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Encyclopedia > In vitro fertilisation

In vitro fertilisation[1] (IVF) is a technique in which egg cells are fertilised by sperm outside the woman's womb, in vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman's ovaries and letting sperm fertilise them in a fluid medium. The fertilised egg (zygote) is then transferred to the patient's uterus with the intent to establish a successful pregnancy. UCCF (the Universities and Colleges Christian Fellowship) is a UK-based evangelical Christian charity which operates on university campuses. ... Indeo Video (commonly known now simply as Indeo) is a video codec developed by Intel in 1992. ... Brainiacs Test Tube Baby is a live British scientific entertainment TV show hosted by Dominic Wood. ... Test Tube Babies is a 1948 exploitation film known by several titles. ... A human ovum Sperm cells attempting to fertilize an ovum An ovum (plural ova) is a haploid female reproductive cell or gamete. ... This article is about fertilisation in animals and plants. ... A spermatozoon or spermatozoan ( spermatozoa), from the ancient Greek σπέρμα (seed) and (living being) and more commonly known as a sperm cell, is the haploid cell that is the male gamete. ... In vitro (Latin: within the glass) refers to the technique of performing a given experiment in a test tube, or, generally, in a controlled environment outside a living organism. ... Infertility primarily refers to the biological inability of a man or a woman to contribute to conception. ... Assisted reproductive technology (ART) is a general term referring to methods used to achieve pregnancy by artificial or partially artificial means. ... A human ovum Sperm cells attempting to fertilize an ovum An ovum (plural ova) is a haploid female reproductive cell or gamete. ... // For ovary as part of plants see ovary (plants) An ovary is an egg-producing reproductive organ found in female organisms. ... A spermatozoon or spermatozoan ( spermatozoa), from the ancient Greek σπέρμα (seed) and (living being) and more commonly known as a sperm cell, is the haploid cell that is the male gamete. ... It has been suggested that Biparental zygote be merged into this article or section. ... This article is about female reproductive anatomy. ...

Oocyte with surrounding granulosa cells
"Naked" Egg
"Naked" Egg

Contents

Image File history File links Oocyte with surrounding granulosa cells, after aspiration File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... Image File history File links Oocyte with surrounding granulosa cells, after aspiration File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... Image File history File links Oocyte. ... Image File history File links Oocyte. ...

"In vitro"

Main article: In vitro

The term in vitro, from the Latin root meaning in glass, is used, because early biological experiments involving cultivation of tissues outside the living organism from which they came, were carried out in glass containers such as beakers, test tubes, or petri dishes. Today, the term in vitro is used to refer to any biological procedure that is performed outside the organism it would normally be occurring in, to distinguish it from an in vivo procedure, where the tissue remains inside the living organism within which it is normally found. A colloquial term for babies conceived as the result of IVF, test tube babies, refers to the tube-shaped containers of glass or plastic resin, called test tubes, that are commonly used in chemistry labs and biology labs. However in vitro fertilisation is usually performed in the shallower containers called petri dishes. (Petri-dishes may also be made of plastic resins.) However, the IVF method of Autologous Endometrial Coculture is actually performed on organic material, but is yet called in vitro. In vitro (Latin: within the glass) refers to the technique of performing a given experiment in a test tube, or, generally, in a controlled environment outside a living organism. ... For other uses, see Latin (disambiguation). ... Illustration of a Beaker A beaker is a type of laboratory glassware which consists of a cylindrical cup with a notch on the top to allow for the pouring of liquids. ... A test tube (Sometimes culture tube) is a kind of laboratory glassware, composed of a fingerlike length of glass tubing, open at the top, sometimes with a rounded lip at the top, and a rounded U shaped bottom. ... Man looking at fungus inside of petri dishes A Petri dish is a shallow glass or plastic cylindrical dish that biologists use to culture microbes. ... In vivo (Latin for (with)in the living). ... Man looking at fungus inside of petri dishes A Petri dish is a shallow glass or plastic cylindrical dish that biologists use to culture microbes. ... This article does not cite any references or sources. ... Autologous Endometrial Coculture is a technique of assisted reproductive technology. ...


