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In vitro fertilization

American and European registries reported 352,769 initiated cycles in 2002.

Presently more than 40% of couples conceive by a single trial of IVF compared with less than 20% 1980s.

The success rate of in vitro fertilization is modest: the probability of live birth is approximately 25-30% per initiated cycle.

5 million infants born worldwide in 2012 as a result of IVF.

Estimated 350,000 infants born annually worldwide, as a result of 1.5 million IVF cycles.

More than 60,000 IVF infants born annually, accounting for 1.4% of births in the US.

At present about half the IVF cycles patients are 35 years of age or older.

In vitro fertilization

A standard IVF cycle takes approximately 2 weeks from initiation of ovarian stimulation until oocyte retrieval.

After about 40 hours of observation the eggs are examined for fertilization and then placed into the women’s uterus.

Single embryo transfers have been replaced by multifollicular ovarian stimulation followed by transfer of multiple embryos.

In the UK 2003-2004 statistic revealed a mean livebirth rate of 28% per cycle in women younger than 35 years, and many cycles of IVF can generate embryos that can be frozen for later use, giving a cumulative chance of more than 40% for a live birth per stimulated cycle for such women.

Indications include tubal disease and persistent infertility after initial treatment for other diagnoses are unsuccessful.

Success declines with increasing female age.

In the women who received up to 12 cycles of insemination with donor sperm, 74% of women younger than 31 years of age conceived, compared with 54% of women older than 35 years of age,.

Increased incidence of numerical chromosomal abnormalities in women over the age of 35 years, and most of these abnormal embryos do not develop to term.

Preimplantation genetic screening consists of aspiration of a single blastomere from each embryo and the copy number of a set of chromosomes is determined with discarding of abnormal embryos ad those with normal genetic constitutions are selected for transfer.

Dietary supplementation with folic acid increases rate of twinning.

Associated with increased risks of multiple births, ovarian hyperstimulation syndrome, spontaneous abortion, ectopic pregnancy, and preterm deliveries.

Most important side effect is multiple pregnancy.

Less than 10% of infertile couples undergo in vitro fertilization.

Risk of premature birth and perinatal death are increased as a result of high incidence of multiple births, which is related to the number of embryos transferred.

Singletons born after in vitro fertilization have increased incidence of adverse outcomes than children born of spontaneous conception.

Increased incidence of neurologic sequelae, especially in preterm infants, conceived by in vitro fertilization.

The risk of malformations in children born after in vitro fertilization is increased, particularly for multiple pregnancy.

Compared to spontaneous conception pregnancies from IVF have risks related to obstetrical and perinatal health with increased preterm delivery, low birth weight, neonatal admissions, and perinatal death.

Using single-embryo transfers decreases the risk of multiple gestations.

The risk of multiple gestation after in vitro fertilization is 35% in the U.S.

Couples followed from the initiation of IVF to 6 months after becoming pregnant or having completed 3 cycles without a pregnancy, at the 6 months follow-up, women who do not become pregnant have higher levels of anxiety, depression, poorer marital function, poorer communication and sexual dissatisfaction.

Ovarian stimulation aims to generate oocytes and to generate several embryos for transfer into the uterus.

Ovarian stimulation also associated with treatment with gonadotropin releasing hormone (GnRH) agonists to desensitize the pituitary gland.

GnRH antagonists can be administered on only those days in the mid to late follicular phase of the menstrual cycle during which there is a risk of premature rise in the lutenizing hormone allowing the endogenous intercycle rise in follicle stimulating hormone.

Suppression of spontaneous ovulation as part of controlled ovarian hyperstimulation, which is an essential component in in vitro fertilisation (IVF). 

 

 

After GnRH agonists have induced a state of hypoestrogenism, exogenous FSH is given to stimulate ovarian follicle, followed by human chorionic gonadotropins (hCG) to trigger oocyte release. 

 

 

GnRH agonists routinely used for this purpose are: buserelin, leuprorelin, nafarelin, and triptorelin.

Compared with spontaneous conception IVF is not associated with autistic disorders but is associated with a small increase in the risk of mental retard station (Sandin S et al).

Endometrial scratching does not result in a higher rate of live birth than no intervention among women undergoing IVF.
The selection of the best embryo optimizes live-birth rate per transfer, especially when only a single embryo is transferred instead of multiple embryos to reduce the likelihood of multiple pregnancy.
The morphologic score, and the genetic status of the embryo are associated with treatment success.
2222The presence of aneuploidy is likely to result in implantation failure or spontaneous abortion.

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