Presentation on theme: "In Vitro Fertilization IVF. The first IVF baby in the world was born in July of 1978 in England. Today, many thousands of children are born annually as."— Presentation transcript:
In Vitro Fertilization IVF
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. IVF 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.
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. 2. Severe male factor infertility (low sperm count or low motility) 3. Failed 2-6 cycles of ovarian stimulation with intrauterine insemination (IUI). 4. Advanced female age - over Reduced ovarian reserve, which means lower quantity (and sometimes quantity) of eggs. 6. Severe endometriosis Who should be treated with in vitro fertilization?
IVF- Clinical Processes
The 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 stimulation Puregon (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 endometrium Profasi, Pregnyl(human chorionic gonadotropin (hCG)) Prometrium (Progesterone) Estradot patch, Estrace (Estradiol)
Embryo Development in the Lab Day 1 Day 5 Day 4Day 3 Day 2 Day 6
Safety Endpoints Ovarian hyperstimulation syndrome –Monitor using blood test Miscarriage rate –PGD –Progesterone supplement Multiple pregnancy rate –5 day blastocyst transfer Ectopic pregnancy rate
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. Blood test in monitoring IVF
Estradiol ("E2") Ovary stimulation: development of follicles (e.g. 150 to 500 pg/ml on day 8, doubles every 48 hrs.) Ovary suppression <30pg/ml luteinizing hormone ("LH") LH surge: ovulation and release of the oocyte has begun. Progesterone forms once there has been an LH surge : problem in development of follicles
Commonly, more than 100 diseases can be detected through testing, including… Hemophilia A Muscular dystrophy Tay-Sachs disease Cystic fibrosis Down Syndrome Removal of one cell from day 3 embryo for testing Preimplantation Genetic Diagnosis (PGD)
PGD Can Improve Implantation Rate Identification of chromosomes X,Y,13,18,21,15,16,22 Implantation Rate PGD24.2% Controls12.4% (p<0.001)
PGD Predicts IVF Outcome Age >37 > 2 failed cycles of IVF 216 couples 3 groups, depending on # normal embryos available after PGD 0 normal1 normal>1 normal #patients #embryos #transfers81448 Births/patient4%15%31% Ferraretti, et al World Congress IVF, 2002