method for women with advanced maternal age. 
• It is a good method for people who underwent prior reproductive surgeries. 

Practice Problems

Q 1. Identify the correct statement with respect to infertility?

a. Despite unprotected sexual intercourse, the couple is unable to have a child
b. It is the capacity to conceive despite the female's abnormalities
c. Infertility can occur because of physical, congenital, immunological, or psychological disorders only in females
d. It cannot be cured by assisted reproductive technology

Answer: The failure to have children despite unprotected sexual intercourse is known as infertility. It can be caused due to various reasons, such as physical, congenital, immunological, or psychological disorders. It occurs in both, male and female partners. Hence, the correct option is a.

Q 2. Identify the correct statement regarding ZIFT.

a. It stands for zygote intra fallopian transfer
b. After in vitro fertilisation, the zygote is moved into the uterus in this case
c. The fallopian tube receives early embryos with more than 8 blastomeres|
d. This is done when the sperm count is low and is also called artificial fertilisation

Answer: The fallopian tube receives the zygote or early embryo (up to 8 blastomeres). Therefore, it is also called zygote intrafallopian transfer (ZIFT). The uterus receives embryos with more than 8 blastomeres instead of the fallopian tube. This is known as IUT or intrauterine transfer. Hence, the correct option is a.

Q 3. Who is a surrogate mother?

a. Female who cannot produce children.
b. A female that delivers a child for another couple
c. Female who provides ovum to another woman
d. Both a and c

Answer: An example of assisted reproductive technology (ART) is surrogacy, in which a woman conceives and gives birth to a child on behalf of another couple. A woman who carries a baby in this way is referred to as a surrogate mother. Hence, the correct option is b.

Q 4. Identify the correct option from the given options regarding ARTs. 

a. GIFT: Gamete inter fallopian transfer
b. IUT: Inter uterine transfer
c. ZIFT: Zygote inter fallopian transfer
d. ICSI: Intra cytoplasmic sperm injection

Answer: A number of assisted reproductive technologies can help infertile couples conceive, including GIFT, IUT, ZIFT, and ICSI.

• GIFT : Gamete intrafallopian transfer
• IUT : Intra uterine transfer
• ZIFT : Zygote intrafallopian transfer
• ICSI : Intra cytoplasmic sperm injection

Hence, the correct option is d.

FAQs

Q 1. How successful is in vitro fertilisation?
Answer: The success rate of in vitro fertilisation is 45 - 53%.

Q 2. How many times a person can do IVF to conceive?
Answer: There are no limits on the number of cycles a person can have. Some couples conceive after the first cycle but there are some couples who conceive even after 10 cycles.

Q 3. How old can a person get IVF?
Answer: IVF is best performed on women between the ages of 47 and 50, but if she is exceptionally fit, this age limit can be increased to 52 to 53.

Q 4. How many eggs are retrieved in one IVF cycle?
Answer: On average, 10 - 20 eggs are retrieved for one IVF cycle.

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