IVF case study

In 1978 the first human IVF-baby was born. Today IVF is a standard procedure in the treatment of infertility in industrialized Western countries. In this study we analyzed how IVF reached an established position as a medical innovation in Finland, how IVF-care was organized between 1991-1993, and which kind of women used IVF-services and delivered a child as a result. The data sources were interviews with practicing IVF-physicians, a survey of Finnish IVF-clinics, telephone interviews with a sample of the adult population, and data of mothers from the Finnish Birth Registry. IVF in Finland followed the four stages of a medical innovation from a promising report into a standard procedure. Key factors in the introduction of IVF-methods were the work of andrologists', and later, IVF-physicians' associations, the approval of the method by head gynecologists in university clinics and among other colleagues, and later, the increase in IVF-services without regulatory government policy. IVF has become increasingly available in private clinics because pioneer physicians have established such services. In principle there was no social discrimination in having IVF, because it was available almost free of charge in public clinics. But the costs and availability of private clinics created unequal access to IVF services. IVF-women were more often upper-class white collar employees living in southern Finland than women in the control group. IVF has been a routine treatment option of infertility since the end of the 1980s. It has provided a medical technology solution to infertility. The supply and demand of IVF has increased and its indications have widened in the treatment of infertility. This is the inner logic of a successful technology: after the developmental processes of a revolutionary innovation, the use of technology escalates rapidly and the barriers for its use decrease.

Ivf Case Study

As a member of a Catholic Hospital ethics board I would see many ethical problems in this case.   In vitro fertilization is not a natural process, and the process of procreating should not be tampered with.   Conceiving a child is meant to be done only one way.   Having a child is a blessing from God, and the process of in vitro fertilization is not the way God intended.   Pope Paul VI has taught that there is an "inseparable connection, willed by God, and unable to be broken by man on his own initiative, between the two meanings of the conjugal act: the unitive meaning and the procreative meaning."   Also, there is an ethical problem with stem cell research.   The Catholic Church teaches that medical research must refrain from operations on live embryos, unless there is moral certainty of not causing harm to the life or integrity of the unborn child and mother, and on condition that the parents have given free and informed consent to the procedure.   And since stem cell research inevitably causes the death of the embryos, this is not moral.     
I would not recommend that the hospital allow John, Liz, and their doctors to go forward with their plans.   From a Catholic standpoint, this procedure is not moral, and the hospital representing these beliefs should not give treatment that is in violation of Catholic beliefs.   In vitro fertilization violates the rights of the child and deprives him of his filial relationship with his parental origins and can hinder the maturing of his personality.   The Catholic Church condemns both in vitro fertilization and stem cell research, and I would strongly argue for this not to take place in our hospital.

History

John Rock was the first to extract an intact fertilised egg. The first pregnancy achieved through in vitro human fertilisation of a human oocyte was reported in The Lancet from the Monash University team  in 1973, although it lasted only a few days and would today be called a biochemical pregnancy. In 1977, Patrick Steptoe and Robert Edwards successfully carried out a pioneering conception which resulted in the birth of the world's first baby to be conceived by IVF, Louise Brown on 25 July 1978, in Oldham General Hospital, Greater Manchester, UK followed by Courtney Cross on 16 October 1978 and Alastair MacDonald on 14 January 1979. This was then followed by the birth of Candice Reed in Melbourne in 1980. It was the subsequent use of stimulated cycles with clomiphene citrate and the use of human chorionic gonadotrophin (hCG) to control and time oocyte maturation, thus controlling the time of
collection, that converted IVF from a research tool to a clinical treatment.

This was followed by a total of 14 pregnancies resulting in nine births in 1981 with the Monash University team. The Jones team at the Eastern Virginia Medical School in Norfolk, Virginia, further improved stimulated cycles by incorporating the use of a follicle-stimulating hormone (uHMG). This then became known as controlled ovarian hyperstimulation (COH). Another step forward was the use of gonadotrophin-releasing hormone agonists (GnRHA), thus decreasing the need for monitoring by preventing premature ovulation, and more recently gonadotrophin-releasing hormone antagonists (GnRH Ant), which have a similar function. The additional use of the oral contraceptive pill has allowed the scheduling of IVF cycles, which has made the treatment far more convenient for both staff and patients.

Preimplantation genetic screening (PGS) and preimplantation genetic diagnosis

Preimplantation genetic diagnosis and screening used in conjunction with IVF treatments appeared in the early 1990s, and since then hundreds of normal, healthy babies have been born using this advanced reproductive technology. PGD is performed for couples who are at risk for passing on inherited genetic disease to their offspring. It has been suggested that screening of embryos for chromosomal abnormalities (PGS) improves the likelihood of a successful pregnancy and birth for couples with infertility related to recurrent miscarriage or unsuccessful IVF cycles.
Patients who also can benefit from PGS/PGD include:
Couples who have a family history of inherited disease
Couples who want to use gender selection to prevent a gender-linked disease
Women who have had repeated failures with IVF
Women with a history of unexplained miscarriage
Women who are more than 40 years old
PGS screens for numeral chromosomal abnormalities while PGD diagnosis the specific molecular defect of the inherited disease. In both PGS and PGD, individual cells from a pre-embryo are analysed during the IVF process. Before the transfer of a pre-embryo back to a woman's uterus, one or two cells are removed from the pre-embryos (8-cell stage). These cells are then evaluated for normality. Typically within one to two days, following completion of the evaluation, only the normal pre-embryos are transferred back to the woman's uterus. In addition, PGS can reduce the risk of multiple pregnancies because fewer embryos are needed for implantation.

