2IVF involves taking eggs from the woman, fertilizing them in the laboratory with her partner's sperm and transferring the resulting embryos back to her uterus 2-6 (usually 3 or 5) days later.The first IVF baby in the world was born in July of 1978 in England. Today, many thousands of children are born annually as a result of this technique.
3Who should be treated with in vitro fertilization? It is generally used in couples who have failed to conceive after at least one year of trying who also have one or more of the following:1. Blocked fallopian tubes or pelvic adhesions with distorted pelvic anatomy Severe male factor infertility (low sperm count or low motility) Failed 2-6 cycles of ovarian stimulation with intrauterine insemination (IUI) Advanced female age - over Reduced ovarian reserve, which means lower quantity (and sometimes quantity) of eggs.6. Severe endometriosis
5The medications used fall into 3 groups. 1.For ovarian suppression. These drugs put the ovaries to sleep and allow us to manipulate the growth of the follicles using medications.Synarel Suprefact Lupron (gonadotropin-releasing hormone (GnRH) analogues.)2.For ovarian stimulationPuregon (follitropin beta, synthetic form of follicle stimulating hormone (FSH) from CHO cells via recombinant DNA technology)Gonal F(follitropin alpha)Pergonal, Repronex, Bravelle (gonadotropins that include FSH and luteinizing hormone (LH) extracted from the urine of postmenopausal women )3.For egg maturation and then support of the endometriumProfasi, Pregnyl(human chorionic gonadotropin (hCG))Prometrium (Progesterone)Estradot patch, Estrace (Estradiol)
6IVF- Laboratory Processes Eggs retrievedSperm collectionEggs stripped and cleanedWash sampleEgg equilibrationAssess sperm quality and countFertilization- IVF or ICSIWash/removeexcess spermAssess fertilizationIncubate
9Embryo Development in the Lab Day 1Day 5Day 4Day 3Day 2Day 6
10Safety Endpoints Ovarian hyperstimulation syndrome Miscarriage rate Monitor using blood testMiscarriage ratePGDProgesterone supplementMultiple pregnancy rate5 day blastocyst transferEctopic pregnancy rate
11Blood test in monitoring IVF 1. To be certain that there is an adequate, but not excessive response to the hormones.2. To time oocyte (egg) retrieval.3. To be sure that as many mature oocytes as possible are retrieved.4. To watch for changes in hormone levels. Particularly those hormones that are thought to indicate, or to cause poor oocyte quality One or another of three different hormones:estradiol ("E2"), luteinizing hormone ("LH"), and progesterone.
12luteinizing hormone ("LH") Estradiol ("E2")Ovary stimulation: development of follicles (e.g. 150 to 500 pg/ml on day 8, doubles every 48 hrs.)Ovary suppression <30pg/mlluteinizing hormone ("LH")LH surge: ovulation and release of the oocyte has begun.Progesteroneforms once there has been an LH surge: problem in development of follicles
13Removal of one cell from day 3 embryo for testing Preimplantation Genetic Diagnosis (PGD)Commonly, more than 100 diseases can be detected through testing, including…Hemophilia AMuscular dystrophyTay-Sachs diseaseCystic fibrosisDown SyndromeRemoval of one cell from day 3 embryo for testing
14PGD Can Improve Implantation Rate Identification of chromosomes X,Y,13,18,21,15,16,22Implantation RatePGD %Controls % (p<0.001)
15PGD Predicts IVF Outcome Age >37> 2 failed cycles of IVF216 couples3 groups, depending on # normal embryos available after PGD0 normal 1 normal >1 normal#patients#embryos#transfersBirths/patient 4% 15% 31%Ferraretti, et al World Congress IVF, 2002