In vitro fertilization (IVF), commonly known as “test-tube baby,” is the most widely used assisted reproductive technology in the world.
”IVF is not a baby that grows up in a test tube, but a few eggs are removed from the ovaries, combined with the male partner’s sperm in a laboratory to form an embryo, which is then transferred to the uterus, where it will implant in the mother’s uterus and become pregnant.
Normal conception requires the sperm and egg to meet in the fallopian tube, where they combine to form a fertilized egg, which then returns to the uterine cavity to continue the pregnancy. Therefore, IVF can be simply understood as the replacement of the fallopian tube by a laboratory test tube and is called “in vitro fertilization”.
How does IVF work?
1. In vitro fertilization pre-treatment and ovulation monitoring
In order to collect preovulatory mature or near-mature oocytes from the ovaries at the right time, it is important to accurately monitor the process of follicular maturation prior to ovulation.
In order to increase the chance of success and to increase the number of developing follicles to obtain multiple eggs, stimulation cycles (also called ovulation promotion) are now used to obtain more than 3 oocytes at a time.
2. Egg collection
The eggs are harvested at a determined time. The routes of egg collection are
Direct visualization of the follicle under dissection for egg retrieval;
Trans-laparoscopic egg retrieval;
Ultrasound-guided transabdominal wall, urinary bladder or vaginal puncture for egg retrieval.
3. Egg culture
Immediately after aspiration of the follicular fluid, the eggs are searched for.
After the oocytes are removed, they need to be placed in a culture dish with artificial culture fluid and a certain amount of follicular fluid to help the growth and development of the oocytes.
The incubation time depends on the maturity of the follicles taken, and mature ones are usually incubated for 2 to 6 hours.
4. In vitro fertilization
The semen is collected and washed to obtain the semen in vitro, then placed in a culture medium with oocytes and incubated for 15 to 24 hours, examined under a dissecting microscope, and if two protoplasts are seen in the oocyte primordium indicating that fertilization has occurred, the culture is continued for another 36 to 42 hours.
When microscopic observation shows that the fertilized egg has divided to 4 to 8 cells, it can be considered for embryo transfer.
5. Embryo transfer
The vagina and cervix are cleaned with saline and then scrubbed with culture fluid, and a metal or plastic catheter is placed into the cervical canal.
The culture solution is then inserted into the cervical canal catheter to 0.5 cm from the fundus of the uterus and the embryo is sent into the uterine cavity. After embryo transfer, it is necessary to stay in bed for 24 hours, restrict activities for 3-4 days and receive progesterone therapy.
2 weeks after transfer, β-GCG measurement is required and progesterone is discontinued if there is no pregnancy.
What is the success rate of IVF?
”The success rate of IVF depends on many factors, such as the age of the patient, the condition of the uterus and ovaries and the absence of other diseases, the condition of the laboratory, the level of technical staff, etc. The most influential factors are the age of the patient, the condition of the uterus and ovaries and the absence of other diseases.
The most influential factor is the age of the woman, as age implies a corresponding level of ovarian function.
Researchers have also found that smoking can affect the success rate of IVF. If a woman smoked more than one cigarette a day for a year, her success rate with IVF treatment was reduced by 28%.
Body mass index also affects IVF success rates, and when it exceeds 27, success rates are 30 percent lower than the average success rate.
Emotions also have an impact on IVF success rates. The success rate of IVF is generally higher for optimistic patients than for pessimistic ones.
The support and understanding of the family plays a key role in the adjustment of the woman. The more the doctor knows about the parents, the better the chances of success. The technology of “IVF” is rapidly developing and the success rate is increasing.
Who is suitable for IVF?
Who is suitable
Patients with unexplained infertility, but with low chances of conception;
Patients with endometriosis;
Male and/or female partner with anti-sperm antibodies;
Patients with low sperm count, poor motility, abnormal ejaculation or azoospermia;
Patients with pelvic tuberculosis, but with endometrial destruction, who are unable to conceive;
Patients with infertility caused by tubal factors: tubal obstruction caused by inflammatory diseases that cannot be restored to patency after conventional treatment;
Patients with tubal ligation: Patients who have had both fallopian tubes removed due to ectopic pregnancy can only rely on IVF for the purpose of having a child.
Required conditions
The female partner is less than 40 years old, in good health and able to conceive.
The woman’s uterine cavity is basically normal and the endometrium has physiological cycle changes.
No history of mental illness in both sexes.
Laparoscopy should be done if there are inflammatory adhesions in the pelvis and at least one ovary can reach the approach for egg harvesting.
Key points
The timing of maternal ovulation must be accurately determined, and mature eggs must be obtained safely and without injury;
It is necessary to create a suitable condition for the egg and sperm to unite and become viable outside of the body, i.e., in vitro fertilization and gestation for about three days;
The fertilized egg must be reinserted into the maternal endometrium with great precision. Any of these steps requires advanced scientific techniques and cannot be abused.
Side effects of in vitro fertilization
Ovarian torsion, with acute abdominal pain, occurs in less than 1% of cases.
Undetermined comorbidity – ovarian cancer.
Ovarian hyperstimulation syndrome (ovarian enlargement, ascites, abdominal distention, abdominal pain, dehydration, oliguria)
Multiple pregnancy, 20% incidence (prone to preterm delivery, requiring reduction to twins).
Pain at the site of ovulation injection, which is relieved by heat, massage or more walking.