1. In Vitro Fertilization
IVF

2. 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.
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.

3. Who 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

4. IVF- Clinical Processes

5. 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)

6. IVF- Laboratory Processes
Eggs retrieved
Sperm collection
Eggs stripped and cleaned
Wash sample
Egg equilibration
Assess sperm quality and count
Fertilization- IVF or ICSI
Wash/remove
excess sperm
Assess fertilization
Incubate

7. Egg Retrival

8. ICSI

9. Embryo Development in the Lab
Day 1
Day 5
Day 4
Day 3
Day 2
Day 6

10. Safety Endpoints Ovarian hyperstimulation syndrome Miscarriage rate
Monitor using blood test
Miscarriage rate
PGD
Progesterone supplement
Multiple pregnancy rate
5 day blastocyst transfer
Ectopic pregnancy rate

11. Blood 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.

12. luteinizing 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/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

13. Removal 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 A
Muscular dystrophy
Tay-Sachs disease
Cystic fibrosis
Down Syndrome
Removal of one cell from day 3 embryo for testing

14. PGD Can Improve Implantation Rate
Identification of chromosomes X,Y,13,18,21,15,16,22
Implantation Rate
PGD %
Controls % (p<0.001)

15. PGD Predicts IVF Outcome
Age >37
> 2 failed cycles of IVF
216 couples
3 groups, depending on # normal embryos available after PGD
0 normal 1 normal >1 normal
#patients
#embryos
#transfers
Births/patient 4% 15% 31%
Ferraretti, et al World Congress IVF, 2002

16. Two blastocysts transferred

17. Two frozen-thawed embryos transferred

18. A single embryo transferred