Birth defects

The issue of birth defects has been a controversial topic in IVF. Many studies do not show a significant increase after use of IVF, and some studies suggest higher rates for ICSI, whereas others do not support this finding. In 2008, an analysis of the data of the National Birth Defects Study in the US found that certain birth defects were significantly more common in infants conceived through IVF, notably septal heart defects, cleft lip with or without cleft palate, esophageal atresia, and anorectal atresia; the mechanism of causality is unclear.

IVF case study

A married couple –   wife 32, husband 34 – came to see me at my office as she had not been   able to get pregnant for the past four years despite regular sexual   intercourse. The first visit revealed that she had had recurrent   adnexitis and her husband had had frequent prostatitis. 

We started investigating their infertility and carried out hormonal   cycle monitoring, tests for specific bacteria cultures, took pap-smear   and made tubal patency check-up for her, and took qualitative and   quantitative spermiograms as well as bacteria testing for him as well.   Results of the wife’s tests showed normal hormonal status and positivity   for Chlamydia. The tubal patency examination however revealed bilateral   tube occlusion and a normal uterus cavity. Results of the spermiograms   suggested that both the qualitative and qualitative parameters were   slightly below the normal range, and the tests demonstrated E.Coli   positivity. 

The wife was given medication for Chlamydia and I suggested laparoscopy   for a possible re-opening of her tubes, which she refused. Following an   andrology examination the husband was given antibiotics and specific   vitamin complex, which significantly improved his spermiograms. As the   next step, we launched an IVF program due to her bilateral tube   occlusion. During the second cycle I transferred 2 embryos, one of which   was implanted and on week 39 of her pregnancy she gave birth to a   healthy girl.

IVF case study

Lucy and Graheme had been trying to conceive for two years before they came to SEFC. Lucy, 28 years was a legal assistant and Graheme 27 years, a warehouse manager. The couple were both in good health.

Previous investigations had been carried out at their local hospital. 
A Laparoscopy under general anaesthetic allowed Lucy's gynaecologist to assess her pelvis. This showed pelvic adhesions with both fallopian tubes being blocked. Graheme had a normal semen analysis. In view of the obvious tubal damage the couple were advised to seek treatment by in vitro fertilisation (test tube baby technique).

The couple went for consultation at SEFC where the Consultant confirmed the need for IVF. Treatment would involve a course of ovarian stimulation by injection to produce approximately 10-12 eggs followed by an egg collection. Lucy would have to attend for three or four ultrasound appointments to watch the follicles, which contain the eggs, develop. The eggs would be harvested as a day case procedure, under sedation, using transvaginal ultrasound. The eggs would then be inseminated to achieve fertilisation and up to two embryos transferred to the uterus after three days. Typical pregnancy rates were in the order of 35% at embryo transfer. As Lucy was under 35 years, the couple were asked to consider egg sharing as an option. This would involve undergoing IVF but giving half of the eggs gathered to an anonymous recipient who herself needs donated eggs to get pregnant. In return for this the cost of treatment would be heavily subsidised. If less than eight eggs were collected the couple would keep all the eggs for their own treatment at no additional cost. Prior to taking part in the scheme the couple would need to undergo thorough screening to ensure good health and implications counselling to ensure they were happy to take part in the scheme. The couple were given the ‘Patient Information Book’ which describes all treatments at SEFC in detail.

After consideration, Lucy and Graheme decided they would like to have IVF within the egg share scheme. Screening tests were normal and counselling raised no issues with regard to treatment. Lucy had a nurse consultation to plan a treatment cycle and to complete a number of consent forms.

Lucy underwent a course of ovarian stimulation and responded well to the medication. The egg procedure was uncomplicated and nine eggs were collected. Lucy and Graheme were given five eggs for their own treatment 
and four were donated to another couple. Two of the eggs fertilised normally. Three days later two good embryos were available for transfer. The couple were not keen on a twin pregnancy and elected to have just one embryo transferred to the uterus.

Lucy and Graheme had a positive pregnancy test two weeks later and the pregnancy scan at seven weeks confirmed a foetal heartbeat. The couple were advised to contact their family doctor to arrange antenatal booking.

Cost:
Lucy and Graheme paid £160.00 for their initial consultation. All screening tests and the HFEA licence fee cost approximately £1000.00. There was no cost for Lucy’s medication as this was included in the egg share scheme. Normally a single attempt at IVF would have cost them a total in the order of £3500.00. A detailed and up to date price list is available from the clinic.