History

On the basis of the findings of Min Chueh Chang's application of in vitro fertilization to animals, the technique was developed for humans in the United Kingdom by Patrick Steptoe and Robert Edwards. The first "test-tube baby", Louise Brown, was born in Oldham, Greater Manchester, England, as a result on July 25, 1978 amid intense controversy over the safety and morality of the procedure.[2] Wikipedia does not have an article with this exact name. ... Patrick Christopher Steptoe (June 9, 1913, Witney, England - March 21, 1988) was a British obstetrician and gynaecologist and a pioneer of fertility treatment. ... Robert Geoffrey Edwards, born September 29, 1925 in Leeds, England, is a physiologist and pioneer in reproductive medicine. ... Louise Joy Brown (born July 25, 1978, in England) was the worlds first baby to be conceived by in vitro fertilisation, or IVF. She is currently a postal worker and was previously a nurse at a childcare centre in Bristol. ... For the larger local government district, see Metropolitan Borough of Oldham. ... Greater Manchester is a metropolitan county in North West England which has a population of 2. ... For other uses, see England (disambiguation). ... is the 206th day of the year (207th in leap years) in the Gregorian calendar. ... Year 1978 (MCMLXXVIII) was a common year starting on Sunday (link displays the 1978 Gregorian calendar). ...


Subhash Mukhopadhyay became the first physician in India, and the second in the world after Steptoe and Edwards, to perform the procedure and produce the test tube baby "Durga" (alias Kanupriya Agarwal) on October 3, 1978. Facing social ostracism, bureaucratic negligence, reprimand and insult instead of recognition from the Marxist West Bengal government and refusal of the Government of India to allow him to attend international conferences, Mukhopadhyay committed suicide in his Calcutta residence in 1981. Dr Subhash Mukhopadhyay (Bengali: সুভাষ মুখোপাধ্যায় Shubhash Mukhopaddhae) (died June 19, 1981) was an Indian physician from Calcutta in India. ... is the 276th day of the year (277th in leap years) in the Gregorian calendar. ... Year 1978 (MCMLXXVIII) was a common year starting on Sunday (link displays the 1978 Gregorian calendar). ... Marxism is the political practice and social theory based on the works of Karl Marx, a 19th century philosopher, economist, journalist, and revolutionary, along with Friedrich Engels. ... , West Bengal (Bengali: পশ্চিমবঙ্গ Poshchimbôŋgo) is a state in eastern India. ... This article is on Calcutta/Kolkata, the city. ...


Major pioneering developments in IVF also occurred in Australia under the leadership of Carl Wood, Alan Trounson and Ian Johnston.[3][4] The world's third IVF baby, Candice Reed was born on June 23, 1980 in Melbourne, Australia. Carl Wood was a pioneer of the in vitro fertilization technique who worked at the Monash University in Victoria, Australia. ... Alan O. Trounson, Ph. ... Wikipedia does not have an article with this exact name. ... Candice Reed, Born June 23, 1980 in Melbourne, was Australias First IVF baby and the worlds third under the leadership of Carl Wood, Alan Trounson and Ian Johnston. ... is the 174th day of the year (175th in leap years) in the Gregorian calendar. ... Year 1980 (MCMLXXX) was a leap year starting on Tuesday (link displays the 1980 Gregorian calendar). ... This article is about the Australian city; the name may also refer to City of Melbourne or Melbourne city centre (also known as The CBD). ...


The first successful IVF treatment in the USA (producing Elizabeth Jordan Carr) took place in 1981 under the direction of Doctors Howard Jones and Georgeanna Seegar Jones in Norfolk, Virginia. Since then IVF has exploded in popularity, with as many as 1% of all births now being conceived in-vitro, with over 115,000 born in the USA to date. At present, the percentage of children born after IVF (including with intracytoplasmic sperm injection (ICSI)) has been up to 4% of all babies born in Denmark. Elizabeth Jordan Carr (born 28 December 1981) was the United States first baby born from the in-vitro fertilization procedure. ... In vitro fertilization(AE) or fertilisation(BE) (IVF) is a technique in which egg cells are fertilized outside the womans body. ... Motto: Crescas (Latin for, Thou shalt grow. ... This article is about the U.S. state. ... Oocyte is injected during ICSI Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an egg; this procedure is most commonly used to overcome male infertility problems. ...


Jane Mohr of Manhattan Beach California, gave birth to the nation's first set of triplets born 21 months apart due to in vitro fertilisation (IVF) and long-term embryo storage. Jane gave birth November 29, 1988 to two daughters, Mollie McKenna and Hannah Christina Mohr, nearly two years after the birth of her son, Cooper Patrick Mohr.


