Transcript In Vitro Fertilization

In Vitro Fertilization
IVF
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.
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.
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 38
5. Reduced ovarian reserve, which means lower quantity
(and sometimes quantity) of eggs.
6. Severe endometriosis
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)
IVF- Laboratory Processes
Eggs retrieved
Eggs stripped and cleaned
Sperm collection
Wash
sample
Egg equilibration
Fertilization- IVF or
ICSI
Wash/remove
excess sperm
Assess fertilization
Incubate
Assess sperm
quality and count
Egg Retrival
ICSI
Embryo Development in the Lab
Day 1
Day 2
Day 3
Day 4
Day 6
Day 5
Safety Endpoints
• Ovarian hyperstimulation syndrome
– Monitor using blood test
• Miscarriage rate
– PGD
– Progesterone supplement
• Multiple pregnancy rate
– 5 day blastocyst transfer
• Ectopic pregnancy rate
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.
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
Preimplantation Genetic Diagnosis (PGD)
Commonly, more than 100 diseases can be detected through
testing, including…
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Hemophilia A
Muscular dystrophy
Tay-Sachs disease
Cystic fibrosis
Down Syndrome
Removal of one cell from
day 3 embryo for testing
PGD Can Improve Implantation Rate
Identification of chromosomes X,Y,13,18,21,15,16,22
PGD
Controls
Implantation Rate
24.2%
12.4% (p<0.001)
PGD Predicts IVF Outcome
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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
27
26
55
#embryos
114
118
322
#transfers
8
14
48
Births/patient
4%
15%
31%
Ferraretti, et al World Congress IVF, 2002
Two blastocysts transferred
Two frozen-thawed embryos transferred
A single embryo transferred