Comment:
IVF is an expensive type of fertility treatment and may require more than one attempt. For many young couples IVF can be simply unaffordable. There are a large number of women who require donated eggs to start a family and waiting lists can be long. IVF with egg sharing is available to suitable women under the age of 35 years. It can make treatment accessible to many couples and allows another woman to be helped.
Typical pregnancy rates for IVF are around 35% at embryo transfer. Multiple pregnancy rates are in the order of 20%. Many couples are happy with the idea of a multiple pregnancy although there is no doubt that multiple pregnancies can be more complicated. Lucy and Graheme elected to have a single embryo transfer to minimise any risk. Single embryo transfer is becoming a more popular decision for many couples.
At SEFC we believe that the egg share scheme offers couples access to high quality affordable fertility care with no compromise on the pregnancy rates. It also reduces the waiting time for those women who require donated eggs.

Success rate

The success rate of IVF is determined to a large degree by the age of the woman undergoing the treatment. Younger women tend to have healthier eggs, which increase the chances of success.

In 2006, the percentage of IVF cycles started that resulted in a live birth were:

• 29% for women aged under 35,
• 26% for women aged 35-37,
• 17% for women aged 38-39,
• 11% for women aged 40-42,
• 5% for women aged 43-44, and
• less than 1% for women aged over 44.

WHEN IN VITRO FERTILIZATION IS NOT SUCCESSFUL?

In vitro fertilization has a reasonable rate of success in most cases. Overall, approximately 27 percent of IVF cycles will end in a live birth, and the cumulative chances of success are higher when more than one cycle of IVF is done .

However, an individual's chance of success depends on several factors, including the woman's age, cause of infertility, and treatment approach. For example, in the United States, the live birth rate for each IVF cycle started is approximately 30 to 35 percent for women under age 35; 25 percent for women ages 35 to 37; 15 to 20 percent for women ages 38 to 40; and 6 to 10 percent for women over 40. The success rates of individual infertility clinics in the United States is published on the internet at the Society for Assisted Reproductive Technology.

It can be difficult to deal with the emotional highs and lows of infertility treatment. This is especially true if the woman (and her partner) have been trying to conceive for a long time, if treatment is not covered by insurance, or if there are any underlying problems in the couple's life (eg, medical, family or partner, job, financial).

Support groups and counseling services are available at many infertility treatment centers, as well as on the internet. To find a reputable group, talk to your healthcare provider

TESTING FOR PREGNANCY AFTER IN VITRO FERTILIZATION

Blood testing — Approximately two weeks after the embryo transfer, a blood or urine test for hCG, the hormone that signifies pregnancy, can be done. Home urine pregnancy testing is not as sensitive for detecting an early pregnancy as blood testing.

• If the first blood hCG level is <5 IU/L, the woman is not pregnant.
• If the first hCG level is >10 IU/L, the test is usually repeated 48 hours later to confirm that the levels are increasing. The hCG level should approximately double every 48 hours during the first 21 days after embryo transfer.
• If the second hCG level does not double or decreases, the blood test may be repeated again 48 hours later. Depending upon the situation, there is a possibility that the pregnancy is not viable. hCG levels do not increase or begin to decline when the pregnancy is not progressing normally. (See 'When in vitro fertilization is not successful' below.)

Ultrasound — If the hCG levels increase as expected, a pelvic ultrasound may be done three to four weeks after the transfer. At this time, it is usually possible to see a gestational sac inside the uterus. The gestational sac is a fluid-filled sac containing the embryo.

At five to six weeks of pregnancy (four to five weeks after the transfer), the yolk sac is usually visible. The yolk sac provides nourishment to the embryo early in development. A heart beat is usually visible by 6 to 6.5 weeks of pregnancy (4 to 4.5 weeks after the transfer).

Pregnancy care — In most cases, prenatal care begins at 6 to 10 weeks of pregnancy. At this time, the woman will begin to see her obstetrical physician or nurse on a regular basis. These visits allow the obstetrical provider to monitor the woman and baby's health and to answer any questions

IVF in India

The IVF Center of the Department of Assisted Reproduction and Genetics, Jaslok Hospital and Research Centre, Mumbai, India, has been functional since October 1990. We have had the privilege to render fertility treatment to infertile couples from every state of India and from 40 different countries resulting in the birth of over 3000 babies.

A survey to help patients find the best infertility clinic in India for giving infertility treatment was conducted by India's leading weekly News Magazine - OUTLOOK in July 2002. The opinion of 679 doctors around the country was taken. Jaslok's IVF clinic was rated as one of the best IVF clinics in India and the best IVF/ICSI clinic in Bombay (Mumbai).

Dr. Firuza Parikh who is responsible for the birth of the first ICSI baby in India has been selected by doctors and patients interviewed by THE WEEK (May 6, 2007) which is one of the leading News Magazine in India as a pioneer in the field of IVF and Assisted Reproduction (Test Tube Baby) and the IVF clinic has also been selected as one of the best IVF clinics in India for infertility treatment.