Indications

Initially IVF was developed to overcome infertility due to problems of the fallopian tube, but it turned out that it was successful in many other infertility situations as well. The introduction of intracytoplasmic sperm injection (ICSI) addresses the problem of male infertility to a large extent. Infertility primarily refers to the biological inability of a man or a woman to contribute to conception. ... The Fallopian tubes, also known as oviducts, uterine tubes, and salpinges (singular salpinx) are two very fine tubes leading from the ovaries of female mammals into the uterus. ... Oocyte is injected during ICSI Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an egg; this procedure is most commonly used to overcome male infertility problems. ...


Thus, for IVF to be successful it may be easier to say that it requires healthy ova, sperm that can fertilise, and a uterus that can maintain a pregnancy. Cost considerations generally place IVF as a treatment when other less expensive options have failed. This article is about human pregnancy in biological females. ...


This means that IVF can be used for females who have already gone through pregnancy. The donated oocyte can be fertilised in a crucible. If the fertilisation is successful, the fertilised egg will be transferred into the uterus, within which it will develop into an embryo. For other uses, see Crucible (disambiguation). ...


Method

Ovarian stimulation

Treatment cycles are typically started on the third day of menstruation and 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. Spontanenous ovulation during the cycle is prevented by the use of GnRH agonists or GnRH antagonists, which block the natural surge of luteinizing hormone (LH). Not to be confused with Mensuration. ... Ovarian follicles or Graafian follicles (after Regnier de Graaf) are the roughly spherical cell aggregations in the ovary containing an ovum and from which the egg is released during ovulation. ... Gonadotropins are protein hormones secreted by gonadotrope cells of the pituitary gland of vertebrates. ... Follicle stimulating hormone (FSH) is a hormone produced by gonadotropes in the anterior pituitary gland. ... Estradiol (17β-estradiol) (also oestradiol) is a sex hormone. ... Gynecologic ultrasonography or Gyn sonography refers to the application of medical ultrasonography to the female pelvic organs, specifically the uterus, the ovaries, the Fallopian tubes, as well as the bladder, the Pouch of Douglas, and any findings in the pelvis of relevance outsite of pregnancy. ... Gonadotropin-releasing hormone 1 (GNRH1 also called LHRH) is a peptide hormone responsible for the release of FSH and LH from the anterior pituitary. ... Luteinizing hormone (LH) is a hormone synthesized and secreted by gonadotropes in the anterior lobe of the pituitary gland. ...


Oocyte retrieval

Main article: Transvaginal oocyte retrieval

When follicular maturation is judged to be adequate, human chorionic gonadotropin (β-hCG) is given. This agent, which acts as an analogue of luteinizing hormone, would cause ovulation about 36 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 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. The retrieval procedure takes about 20 minutes and is usually done under conscious sedation or general anesthesia. Transvaginal oocyte retrieval or simply oocyte retrieval (OCR) is a technique used in in vitro fertilization in order to remove oocytes from the ovary of the female, enabling fertilization outside the body. ... Human chorionic gonadotropin (hCG) is a peptide hormone produced in pregnancy, that is made by the embryo soon after conception and later by the syncytiotrophoblast (part of the placenta). ... Luteinizing hormone (LH) is a hormone synthesized and secreted by gonadotropes in the anterior lobe of the pituitary gland. ... Sedation is a medical procedure involving administration of sedative drugs, generally to facilitate a medical procedure, such as endoscopy, vasectomy, or minor surgery with local anaesthesia. ... This article or section may be confusing for some readers, and should be edited to be clearer. ...

Oocyte is injected during ICSI
Oocyte is injected during ICSI

Image File history File links ICSI sperm injection into oocyte File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... Image File history File links ICSI sperm injection into oocyte File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ...

Fertilisation

In the laboratory , the identified eggs are stripped of surrounding cells and prepared for fertilisation. In the meantime, semen is prepared for fertilisation by removing inactive cells and seminal fluid. 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. The sperm and the egg are incubated together (at a ratio of about 75,000:1) in the culture media for about 18 hours. By that time fertilisation should have taken place and the fertilised egg would show two pronuclei. In situations where the sperm count is low, a single sperm is 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 has reached the 6-8 cell stage. Horse semen being collected for breeding purposes. ... A growth medium is an object in which microorganisms or cells in experience growth. ... This article is about fertilisation in animals and plants. ... Pronuclei - plural for pronucleus. ... Oocyte is injected during ICSI Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an egg; this procedure is most commonly used to overcome male infertility problems. ...

