About IVF

IVF History Highlights

After years of research and almost a hundred attempts, the first in utero conception and delivery of an in vitro baby succeeded. The first in vitro fertilization or "test tube" baby named Louise Brown was born in 1978. The breakthrough proved shortsighted the initial belief that this procedure was only useful for women with a tubal problem.



By 1981, the Jones Institute at Eastern Virginia Medical School in Norfolk, Virginia became an international center for IVF. Pioneers in Europe, Australia, and the United States facilitated the establishment of centers elsewhere in the world.

With time various centers experimented with ovulation stimulating agents such as human menopausal gonadotropin (hMG, Pergonal) and clomiphene. This increased the chance for fertilization, development, and transfer. As these services improved, so did the indications for IVF.

In addition to tubal factors, IVF was now performed on couples having infertility from ovulatory problems, endometriosis, male factors, age related concerns, and unknown underlying reasons.

In 1985, the purified urinary FSH (follicle stimulating hormone) was developed by Serono. The use of FSH either alone or in combination with other ovulation stimulating agents, was observed to improve both the number and quality of the oocytes.

In 1986, GnRH agonist - Lupron (originally used for the treatment of prostate cancer) was developed and distributed allowing the suppression of the normal LH surge in order to time retrievals. As desired, the number of follicles stimulated increased, thereby enabling the capture of more oocytes.

The ultrasound guided ovarian cyst aspiration was developed in the mid-1980s, a welcome innovative method that transformed oocyte collection from a surgical procedure to one performed in an office setting.

Meanwhile, the pregnancy of women with normal fallopian tubes was assisted by GIFT (gamete intrafallopian tube transfer).

The success rates for IVF have risen dramatically over the last two decades. With the aid of cultural media changes and public awareness, and more importantly, the quality, expertise and improvements of the IVF lab indicated success rates to increase to over 50% in women under 37.

To date, the highest quality results for inseminations and semen analyses are available, as well as new techniques such as Assisted Hatching and ICSI, increasing IVF success rates.

The IVF Process

The treatment process can be complicated. It takes a lot of understanding and comprehension to familiarize with the terms and treatments associated with infertility. Australian IVF Resources Site wants to lessen, if not eliminate any confusion. We will help you understand the options you have.

IVF is recommended as a treatment for many types of infertility because it uses lab techniques to aid fertilization and early embryo development.

When IVF is performed eggs are fertilized outside the body in the laboratory. · IUI (Intrauterine Insemination) follows a fertilization process occurring in the fallopian tube.

ART (Assisted Reproductive Technologies) is a term often used to describe IVF and related techniques.

Here is a Rundown of the Step by Step Process

Evaluation and Pre-Treatment process include pre-conception counseling, anatomic assessment, semen analysis and sperm storage, and HIV and hepatitis test for both partners.

Ovulation Induction is done to induce multiple mature eggs available for fertilization. Available treatments are 'Gonadotropin Releasing Hormone Agonist, Lupron' - used to temporarily suppress cycle and influence timing of egg maturation and number of eggs produced; Gonadotropin therapy is given daily after the baseline visit to stimulate egg development; and, HCG, given once for the final stages of egg maturation.

Hormone Tests Ultrasound and Cycle Monitoring Ultrasound.

Baseline levels of estradiol - an estrogen made by the cells around the egg as it matures - are used to determine whether the Lupron is working. To check response to gonadotropins, Estradiol is measured every few days.

Transvaginal ultrasound is used to image the ovaries and measure the follicles, which grow as the egg(s) mature. The last medication given before egg retrieval requires the checking of images every few days to adjust medication dose and timing of hCG.

Egg Retrieval --

On the day of retrieval: no food or drink should be consumed on the day of egg retrieval; an IV line will be placed for administration of medications; antibiotics will be given to prevent an infection; sedation, narcotics and local anesthesia will be used to ease pain; and, bed rest is required after the procedure.

The retrieval process: a transvaginal ultrasound is used to help guide a needle into the ovary; the follicle is drained of fluid and often rinsed; and, the fluid is sent to a laboratory for isolation of the egg.

After the egg retrieval: pelvic soreness and fatigue are common the day after the retrieval; progesterone injections are started to prepare the uterine lining for embryo implantation; and, antibiotics and anti-inflammatory medications are also given if assisted hatching is performed on the embryos.

Fertilization --

Insemination: the ejaculate is treated to remove impurities and dead sperm, and a fraction of motile sperm is placed with the egg in media (nutrient solution) in a small container in an incubator and kept at carefully controlled temperatures and conditions.