Our IVF Center has state-of-the art facilities for In Vitro Fertilization (IVF), Intra Cytoplasmic Sperm Injection (ICSI), Laser Assisted Hatching (LAH), Semen banking, Embryo Cryopreservation and Cumulus Aided Transfer (CAT- a technique pioneered by Dr. Firuza Parikh for the first time in the world) and a fully functional Andrology Laboratory for diagnostic and therapeutic tests. Facilities for Genetic tests utilize an automatedKaryotyping Workstation for chromosome analysis and Fluoresecnce in situ hybridization(FISH) and advanced equipment for molecular genetic tests like the Polymerase Chain Reaction (PCR). Prenatal, Postnatal and Preimplantation Genetic Diagnostic tests (PGD) are carried out in our laboratory. Our IVF centre set up the first PGD lab in India in 1999 for testing certain genetic disorders using FISH technique.

Couples with female infertility or male infertility are counseled for both medical and surgical causes of infertility. We offer treatment for ovulatory disorders and other endocrine problems which cause infertility. Endoscopic procedures & surgical management of infertility are also carried out. We have a large series of more than 2000 cases of endoscopy including operative laparoscopy and hysteroscopy.

The science of Assisted Reproduction has moved forward by leaps and bounds. Since its inception in 1990, the Department of Assisted Reproduction & Genetics has endeavored to help infertile couples, have normal babies. We pledge to continue our research to provide the best infertility treatment In India in order to help couples realize their dream of having a healthy child.

Catholic objections

According to the Catechism of the Catholic Church,

Techniques involving only the married couple (homologous artificial insemination and fertilization) dissociate the sexual act from the procreative act. The act which brings the child into existence is no longer an act by which two persons give themselves to one another, but one that "entrusts the life and identity of the embryo into the power of doctors and biologists and establishes the domination of technology over the origin and destiny of the human person. Such a relationship of domination is in itself contrary to the dignity and equality that must be common to parents and children."

The Catholic Church maintains that it is not objectively evil to be infertile, and advocates adoption as an option for such couples who still wish to have children:

The Gospel shows that physical sterility is not an absolute evil. Spouses who still suffer from infertility after exhausting legitimate medical procedures should unite themselves with the Lord's Cross, the source of all spiritual fecundity. They can give expression to their generosity by adopting abandoned children or performing demanding services for others.

Beginning of pregnancy controversy

In a few cases, laboratory mix-ups (misidentified gametes, transfer of wrong embryos) have occurred, leading to legal action against the IVF provider and complex paternity suits. An example is the case of a woman in California who received the embryo of another couple and was notified of this mistake after the birth of her son. This has led to many authorities and individual clinics implementing procedures to minimise the risk of such mix-ups. The HFEA, for example, requires clinics to use a double witnessing system, where the identity of specimens is checked by two people at each point at which specimens are transferred.

Alternatively, technological solutions are gaining favour, to reduce the manpower cost of manual double witnessing, and to further reduce the risk of human error. Technological solutions typically involve tagging individual specimen containers with uniquely numbered RFID tags which can be identified by readers connected to a computer. The computer tracks specimens throughout the process and alerts the embryologist if non-matching specimens are identified.

Another concern is that people will screen in or out for particular traits, using preimplantation genetic diagnosis. For example, a deaf British couple, Tom and Paula Lichy, have petitioned to create a deaf baby using IVF. Some medical ethicists have been very critical of this approach. Jacob Appel wrote that "intentionally culling out blind or deaf embryos might prevent considerable future suffering, while a policy that allowed deaf or blind parents to select for such traits intentionally would be far more troublesome."

Embryo donation and Egg donor

There may be leftover embryos or eggs from IVF procedures if the woman for whom they were originally created has successfully carried one or more pregnancies to term. With the woman's or couple's permission, these may be donated to help other women or couples as a means of third party reproduction.

In embryo donation, these extra embryos are given to other couples or women for transfer with the goal of producing a successful pregnancy. The resulting child is considered the child of the woman who carries it and gives birth, and not the child of the donor, the same as occurs with egg donation or sperm donation.

Typically, genetic parents donate the eggs to a fertility clinic or embryo bank where they are cryogenically preserved until a carrier is found for them. Typically the process of matching the embryo(s) with the prospective parents is conducted by the agency itself, at which time the clinic transfers ownership of the embryos to the prospective parents.

IVF case study – Chloe and Colin

Chloe was 36 years old and had been trying to conceive for over 2 years.  She and Colin had been fully investigated and no cause was found for their infertility.  She had been prescribed clomiphene which she took for three cycles, but she did not conceive.  It was suggested that in her case intra-uterine insemination (IUI) would not have a very high success rate so they should consider moving straight to in-vitro fertilization (IVF). 

 

Chloe was very unsure about IVF.  She was very confused about all the clinic statistics.  She felt this was very much the end of the road and had always felt IVF was for other women, not for her.  She was very health-conscious and refused to take any medication unless absolutely necessary.  She was concerned as she had a family history of breast cancer and was very anxious about the side effects of the drugs which would be used to stimulate her ovaries.  She had friends who had split up due to the tensions during IVF treatment and was really concerned for her own relationship which she felt was good.

 

At the initial consultation, the fertility nurse specialist was able to help Chloe to consider the whole process of IVF – the physical and emotional aspects.  Chloe was feeling very isolated as she did not want to tell family or friends about their fertility problems.  She described herself as a very private person.  She also found work very stressful and was unsure how she would manage a demanding job with the pressures of an IVF cycle.  It became apparent that Chloe’s desire for a child was much stronger than she dared to admit to herself and she was trying to protect herself from the possible thought of not having a family and the devastation she might feel if an IVF cycle failed. 