8-cell embryo for transfer fetus
8-cell embryo for transfer fetus

Image File history File links 8-cell embryo, day 3 Courtesy: RWJMS IVF Program File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... Image File history File links 8-cell embryo, day 3 Courtesy: RWJMS IVF Program File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ...

Selection

Laboratories have developed grading methods to judge oocyte and embryo quality. Typically, embryos that have reached the 6-8 cell stage are transferred three days after retrieval. In many American and Australian programmes[citation needed], however, embryos are placed into an extended culture system with a transfer done at the blastocyst stage, especially if many good-quality day-3 embryos are available. Blastocyst stage transfers have been shown to result in higher pregnancy rates.[5]. In Europe, day-2 transfers are common.[citation needed] For other uses, see Embryo (disambiguation). ... The blastocyst is an early stage of the human (or any other mammal) development early in pregnancy. ...


Embryo transfer

Main article: 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 the UK, Australia and New Zealand, a maximum of two embryos are transferred except in unusual circumstances. For instance, a woman over 35 may have up to three embryos transferred. This is to limit the number of multiple pregnancies. 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. Embryo transfer refers to a step in the process of in vitro fertilization (IVF) whereby one or several embryos are placed into the uterus of the female with the intent to establish a pregnancy. ... Catheter disassembled In medicine, a catheter is a tube that can be inserted into a body cavity, duct or vessel. ... The vagina, (from Latin, literally sheath or scabbard ) is the tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. ... Implantation is a phenomenon in prenatal development, i. ... This article is about human pregnancy in biological females. ...

Blastocyst for transfer
Blastocyst for transfer

Image File history File links Blastocyst on day 5 after fertilization Courtesy: RWJMS IVF Program File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ... Image File history File links Blastocyst on day 5 after fertilization Courtesy: RWJMS IVF Program File history Legend: (cur) = this is the current file, (del) = delete this old version, (rev) = revert to this old version. ...

Success rates

While the overall live birth rate via IVF in the U.S. is about 27% per cycle (33% pregnancy rate), the chances of a successful pregnancy via IVF vary widely based on the age of the woman (or, more precisely, on the age of the eggs involved). [2] Where the woman's own eggs are used as opposed to those of a donor, for women under 35, the pregnancy rate is commonly approximately 43% per cycle (36.5% live birth), while for women over 40, the rate falls drastically - to only 4% for women over 42. [3] Other factors that determine success rates include the quality of the eggs and sperm, the duration of the infertility, the health of the uterus, and the medical expertise. It is a common practice for IVF programmes to boost the pregnancy rate by placing multiple embryos during embryo transfer. A flip side of this practice is a higher risk of multiple pregnancy, itself associated with obstetric complications. Quadruplet, quintuplet, etc. ...


A recent technique is to bathe an embryo in a culture of nutrients for five days until it reaches a developmental landmark known as the blastocyst stage. The doctors then determine which embryos are most likely to thrive long term. The best quality of these are transferred into a woman's uterus. In this way it is possible to enable pregnancy without the risk of multiple pregnancy. This technique is relatively new and has yet to be well tested.


IVF programmes generally publish their pregnancy rates. However, comparisons between clinics are difficult as many variables determine outcome. Furthermore, these statistics depend strongly on the type of patients selected.


There are many reasons why pregnancy may not occur following IVF and embryo transfer, including

  • The timing of ovulation may be misjudged, or ovulation may not be able to be predicted or may not occur
  • Attempts to obtain eggs that develop during the monitored cycle may be unsuccessful
  • The eggs obtained may be abnormal or may have been damaged during the retrieval process
  • A semen specimen may not be able to be provided
  • Fertilisation of eggs to form embryos may not occur
  • Cleavage or cell division of the fertilised eggs may not take place
  • The embryo may not develop normally
  • Implantation may not occur
  • Equipment failure, infection and/or human error or other unforeseen and uncontrollable factors, which may result in the loss of or damage to the eggs, the semen sample and/or the embryos[6]

According to a 2005 Swedish study published in the Oxford Journal 'Human Reproduction' 166 women were monitored starting one month before their IVF cycles and the results showed no significant correlation between psychological stress and their IVF outcomes. The study concluded with the recommendation to clinics that it might be possible to reduce the stress experienced by IVF patients during the treatment procedure by informing them of those findings. While psychological stress experienced during a cycle might not influence an IVF outcome, it is possible that the experience of IVF can result in stress that leads to depression. The financial consequences alone of IVF can influence anxiety and become overwhelming. However, for many couples, the alternative is infertility, and the experience of infertility itself can also cause extreme stress and depression.


