In Vitro Fertilization(Synonym: Test Tube Baby):

Guan Wei, Test tube baby series nos 18, 4 and 19. 1992/3. Acrylic on canvas, 125 x 48cm each panel. Acquired 1995. UNSW P 1995/0658; 0685 and 0659

What is In Vitro Fertilization?

In Vitro Fertilization (IVF) is the scientific name given to the process with is used to conceive a child outside the body. A woman's egg (ovum) and her partner's sperm are placed together in a plastic dish or a test tube in the hope that fertilization will occur. IVF is a technique in which egg (ovum) is fertilized outside the woman's body. IVF is a revolutionary treatment for infertility and is performed when other methods of achieving conception have failed.

What is the goal of IVF?

Women with Fallopian tube blockages cannot conceive because their eggs cannot travel through their Fallopian tubes to get fertilized. The goal of IVF is to achieve fertilization outside the body, implant this fertilized egg in the woman's womb which may result in pregnancy.

Who is an ideal candidate for IVF?

If you are under 35 years of age and are unable to become pregnant after one year of unprotected intercourse, if you have had Pelvic Inflammatory Disease and have suffered damage to your fallopian tubes resulting in permanent blockage of your tubes or if your partner has been diagnosed with having low sperm counts or if the sperms have abnormal morphology or motility, then you are an ideal candidate for IVF.

What does the procedure for IVF involve?

IVF is performed in treatment cycles. Pregnancy may be achieved after one treatment cycle or it may take up to four treatment cycles to achieve a successful pregnancy. Each treatment cycle of IVF consists of the following steps:

• Evaluation for IVF - Infertility evaluation prior to IVF is done by blood tests to monitor your hormone levels and ultrasound examination to determine the optimum time to harvest your egg from the ovary. You will be administered an injection of human Chorionic Gonadotrophin (hCG) 35 hours before your egg is retrieved from the ovary. Human Chorionic Gonadotrophin (hCG) triggers final stages of ovulation.
• Egg Retrieval - During this step in IVF procedure, the eggs from the ovary are aspirated transvaginally by an ultrasound guided probe. A fine needle pierces the ovarian follicle and the follicular fluid, which contains the egg, is extracted. This step of IVF procedure is performed under local anesthesia and intravenous sedation to help you relax and minimize discomfort during the procedure.
• IVF Lab.- The eggs are washed and then cultured in a fluid containing specialized chemicals and nutrients. A couple of hours after egg collection, the husband / partner provides a semen specimen. It is extremely important that both egg and sperm are maintained at body temperature. The embryologist adds a droplet of semen to each test tube containing the eggs and places it in the incubator. After 16 - 20 hours, the eggs are examined under the microscope and checked for the first signs of fertilization. A fertilized ovum looks like a small ball with two eyes under the microscope. After two to three days, if the embryos are growing normally, they are ready to be transferred to the woman's uterus.
• Embryo Transfer (ET) of IVF - This is not complicated at all. You will be given some sedation, your legs will be placed in stirrups in gynecologic (lithotomy) position. The embryos are placed in a tiny plastic tube which is introduced into the uterus through the cervix, the embryo(s) are transferred into the endometrial cavity (uterus). You will be required to remain lying down for about an hour after the embryo transfer procedure.

How do I prepare for IVF?

The preparation for IVF basically consists of a thorough physical examination including a vaginal examination to ensure the normal anatomy of vagina, cervix and uterus. Blood tests will be performed to monitor your estradiol, progesterone, follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels. Make sure to inform your physician about all the prescription and non-prescription medications (including vitamin, mineral and herbal supplements) that you take. Stop smoking as it may create problems during pregnancy.

What is the recovery period like following IVF?

If pregnancy does not occur from the fresh embryo transfer, then the step of embryo transfer can be repaeted from the frozen embryos. Frozen embryos are thawed and transfer is recommended before commencing another stimulated cycle. After the embryo transfer, you will be instructed to absolutely restrict your physical activities for the first 24 - 72 hours. A pregnancy test will be performed approximately 9 - 12 days after the embryo transfer. Your blood levels of progesterone, estradiol, and beta hCG (pregnancy test) are monitored. If there is a positive pregnancy test, close monitoring of the early pregnancy is highly recommended. The first pregnancy ultrasound for detection of the baby's heartbeat and evaluation of the number of embryos implanted is usually done between the 4th and 6th week after embryo transfer stage of IVF.

What is the outcome of IVF?

There is a 20 - 50% success rate per IVF cycle. There are various factors that may contribute to infertility. They can be attributed to either the male or female partner, or both. An infertility work-up is necessary to determine the specific cause and subsequent treatment. To provide optimum opportunity for success, it is important that the timing of the entire IVF procedure be accurate.

Benefits of In Vitro Fertilization

IVF is a procedure designed to enhance the likelihood of conception and establish a pregnancy in couples for whom other infertility treatments have been unsuccessful or are not possible. IVF is a complex process and involves multiple steps resulting in the insemination and fertilization of eggs outside the body.

Risks of In Vitro Fertilization

• Allergic reaction to medications required to boost egg production.
• Overstimulation of ovaries - This may occur as a result to excessive secretion of estrogen by the ovaries followed by injection of Human Chorionic Gonadotrophin (hCG) to trigger final stages of ovulation.
• Failure of the ovaries to respond to stimulation

Alternatives to In Vitro Fertilization

• Artificial Insemination
• Intrauterine Insemination
• ICSI (Intracytoplasmic Sperm Injection) - Intracytoplasmic sperm injection (ICSI) is a technique to directly inject the sperm into eggs
• IVF using donor eggs
• Ovulation Induction - This method uses fertility drug therapy to stimulate egg development
• GIFT (Gamete Intrafallopian Transfer) - In this treatment the eggs are retrieved laparoscopically and 3 or 4 eggs are transferred back into the fallopian tubes with the sperm at the same time
• Embryo Freezing - This procedure is used to preserve (by freezing) and store embryos for implantation at a later time.
• Natural IVF (Drug-free IVF) - An IVF procedure without the use of any drugs
  Ovum Donation - A procedure which involves the removal of eggs from one woman for use by another female unable to produce her own eggs.
• Gestational Surrogacy - A woman who carries a pregnancy produced by an embryo that is not genetically related to her and then returns the child to its genetic parents at birth
• Donor Frozen Embryo Program - A program whereby couples donate their frozen embryos to anonymous recipient couples, usually after the donating couple have achieved pregnancy(ies) and completed their family.

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