 

By the end of her initial consultation, Chloe was feeling more sure about her feelings about IVF and her resistance to the treatment.  She felt she had a focused plan.  She wanted to see the fertility counselor with her husband to help support them through IVF.  She also had 2 sessions of hypnotherapy and positive visualization, which helped her to manage her emotions through her IVF cycle. 

Who Qualifies to Receive an Egg?

The criteria for women to qualify to receive eggs are:

Early menopause
Abnormal ovarian reserve
Previous failures to conceive with IVF
Very low egg quality
Genetic disease
Ovaries unresponsive to stimulation
Over the age of 39
The Egg Donation Process
Couples sometimes choose a known donor. Else, it is an anonymous donor. The donor is screened for any
diseases like HIV, chlamydia, hepatitis, toxicology testing and other diseases and also certain genetic
predispositions. The donor is usually young, not more than 25 years of age, so that the quality of the eggs is high.

What Exactly is Donor Egg IVF?

Donor egg IVF is a fertility treatment or Assisted Reproductive Technology (ART) in which the egg from a donor is subjected to IVF. That is, the egg from the donor is mixed with the sperm from the biological father in the laboratory. If embryos are produced, they are grown in a lab dish and then transferred to the recipient’s uterus. If this results in a pregnancy, the baby thus born will have genetic linkage to the donor of the egg.

Donor Egg IVF in India

Egg donation or oocyte donation makes it possible for those women to get pregnant who cannot do so with their own eggs. Older women most often opt for this method of fertility treatment. Attempts to conceive with donor egg IVF have a high rate of success.

IVF Research: Want to Have a Baby?

Staying positive and relaxed can help you conceive

It may be easier said than done, but taking a low-stress approach to IVF may help women conceive.

When you're already undergoing costly, time-intensive in vitro fertilization (IVF) treatments, advice to "just relax" may be easier said than done. But taking a low-stress approach to having a baby may actually help some women get pregnant, according to research from Harvard University's Domar Center for Mind/Body Health.

In the study, 97 women at a Boston fertility clinic took part in the Domar Center's mind/body relaxation program. Women were taught deep breathing, guided imagery, and other stress reduction techniques. After the first round of IVF, similar pregnancy rates were seen in women undergoing IVF at the clinic, whether or not they had participated in the program. But for women who failed the first time and were undergoing a second round of IVF, 52 percent who took part in the mind/body program became pregnant, compared to only 20 percent of those who did not.

While it's still a bit of a mystery why stress affects fertility, researchers believe hormonal changes in the body when under stress leads to decreased uterine blood flow and suppression of key sex hormones in some women.
Need to de-stress right now? Try this technique for instant muscle relaxation: progressively tighten and then relax your muscles, either from head to toe or vice versa. Hold each muscle for a count of 10 before moving on.

POLITICAL REACTION

The four main political parties in the assembly have been asked to respond, and below are the replies received so far.

Conservatives said: "IVF treatment in Wales should not become a postcode lottery under any circumstances."

The party said it would spend "appropriately based on patient need - not ideological warfare - and in this case, make sure that couples seeking IVF treatment in west Wales are not ignored or deprived."

Veronica German, Welsh Liberal Democrat health spokeswoman, said: "Labour-Plaid political dogma is resulting in people travelling longer and reducing their services.

"Stopping NHS funding to the Swansea centre will mean that services in Cardiff will be stretched with longer waiting lists and this could have a detrimental effect on the fertility cycles of patients."

Clinical continuity

Health Minister Edwina Hart has said that health boards were working with the Welsh Health Specialised Services Committee (WHSSC) to replace private provision.

In an answer given to Nick Bourne, the leader of the Conservatives in the assembly, in February, she said: "The transition to an NHS service is planned to ensure that service standards and current waiting times are not adversely affected.

"WHSSC's priority is to ensure that patients' clinical continuity is not compromised and patients who have already been seen by the private provider will be able to complete their cycle of treatment."

The WHSSC said new patients had been seen in Neath since 1 April.

"Patients who have already had a consultation at the London Women's Clinic or those who have had a first cycle and are eligible for a second will continue to be treated at the London Women's Clinic.

"This is to ensure that continuity of care is maintained for patients.

"WHSSC are working with the London Women's Clinic to ensure that patients will not be disadvantaged as a result of the change in provider."

Concern over IVF clinic changes in Swansea

A fertility consultant has warned that changes to NHS-funded IVF treatment in Wales could lead to failed attempts and longer short-term waiting times.

Free IVF will now only be provided by NHS organisations, under assembly government rules.

Peter Bowen-Simpkins, of the private London Women's Clinic Swansea, says NHS units will "struggle to cope".

But Health Minister Edwina Hart has said that standards and current waiting times will not be adversely affected.

The Swansea clinic at Singleton Hospital has lost its NHS contract under the One Wales coalition agreement between Labour and Plaid Cymru after the last assembly election.