Complications

The major complication of IVF is the risk of multiple births.[4] This is directly related to the practice of transferring multiple embryos at embryo transfer. Multiple births are related to increased risk of pregnancy loss, obstetrical complications, prematurity, and neonatal morbidity with the potential for long term damage. Strict limits on the number of embryos that may be transferred have been enacted in some countries (e.g., England) to reduce the risk of high-order multiples (triplets or more), but are not universally followed or accepted. Spontaneous splitting of embryos in the womb after transfer can occur, but this is rare and would lead to identical twins. A double blind, randomised study followed IVF pregnancies that resulted in 73 infants (33 boys and 40 girls) and reported that 8.7% of singeton infants and 54.2% of twins had a birth weight of < 2500 g [7]. However recent evidence suggest that singleton offspring after IVF is at higher risk for lower birth weight for unknown reasons. Quadruplet, quintuplet, etc. ... Prematurity is the condition of being born before a full gestation. ...


Another risk of ovarian stimulation is the development of ovarian hyperstimulation syndrome. Ovarian hyperstimulation syndrome (OHSS) is a complication from some forms of fertility medication. ...


If the underlying infertility is related to abnormalities in spermatogenesis, it is plausible, but too early to examine that male offspring is at higher risk for sperm abnormalities.


Birth defects

The issue of birth defects remains a controversial topic in IVF. A majority of studies do not show a significant increase after use of IVF. Some studies suggest higher rates for ICSI , while others do not support this finding.[8] Hansen et al. conducted a systematic review of published studies (including ICSI) and found a 30-40% increase risk of birth defects associated with assisted reproductive technology when compared to children born after spontaneous conception.[9] Possible explanations offered were the underlying cause of the infertility, factors associated with IVF/ICSI, culture conditions, and medications, however, the actual cause is not known. A congenital disorder is a medical condition or defect that is present at or before birth (for example, congenital heart disease). ... Systematic reviews are named as the highest level of medical evidence, by evidence based medicine professionals. ...


Cryopreservation

Main article: Cryopreservation

Cryopreservation of plant shoots. ...

Embryo cryopreservation

If multiple embryos are generated, patients may choose to freeze embryos that are not transferred. Those embryos are placed in liquid nitrogen and can be preserved for a long time. There are currently 500,000 frozen embryos in the United States.[5] The advantage is that patients who fail to conceive may become pregnant using such embryos without having to go through a full IVF cycle. Or, if pregnancy occurred, they could return later for another pregnancy. Spare embryos resulting from fertility treatments may be donated to another woman or couple, and embryos may be created, frozen and stored specifically for transfer and donation by using donor eggs and sperm. Cryopreservation of plant shoots. ... A tank of liquid nitrogen, used to supply a cryogenic freezer (for storing laboratory samples at a temperature of about -150 Celsius). ...


Oocyte cryopreservation

Cryopreservation of unfertilised mature oocytes has been successfully accomplished, e.g. in women who are likely to lose their ovarian reserve due to undergoing chemotherapy.[10] Cryopreservation of plant shoots. ... Chemotherapy is the use of chemical substances to treat disease. ...


Ovarian tissue cryopreservation

Cryopreservation of ovarian tissue is of interest to women who want to preserve their reproductive function beyond the natural limit, or whose reproductive potential is threatened by cancer therapy. Research on this issue is promising.


Adjunctive interventions

There are several variations or improvements of IVF, such as ICSI, ZIFT, GIFT and PGD. An increasing number of fertility specialists and centers offer acupuncture as a part of their IVF protocol, or maintain a list of acupuncturists specialising in infertility.


ICSI

Intracytoplasmic sperm injection (ICSI) is a more recent development associated with IVF which allows the sperm to be directly injected in to the egg using micromanipulation. This is used where sperm have difficulty penetrating the egg and in these cases the partner's or a donor's sperm may be used. ICSI is also used when sperm numbers are very low. ICSI results in success rates equal to IVF fertilisation. Oocyte is injected during ICSI Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an egg; this procedure is most commonly used to overcome male infertility problems. ...


