Dear Colleagues,

Hello !!!

In this news letter I am describing a bit of test tube baby procedure in general. It will give you a overview of various IVF procedure that are available in India. Newer treatment has generated hopes to the infertile couples. Treatments like ICSI, Egg donation and surrogacy are one of the important mile stones in this field.

There are many IVF centers in our country but giving consistently good result is one of most difficult task. Our center achieve 80 % pregnancy rate in the month of January 2008. It was 56 % and 60% in November and December respectively.

This high success rate is mostly due to :

1. Good case selection

2. Standardized stimulation protocol

3. In-house infertility specialist and the Embryologist : it is most important aspect of getting good success as IVF  
    protocols and laboratory equipments need very strict and continuous vigilance.

4. Blastocyst transfer

But ultimately it is the Almighty who helps us and the confidence shown by the couples.

I wish you all the best.

Dr.D’Pankar Banerji

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Test tube baby – an overview

First of all I wish to state that.

1. Test Tube baby grows inside the womb of the mother ,same as a natural pregnancy.

2. Babies born out of this techniques are same as the natural ones and the chances of birth defects are same as
    natural babies ( although there are concerns from some school of thoughts )

3. The procedure does not require any major surgery .

4. There is no requirement of absolute bed rest for the lady, but advised not to indulge in heavy work.

5. It does not require any hospital stay.

6. If husband is having any amount of sperms , only his sperms are used , donor sperms are only used when there is no sperms from husband and there is a written consent from the couple.
Why test tube baby procedure is required :

To create a baby , it is needed that female egg and male sperm should unite and fuse. Normally this fusion takes place inside fallopian tubes of the lady. Fusion creates an embryo. Embryo is like a sticky tennis ball . This ball is rolled towards uterine cavity by peristaltic movements of tube .After 4-5 days of fusion, it sticks to the internal surface of uterus, and grows and takes a shape of human baby.

Fusion of gametes is not possible in the following conditions:

1. If lady’s tubes are blocked ,so that sperm from her vagina is not able to reach the eggs in the tube.

2. if sperms are not in good number then also nothing reaches there.

3. if environment of tubal area is not good as in endometriosis then also fusion is hampered.
Some times the tubes are open but its musculature is damaged ( most common cause is tuberculosis ),then embryo may form but can not be rolled into the uterine cavity. And unfortunately if it grows inside the tube , then an ectopic pregnancy is the result.

In few cases there is no apparent reasons for infertility, then also couple may need In-vitro fertilization ( fertilization outside the body ).

Steps of test tube baby :

i. Down regulation of ovaries for 10 –14 days started during the 21st to 23rd day of the periods. Downregulation means we make the females ovaries quiescent .It is done by daily injections by a syringe or by nasal spray or some times with a depot injection

ii. Gonadotropins (FSH or human menopausal gonadotropins ) generally in higher doses used in patients to achieve superovulation ( creating more than one egg in her ovary). These injections are for 10-11 days and we evaluate the female’s ovaries whether the eggs are growing or not.

iii. Monitor follicular response : usually by Sonography and/or estradiol

iv. Oocyte collection under ultrasound guidance, through the vaginal wall. Done under propophol or other sedation.10 –14 minutes procedure. The Oocyte yield is usually 90%. Very rarely some cases may require laparoscopic aspiration.

v. Sperm samples are provided on the same day of Oocyte collection .( sperms may be cryopreserved earlier also )

vi. Oocyte and sperms are cultured overnight and, if fertilization has occurred, the embryos are further cultured.

vii. Embryo transfer performed using a fine catheter through the cervix into the uterine cavity 3 days to 5 days postferilization .It does not require and sedation or anesthesia .

Luteal phase support using progesterone is followed by pregnancy test.

Who is the Embryologist?
He/she is person who maintains the life of eggs and sperm and the resultant embryos in the laboratory. The lab equipments need continuous vigil and strict quality control. The pH and the temperature of the gametes and embryos has to be maintained almost same to in-vivo conditions. Actual insemination of eggs or ICSI is done by him/her. A good embryologist gives good embryos and it matters a lot in resulting pregnancies.
Visits required by couple for test tube baby treatment :

It requires two or three visits of one day , at an interval of 7 to 15 days. First visit is very important as gynecologist assesses the ovary and uterus and sperms. After injections when growth of the eggs are to monitored ,the lady is advised to come every day for 6-7 days and needs a stay in that city till embryo transfer is performed( total 10-15 days ). The whole process thus takes one month from down regulation to embryo transfer.
 

Husband without sperms in his semen, can he father his child by test tube baby procedure?

The answer is to a large extent ,yes. As sperms are present in some amount in testes. These sperms can be retrieved and utilized for making an embryo.


Why IVF fails ?

IVF fails mainly because of two reasons .One is due to quality of eggs or sperms and second is failure of implantation. These things happens in natural pregnancies also ,but as there is cost involvement in IVF ,so it pinches. Quality of stimulation and quality of embryology matters a lot .But these can be corrected by taking stringent measures but quality of eggs and implantation is still beyond anybody’s reach.
At the end, a dedicated team of gynecologist and an embryologist with good quality lab is must for any test tube baby clinic for good and, most importantly consistent results,.