ICSI (intracytoplasmic sperm injection): A single sperm can be injected directly into the egg to help fertilization under microscopic guidance. This process is recommended for cases of very abnormal semen analyses or when there are doubts about fertilization capability.

The day after egg retrieval, the embryologist will notify you on the status of fertilization. If successful, embryo transfer will be scheduled.

Embryo Culture

Eggs are examined the day after retrieval to determine whether fertilization has occurred. The resulting embryos are then grown for 3-5 days before transfer to the uterus.

Assisted Embryo Hatching

What remains in place after fertilization is the egg surrounded by a tough protein coating. The embryo has to break through the coating (or hatch) in order to implant. In some cases, the embryo implant is assisted by lab techniques by using an artificial hole opening in this coating.

The Embryo Transfer

A small catheter (tube) through which the embryos are injected, is placed through the cervix into the uterus. The placement of the catheter is guided by an ultrasound. Antibiotics are mandatory to prevent infection.

The following day, bed rest at home is recommended. On the 3rd day after egg retrieval, embryo transfers are mostly performed wherein 3 to 5 of the fastest growing embryos are selected. Cryopreservation may be an option if there are additional embryos.

Day 5 transfers are usually suggested when the patient is at great risk of high order multiple birth (triplets or more).

Day 5 Embryo Transfer

At the blastocyst stage, 5-6 days after ovulation, natural conception is expected to occur followed by the arrival of the embryo in the uterus. Embryos in the lab that grow to the blastocyst stage are more likely to implant, allowing the transfer of fewer embryos without lowering the chance of pregnancy. Recommendations for day of transfer are made on an individual basis.

The Cryopreservation/Embryo Freezing

Use of frozen and thawed embryos involves less medication, time and expense than a complete IVF cycle. Many couples have more embryos that can safely transferred and can be frozen for future use. Embryos are frozen on days 1, 5 and 6 after egg retrieval and can be stored for up to 5 years.

After Embryo Transfer- Important Procedures

Continue to use progesterone, as prescribed; Estrogen may be recommended, if your blood tests shows that the level is too low; A blood pregnancy test will be taken 15 days after egg retrieval (even if you have started to bleed); If the test is positive, levels of hCG, a hormone made by pregnancy tissue, will be monitored; and, 4-5 weeks after egg retrieval, an ultrasound is performed.

IVF Developments

Intracytoplasmic sperm injection (ICSI)- with results in success rates equal to IVF fertilisation - is a more recent development associated with IVF which allows the sperm to be directly injected in to the egg using micromanipulation. The process is used for sperm that have difficulty penetrating the egg and when sperm numbers are very low.

Prior to the embryo transfer, preimplantation genetic diagnosis (PGD) can be performed on embryos.

Ethical Concerns

From the beginning when IVF was introduced certain Ethical Issues have been raised such as bypassing the natural method of conception; creating life in the laboratory; and, infertility is treated as a disease and not as a symptom of underlying medical problems.

Concerns on embryos include: fertilising more embryos than will be needed and discarding excess embryos; unnatural environment for embryos; creating embryos, freezing them, and keeping them "in limbo"; exposing embryos to unnatural substances; destroying embryos in research; potential to create embryos for medical purposes; potential to select embryos (PGD); potential to modify embryos; facilitates idea that embryos are worthless.

Debasing practical issues include using untested technology; not affordable for many; misallocation of medical resources; and, financial rewards for IVF doctors dissuade them from recommending other methods to couples.

The Issue on Birth defects

The issue of birth defects remains a controversial issue in IVF simply because a majority of studies do not show a significant increase after use of IVF. Some studies suggest higher rates for ICSI, still others do not support this finding. Major birth defect include chromosomal abnormalities, multiple organ abnormalities, and genetic imprinting defects.

The Issue on Complications

The major complication of IVF is the development of multiple births, which is directly related to the practice of placing multiple embryos at embryo transfer. Multiple births are related to increased pregnancy loss, obstetrical complications, premature labour, prematurity, and neonatal morbidity with the potential for long term damage. Although strict embryo transfer policies have been enacted to reduce these problems, they are not universally accepted.

Spontaneous splitting of embryos in the womb after transfer does occur, but is rare - at <1% - and would lead to identical twins. Recent evidence, albeit for unknown reasons, suggest that singleton offspring after IVF is at higher risk for lower birth weight.

Another major complication is the development of the ovarian hyperstimulation syndrome, related to the use of ovarian stimulation.