ZIFT

In Zygote intrafallopian transfer (ZIFT) eggs are removed from the woman, fertilised and then placed in the woman's fallopian tubes rather than the uterus. Zygote intrafallopian transfer (ZIFT) is an infertility treatment in which egg cells are removed from a womans ovaries, and fertilized in the laboratory. ...


GIFT

In gamete intrafallopian transfer (GIFT) 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, and not an in vitro fertilisation. Gamete intrafallopian transfer (GIFT) is an infertility treatment in which eggs are removed from a womans ovaries, and placed in one of the fallopian tubes, along with the mans sperm. ... In vivo (Latin for (with)in the living). ...


PGD

PGD can be performed on embryos prior to the embryo transfer. A similar, but more general test has been developed called Preimplantation Genetic Haplotyping (PGH). In medicine and (clinical) genetics preimplantation genetic diagnosis (PGD) (or also known as Embryo Screening) refers to procedures that are performed on embryos prior to implantation, sometimes even on oocytes prior to fertilization. ... Embryo transfer refers to a step in the process of in vitro fertilization (IVF) whereby one or several embryos are placed into the uterus of the female with the intent to establish a pregnancy. ... Preimplantation Genetic Haplotyping (PGH) is a clinical method of preimplantation genetic diagnosis (PGD). ...


Acupuncture

An increasing number of fertility specialists and centers recognise the benefits of acupuncture and offer acupuncture as a part of their IVF protocol. Limited but supportive[11] evidence from clinical trials and case series suggests that acupuncture may improve the success rate of IVF and the quality of life[11] of patients undergoing IVF and that it is a safe[11] adjunct therapy.


Mechanism of acupuncture

Scientific literature lists four[11] mechanisms of how acupuncture can improve IVF outcomes ; these include

  • Neuroendicrinological modulations
  • Increased blood flow to uterus and ovaries
  • Modulation in cytokines
  • Reducing stress, anxiety and depression

Studies

Summarizing four acupuncture trials published in peer reviewed scientific journal Fertility and sterility, involving a total of just under 800 women, the results clearly showed a pregnancy was twice as likely to occur in the acupuncture group compared to the control group[6]. Many fertility specialists recognise the positive role of acupuncture, although there are some methodological issues to be taken into account when assessing non-pharmacological studies, furthermore there are issues when assessing effectiveness of acupuncture, as the treatment is performed in person and is very difficult to fake acupuncture. Even the fake needles used in acupuncture trials as a placebo are considered to be able to produce a therapeutic effect through acupressure, making the research even more difficult.


Following are examples of individual studies. According to a report published in Fertility and Sterility, if done correctly, Acupuncture significantly improves IVF success rate[7]. Acupuncture chart from Hua Shou (fl. ...


Researchers in Adelaide has evaluated the effect of acupuncture on women undergoing IVF, and couldn't exclude a smaller treatment effect. However, there was no (statistically) significant difference compared to a control group of women not getting acupuncture[12]


A randomised, prospective study [13]showed that acupuncture significantly (p<0.01) increased IVF implantation rates and pregnancy rates. Positive trends were also observed in miscarriage rates although the results were not statistically significant. The study has been criticised by one scientist for lacking traditional scientific practices when interpreting the data [14], and by another scientist that positive impact of acupuncture on IVF success rates is not definitive. [15]. However, assessments of nonpharmacological treatments must take into consideration additional methodological issues. This criticism is possibly arising from lack of understanding of methodological differences in clinical trials evaluating nonpharmacological and pharmacological treatments[16] and in particular methodological issues in trials of acupuncture [17].


Electro-acupuncture in oocyte retrieval for IVF

Electro-acupuncture has a proven analgesic effect in oocyte retrieval for IVF[citation needed].


Complementary medicines

Infertility patients commonly use complementary medicines. Health-care practitioners and fertility specialists need to be proactive in acquiring and documenting the use of these practices. There is a need to provide further information to patients on the use of CMs and therapies. Further research examining the reasons for use of CMs and therapies is needed.[8]


Hypnosis

A study of hypnotherapy suggests a higher success rate when integrated with treatment [9]. However, this study is not without criticism. Experts say the study failed to take into account key differences between the groups compared in the study. These differences would have had a major influence on their chances of conceiving [18]. Hypnotherapy is therapy that is undertaken with a subject in hypnosis. ...


