The world’s first “test tube baby,” Louise Brown, was born in January 1978 in England, ushering in a new era of assisted reproductive technology. Millions of IVF babies have been born worldwide.
”The indications for IVF are
1. In vitro fertilization and embryo transfer
(1) Gamete transport disorders caused by various factors in the female partner.
② Ovulation disorders.
③Endometriosis.
④Low or weak spermatozoa of the male partner.
⑤ unexplained infertility.
⑥immune infertility.
2.Intracytoplasmic single sperm microinjection
①Severe oligospermia, weak spermia and teratospermia in the male partner
② irreversible obstructive azoospermia in the male partner
③ male partner with spermatogenic dysfunction (excluding those caused by genetic defects)
④ immune infertility.
⑤ in vitro fertilization failure.
(vi) abnormal sperm acrosome.
(vii) Those requiring preimplantation embryo genetic testing.
Several common protocols
1.Extra-long protocol
2.Long protocol
3.Short protocol
4.Ultra-short protocol
5.Antagonist protocol
6.Natural cycle/microstimulation/gentle stimulation program
Steps of “IVF”.
1.Preparation: Preliminary basic and reproduction related examination for both couples. Preparation of ID card, marriage certificate, fertility certificate, etc.
2. Ovulation induction: Since not every egg can be fertilized and not every fertilized egg can develop into viable embryos, multiple eggs have to be obtained from the woman’s body to ensure that there are embryos that can be transferred, which requires controlled superovulation treatment for the woman. During superovulation, the doctor observes the growth and development of the follicles mainly through transvaginal ultrasound.
It is important to figure out the medication to be administered and to contact the nearest reliable place where the injection can be given if it is not done at the fertility center.
Injectable drugs should be kept between 0-25°C and some drugs at 2-8°C.
3. Egg and sperm collection: The doctor applies a special egg retrieval needle under transvaginal ultrasound guidance to puncture the mature follicles transvaginally and aspirate the eggs. The retrieved eggs are washed and incubated in an incubator to await fertilization.
Egg collection: usually 34-36 hours after HCG injection.
Sperm collection: the morning of the egg retrieval day. For those who have difficulty in retrieving sperm or have very little sperm, it is recommended to freeze the semen in advance.
4. In vitro fertilization and embryo culture.
Conventional in vitro fertilization (IVF): treated sperm and eggs are placed in a special culture dish with a view to natural union, which is known as the conventional method of fertilization.
Single sperm intracytoplasmic injection (ICSI): If the husband’s sperm count is too low or the sperm-egg union is abnormal for normal fertilization, then microscopic manipulation is required to inject sperm into the egg plasma to complete fertilization, which is called intracytoplasmic single sperm microinjection technique.
5. Embryo transfer: 3-5 days after fertilization, a very thin embryo transfer tube is used to transfer the best embryo into the maternal uterus through the cervix. Due to the application of GnRH agonists/antagonists and ovulation-promoting drugs, as well as the loss of follicular granulosa cells due to egg retrieval, women usually have luteal insufficiency during the egg retrieval cycle and require the application of drugs for luteal supplementation/support. If there is no pregnancy, discontinue the luteal support medication and wait for menstruation. If pregnancy occurs, progesterone is continued.
Embryos are classified into four grades, grades I-III are transferable embryos
Only 2 embryos can be transferred in the first cycle under 35 years of age, except for 3 embryos that can be transferred
The transfer is performed under ultrasound guidance in the abdomen with a full bladder
Progesterone medication must be administered after the transfer
You can rest for a few hours after the transfer before going home
Beta-HCG blood test 14 days after the transfer to check if you are pregnant
Ultrasound 15-20 days after pregnancy is confirmed to determine fetal condition
6. Freezing embryos: In some cases, the embryos can be frozen and set aside for another transfer.
When there are remaining embryos
When the lining of the current cycle is not suitable for embryo transfer
When there is a serious risk of ovarian hyperstimulation