Patients living in a catchment area from Bridgend to Aberystwyth are to be catered for at a new NHS clinic that has just been set up at Neath Port Talbot Hospital.

London Women's Clinic medical director Mr Bowen-Simpkins expressed concerns that the new unit would not be able to cope and patients could instead be sent to the NHS clinic in Cardiff.

He told BBC Wales: "The last few years we have been taking patients from Cardiff because of the overflow and this unit in Neath will take a while to set up and become fully operational with good success rates

Whenever you start a new unit, success rates are poor because the unit is setting up and people are getting used to new equipment.

"They will do this at the cost of at least £1m and buy in new equipment when they are already £40m in debt - it's a complete waste of money.

"I am not speaking out because of the financial impact on us as we make very little profit from NHS cycles - I am speaking out as a clinician."

The changes came into force on 1 April but the Swansea clinic still has some 220 NHS patients waiting for results on their second free cycle.

One cycle of IVF treatment normally takes four to six weeks to complete.

Patients with fertility problems were given the right to a second course of treatment in Wales from April 2010.

In the five years before that, women were given one cycle of IVF treatment free on the NHS.

Susan Seenan of the patient charity Infertility Network UK said: "It is extremely important that patients who need fertility treatment are referred and treated as quickly as possible as any lengthy delays could have an adverse effect on success rates, as well as the emotional impact of long waiting times on couples.

"We have already called for additional staffing and other NHS resources to be provided before any changes are made as it would be totally unfair for patients to have their chances of success affected by a lack of resources at Cardiff when there is additional capacity in Swansea."

Increase in Success Rate of IVF

Gynecologists have noted an increase in the success rate in conception of women using In-vitro fertilization (IVF) since November 2010. Renowned gynecologists, Dr. Indira Hinduja and Dr. Kusum Zaveri cited that the success of IVF in 1980s was a meager 10-15%. Then it gradually went up to 30% but over the last few months the success rate has surged up to 72%.

Over 4,000 test tube babies born in HCMC hospital

More than 4,000 test tube babies were born in Ho Chi Minh City’s Tu Du Hospital since the hospital first conducted the reproductive technology 14 years ago.

Tu Du Hospital was the first hospital to introduce in vitro fertilization in Vietnam. The hospital announced on Sunday at the 14th anniversary of the IVF unit that 4,080 babies have been born from the method.

Over the past several years the hospital has applied advanced techniques to raise the success rate of IVF method to 30-40 percent, equivalent to the world’s average.

According to the Ministry of Health, 7-10 percent of Vietnam’s population is infertile, with the male-female ratio being equivalent.

Vietnam has 13 assisted reproductive centers that have IVF units. An estimated 9,000 babies were born to date in Vietnam thanks to the method, including those born in the Tu Du Hospital.

IVF Delhi Clinic

Delhi has developed as a major power in the recent past and emerged as one of the technologically advanced cities in all respects.be it science, medicine, agriculture or any field, Delhi has evolved into an advanced city. One of the major and important discoveries in medicine over the past years has been the innovation to treat infertility among men and women. IVF or in vitro fertilisation has been known to be a boon in the lives of many and has rekindled the dying hopes of many childless couples. It is an advanced medical procedure and can be undertaken by couples declared infertile.

Infertility is a problem which occurs in both males and females. When a woman cannot carry the foetus in her womb or if the ovaries or eggs cannot be fertilised in the fallopian tube, the woman is considered to be infertile as it is not possible for her to undergo a successful pregnancy. Similarly a man is considered infertile if the sperm count is low that is he does not produce enough sperms to facilitate the process of fertilisation. It is thus a disheartening thing to be declared infertile as it causes problems in a marriage and many a times ends up in divorce. This has been the cause of many Indian couples separating from each other. Since treatment was not available and the only way to have children then was to adopt, it became difficult to bear such circumstances.

But now with almost all cities like Delhi, Bengaluru, Kolkata adopting the IVF treatment it has provided a new avenue for the childless couples to regain their incomplete life by having and raising their own child. The process is a technologically and medically advanced procedure and involves the hormonal controlling of the ovaries. The ovaries or eggs to be fertilised are removed from the uterus and fertilised in a petri dish or test tube by the sperms. This process of fertilisation outside the body is termed as ‘in vitro’. This technique has been adopted by many childless couples through the many specialised clinics in Delhi and other major cities in India.

There are many Non-Governmental Organisations also that work for the cause and help in arranging for surrogate mothers if there is a need to do so, since it becomes difficult to do so in a traditional setting like India. Many foreign nationals also come to IVF clinics in Delhi and Bangalore to get the treatment done as surrogate mothers are available at a much cheaper bargain than abroad. Delhi has been a major hub for foreign and national IVF Treatments and has proved to provide efficient service to help many couples complete their incomplete lives by filling it with little bundles of joy and happiness.

IVF COST

Too much work: Career oriented couples are generally exhausted due to long travels and late sittings in the office. They simply stay inactive due to over exertion. This gives rise to sexual problems. Negligence or lack of sexual knowledge: Some males or even females are confused and do not know how to go about during a sexual intercourse. This generally happens when either of the two or even both do not have much knowledge about it. Relying on destiny or time: Some females do not focus on conceiving during their reproductive span. Rather they waste their valuable reproductive years by just praying to god or waiting for time to come.