Ethics

Issues

Certain ethical issues have been raised from the beginning when IVF was introduced.[citation needed] These concerns include: Image File history File links Unbalanced_scales. ... Image File history File links Emblem-important. ...

  • Bypassing the natural method of conception.[citation needed]
  • The creation of an individual human life in the laboratory.[citation needed]
  • Fertilization of more embryos than will be needed.[citation needed]
  • Discarding of excess embryos.[citation needed]
  • Unnatural environment for embryos.[citation needed]
  • Use of untested technology.[citation needed]
  • Not affordable for many.[citation needed]
  • Misallocation of medical resources.[citation needed]
  • Creation of embryos, then freezing them, and keeping them "in limbo".[citation needed]
  • Exposure of embryos to unnatural substances.[citation needed]
  • Destruction of embryos in research.[citation needed]
  • Potential to create embryos for medical purposes.[citation needed]
  • Potential to select embryos (PGD).[citation needed]
  • Potential to modify embryos.[citation needed]
  • Facilitation of the idea that embryos are commodities.[citation needed]
  • Financial rewards for IVF doctors dissuade them from recommending other methods to couples.[citation needed]
  • Infertility is treated as a disease and not as a symptom of underlying medical problems.[citation needed]
  • The long term effect on frozen embryos is unknown.[citation needed]

In medicine and (clinical) genetics preimplantation genetic diagnosis (PGD) (or also known as Embryo Screening) refers to procedures that are performed on embryos prior to implantation, sometimes even on oocytes prior to fertilization. ...

Separating the traditional mother-father model

The IVF process requires sperm, eggs, a uterus and a bed. To achieve a pregnancy any of these requirements can be provided by a third person: third party reproduction. This has created additional ethical and legal concerns. The use of IVF provides also greater range of options for single people and same-sex couples wishing to have children. Although both groups already raise children, IVF facilitates this process. Some people object that this could give psychological problems to the child if they grow up without a mother/father[citation needed]. Third party reproduction refers to a process where another person provides sperm or eggs or where another woman provides her uterus so that a woman can have a child. ...


A number of cases have achieved notoriety:

  • In 2001, a French woman received worldwide publicity when she posed as the wife of her brother in order to give birth to a donor egg fertilised by his sperm. Some saw this as a form of incest; others thought it would prove psychologically unhealthy for the child when he learned how he was delivered; whereas other people simply couldn't see anything wrong with the situation.[citation needed]
  • 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.[19]

Pregnancy past menopause

While menopause has set a natural barrier to further conception, IVF has allowed women to be pregnant in their fifties and sixties. Women whose uteruses have been appropriately prepared receive embryos that originated from an egg of an egg donor. Therefore, although these women do not have a genetic link with the child, they have an emotional link through pregnancy and childbirth. In many cases the genetic father of the child is the woman's partner. Even after menopause the uterus is fully capable to carry out its function.[20]


Religious objections

The Roman Catholic Church is opposed to most kinds of in vitro fertilisation (although GIFT is accepted at certain conditions because fertilisation takes place inside the body and not inside a Petri dish [10]) and advocates that infertility is a call from God to adopt children. According to the Catholic Church, it "infringe[s] the child's right to be born of a father and mother known to him and bound to each other by marriage."[21] Also, embryos are sometimes discarded in the process, resulting in their demise. Catholics and many people of other faiths or none see embryos as human lives with the same rights as all others and, therefore, view the destruction of embryos as unacceptable. Catholic Church redirects here. ... Adoption is the legal act of permanently placing a child with a parent or parents other than the birth parents. ...


Regulatory events

While in the United States IVF programmes operate under voluntary guidelines, programmes in many other countries are subject to regulations that regulate many aspects of IVF practice[citation needed]. In such settings regulations may dictate:

  • The number of oocytes that can be fertilised[citation needed].
  • The number of embryos that can be transferred[citation needed].
  • The use of cryopreservation[citation needed].
  • The use of third party reproduction[citation needed].
  • The ability to perform tests or interventions on the embryo[citation needed].
  • In the US, 21 CFR 1271 defines sperm, oocytes, and embryo as human tissue subject to rules that require testing and screening for infectious disease. These rules focus on anonymous donations and there are broad exemptions for "sexually intimate partners" (i.e. the legal parents using their own sperm/ova) and directed donations from a donor known by the parents (i.e. a relative or a friend).