The IVF process starts with certain blood tests to check the woman’s womb, ovaries and hormone level and an ultrasound scan to check the lining of uterus and ovaries. A detailed sperm count is also carried out. Certain fertility injections and drugs are used to stimulate the ovaries to produce multiple eggs. The eggs are then recovered, and placed together with sperm in a special nutrient rich tube to achieve fertilization. 

After fertilization, one to three embryos are either transferred inside the woman’s uterus to begin pregnancy or kept frozen for future use. The whole process is monitored by the Doctor himself to check the development of follicles and lining of the uterus.  The IVF procedure gives approximately 30 - 35% pregnancy rate per cycle. Nearly 90% of the infertile couples can be successfully treated through IVF. This process is also made available in some cheap hospitals so that it suits all pockets without compromising on quality and results.

Infertility is deeply stressful and often touches every aspect of life. It causes isolation in the life of married couples. Women can achieve fertilization, even after their reproductive age, through In Vitro Fertilization. The IVF treatment is offered at many hospitals as an alternate solution to infertility. IVF procedure aims to replace stress and pains with a hand of friendship and support. Therefore, make sure to see a doctor if you fail to conceive even after having regular, unprotected sex for more than six months or a year.

IVF(Methods)

Pregnancy rate is the success rate for pregnancy. For IVF, it is the percentage of all attempts that lead to pregnancy, which generally refers to treatment cycles where eggs are retrieved and fertilised in vitro. Statistics referring to "pregnancy" may refer to just a positive pregnancy test, and not necessarily "viable pregnancy" which implies the detection of a fetal heart beat. Pregnancies that are delivered with a viable baby are called live birth rate. Increasingly a distinction is also made between singleton and multiple pregnancies as multiple pregnancies, specifically more than twins, should be avoided because of the associated maternal and fetal risks.

With enhanced technology, the pregnancy rates are substantially better today than a couple of years ago. In 2006, Canadian clinics reported an average pregnancy rate of 35%. A French study estimated that 66% of patients starting IVF treatment finally succeed in having a child (40% during the IVF treatment at the center and 26% after IVF discontinuation). Achievement of having a child after IVF discontinuation was mainly due to adoption (46%) or spontaneous pregnancy (42%).

Live birth rateLive birth rate is the percentage of all IVF cycles that lead to live birth, and is the pregnancy rate adjusted for miscarriage and stillbirth. These percentages are for successful pregnancies, regardless of the number of children born, as twins and larger multiple-order births are more common in IVF cycles. The results in labs across the United States show that conception using IVF with a male who has a low sperm count produces a higher chance of a live birth than a female with a low egg count.

In 2006, Canadian clinics reported a live birth rate of 27%. Birth rates in younger patients were slightly higher, with a success rate of 35.3% for those 21 and younger, the youngest group evaluated. Success rates for older patients were also lower and decrease with age, with 37-year-olds at 27.4% and no live births for those older than 48, the oldest group evaluated.Some clinics exceeded these rates, but it is impossible to determine if that is due to superior technique or patient selection, because it is possible to artificially increase success rates by refusing to accept the most difficult patients or by steering them into oocyte donation cycles (which are compiled separately). Further, pregnancy rates can be increased by the placement of several embryos at the risk of increasing the chance for multiples.

Because not each IVF cycle that is started will lead to oocyte retrieval or embryo transfer, reports of live birth rates need to specify the denominator, namely IVF cycles started, IVF retrievals, or embryo transfers. The Society for Assisted Reproductive Technology (SART) summarised 2008-9 success rates for US clinics for fresh embryo cycles that did not involve donor eggs and gave live birth rates by the age of the prospective mother, with a peak at 41.3% per cycle started and 47.3% per embryo transfer for patients under 35 years of age.

IVF attempts in multiple cycles result in increased cumulative live birth rates. Depending on the demographic group, one study reported 45% to 53% for three attempts, and 51% to 71% to 80% for six attempts.

IVF(Methods)

Embryo selection Laboratories have developed grading methods to judge oocyte and embryo quality. In order to optimise pregnancy rates, there is significant evidence that a morphological scoring system is the best strategy for the selection of embryos . However, presence of soluble HLA-G might be considered as a second parameter if a choice has to be made between embryos of morphologically equal quality. Also, two-pronuclear zygotes (2PN) transitioning through 1PN or 3PN states tend to develop into poorer-quality embryos than those who constantly remain 2PN. In addition to tests that optimise pregnancy chances, Preimplantation genetic diagnosis (PGD) or screening may be performed prior to transfer in order to avoid inheritable diseases. Methods are emerging in making comprehensive analyses of transcriptomes of embryos in order to assess embryo quality.

Embryo transfer : Embryos are graded by the embryologist based on the number of cells, evenness of growth and degree of fragmentation. The number to be transferred depends on the number available, the age of the woman and other health and diagnostic factors. In countries such as Canada, the UK, Australia and New Zealand, a maximum of two embryos are transferred except in unusual circumstances. In the UK and according to HFEA regulations, a woman over 40 may have up to three embryos transferred, whereas in the USA, younger women may have many embryos transferred based on individual fertility diagnosis. Most clinics and country regulatory bodies seek to minimise the risk of pregnancies carrying multiples. The embryos judged to be the "best" are transferred to the patient's uterus through a thin, plastic catheter, which goes through her vagina and cervix. Several embryos may be passed into the uterus to improve chances of implantation and pregnancy.

IVF(Methods)

In gamete intrafallopian transfer, eggs are removed from the woman and placed in one of the fallopian tubes, along with the man's sperm. This allows fertilisation to take place inside the woman's body. Therefore, this variation is actually an in vivo fertilisation, not an in vitro fertilisation.
Embryo culture Typically, embryos are cultured until having reached the 6–8 cell stage three days after retrieval. In many Canadian, American and Australian programmes[citation needed], however, embryos are placed into an extended culture system with a transfer done at the blastocyst stage at around five days after retrieval, especially if many good-quality embryos are still available on day 3. Blastocyst stage transfers have been shown to result in higher pregnancy rates. In Europe, transfers after 2 days are common.
Culture of embryos can either be performed in an artificial culture medium or in an autologous endometrial coculture (on top of a layer of cells from the woman's own uterine lining). With artificial culture medium, there can either be the same culture medium throughout the period, or a sequential system can be used, in which the embryo is sequentially placed in different media. For example, when culturing to the blastocyst stage, one medium may be used for culture to day 3, and a second medium is used for culture thereafter.Single or sequential medium are equally effective for the culture of human embryos to the blastocyst stage. Artificial embryo culture media basically contain glucose, pyruvate, and energy-providing components, but addition of amino acids, nucleotides, vitamins, and cholesterol improve the performance of embryonic growth and development.

IVF(Method)

Egg retrieval:

Transvaginal oocyte retrieval:

When follicular maturation is judged to be adequate, human chorionic gonadotropin (hCG) is given. Commonly, this is known as the "trigger shot." This agent, which acts as an analogue of luteinising hormone, makes the follicles perform their final maturation, and would cause ovulation about 42 hours after injection, but a retrieval procedure takes place just prior to that, in order to recover the egg cells from the ovary . The eggs are retrieved from the patient using a transvaginal technique (transvaginal oocyte retrieval) involving an ultrasound-guided needle piercing the vaginal wall to reach the ovaries. Through this needle follicles can be aspirated, and the follicular fluid is handed to the IVF laboratory to identify ova. It is common to remove between ten and thirty eggs. The retrieval procedure takes about 20 minutes and is
usually done under conscious sedation or general anaesthesia.

Egg and sperm preparationIn the laboratory, the identified eggs are stripped of surrounding cells and prepared for fertilisation. An oocyte selection may be performed prior to fertilisation to select eggs with optimial chances of successful pregnancy. In the meantime, semen is prepared for fertilisation by removing inactive cells and seminal fluid in a process called sperm washing. If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined, and it will be thawed ready for use.

Fertilisation :The sperm and the egg are incubated together at a ratio of about 75,000:1 in the culture media for about 18 hours. In most cases, the egg will be fertilised by that time and the fertilised egg will show two pronuclei. In certain situations, such as low sperm count or motility, a single sperm may be injected directly into the egg using intracytoplasmic sperm injection (ICSI). The fertilised egg is passed to a special growth medium and left for about 48 hours until the egg consists of six to eight cells.

IVF OFFICIAL WEBSITE

http://www.ivfmatters.com/

IVF(Methods)

Theoretically, in vitro fertilization could be performed by aspirating contents from a woman's fallopian tubes or uterus with a plastic catheter after natural ovulation, mix it with semen from a man and reinsert into the uterus. However, without additional techniques, the chances of pregnancy would be extremely small. Such additional techniques that are routinely used in IVF include ovarian hyperstimulation to retrieve multiple eggs, ultrasound-guided transvaginal oocyte retrieval directly from the ovaries, egg and sperm preparation, as well as culture and selection of resultant embryos.

Ovarian hyperstimulation

There are two main protocols for stimulating the ovaries for IVF treatment. The long protocol involves downregulation (suppression or exhaustion) of the pituitary ovarian axis by the prolonged use of a GnRH agonist. Stimulation of the ovaries using a gonadotrophin starts once the process of downregualtion is complete generally after 10 to 14 days.

The short protocol consist of a regimen of fertility medications to stimulate the development of multiple follicles of the ovaries. In most patients, injectable gonadotropins (usually FSH analogues) are used under close monitoring. Such monitoring frequently checks the estradiol level and, by means of gynecologic ultrasonography, follicular growth. Typically approximately 10 days of injections will be necessary. Spontaneous ovulation during the cycle is typically prevented by the use of GnRH agonists that are started prior or at the time of stimulation or GnRH antagonists that are used just during the last days of stimulation; both agents block the natural surge of luteinising hormone (LH) and allow the physician to start the ovulation process by using medication, usually injectable human chorionic gonadotropins. Ovarian stimulation carries the risk of excessive or hyperstimulation. This complication is life-threatening and ovarian stimulation using gonadotrophins must only be carried out under strict medical supervision