In 2004, the government of Italy made it a crime to freeze human embryos or to perform pre-implantation diagnosis[citation needed]. Muslims also do not agree with it as they think it is against the laws of God (Allah).


Coping with IVF

Due to the emotional and financial aspects of infertility treatment, many feel isolated and sometimes become depressed. Online support forums and message boards have become a popular way for sufferers to exchange both information and support. Popular forums include Fertiliy Friends and IVF World.


See also

Reproductive technology is a term for all current and anticipated uses of technology in human and animal reproduction, including: cloning (see human cloning for the special case of human beings) artificial wombs genetic engineering artificial insemination embryo transfer in vitro fertilization intracytoplasmic sperm injection hormone treatment to increase fertility sperm... Embryo transfer refers to a step in the process of in vitro fertilization (IVF) whereby one or several embryos are placed into the uterus of the female with the intent to establish a pregnancy. ... Fertility is the natural capability of giving life. ... Infertility primarily refers to the biological inability of a man or a woman to contribute to conception. ... This article is about human pregnancy in biological females. ... For other uses, see Reproduction (disambiguation) Reproduction is the biological process by which new individual organisms are produced. ... Surrogacy is an arrangement whereby a woman agrees to become pregnant for the purpose of gestating and giving birth to a child for others to raise. ...

References

  1. ^ The spelling fertilisation is a British English variant. The spelling fertilization is also used, and is the official spelling in American and Canadian English.
  2. ^ Steptoe PC, Edwards RG (1978). "Birth after the reimplantation of a human embryo". Lancet 2 (8085): 366. PMID 79723. 
  3. ^ Cohen J, Willisburger A, Dawson K, Jones H, Hazekamp J, Nygren KG, Hamberger L. (2005). "The early days of IVF outside the UK.". Hum Reprod Update: 439-59. doi:10.1093/humupd/dmi016. PMID 15923202. 
  4. ^ Leeton J (2004). "The early history of IVF in Australia and its contribution to the world (1970-1990)". Aust N Z J Obstet Gynaecol 44 (6): 495–501. doi:10.1111/j.1479-828X.2004.00305.x. PMID 15598283. 
  5. ^ Papanikolaou EG, Camus M, Kolibianakis EM, Van Landuyt L, Van Steirteghem A, Devroey P (2006). "In Vitro Fertilization with Single Blastocyst-Stage versus Single Cleavage-Stage Embryos". N Engl J Med 354: 1139. PMID 16540614. 
  6. ^ Abington Reproductive Medicine, In Vitro Fertilization (IVF): Why Pregnancy May Not Occur. (2006)
  7. ^ Olivennes F, Mannaerts B, Struijs M, Bonduelle M, Devroey P (2001). "Perinatal outcome of pregnancy after GnRH antagonist (ganirelix) treatment during ovarian stimulation for conventional IVF or ICSI: a preliminary report". Hum. Reprod. 16 (8): 1588–91. PMID 11473947. 
  8. ^ Kurinczuk JJ (2003). "Safety issues in assisted reproduction technology. From theory to reality--just what are the data telling us about ICSI offspring health and future fertility and should we be concerned?". Hum Reprod 18 (5): 925-31. PMID 12721163. 
  9. ^ Hansen M, Bower C, Milne E, de Klerk N, Kurinczuk JJ (2005). "Assisted reproductive technologies and the risk of birth defects--a systematic review". Hum Reprod 20 (2): 328-38. doi:10.1093/humrep/deh593. PMID 15567881. 
  10. ^ Porcu E, Fabbri R, Damiano G, Fratto R, Giunchi S, Venturoli S (2004). "Oocyte cryopreservation in oncological patients". Eur J Obstet Gynecol Reprod Biol 113 Suppl 1: S14-6. doi:10.1016/j.ejogrb.2003.11.004. PMID 15041124. 
  11. ^ a b c d Anderson BJ, Haimovici F, Ginsburg ES, Schust DJ, Wayne PM (2007). "In vitro fertilization and acupuncture: clinical efficacy and mechanistic basis". Altern Ther Health Med 13 (3): 38–48. PMID 17515023. 
  12. ^ Smith C, Coyle M, Norman RJ (2006). "Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer". Fertil. Steril. 85 (5): 1352–8. doi:10.1016/j.fertnstert.2005.12.015. PMID 16600225. 
  13. ^ Dieterle S, Ying G, Hatzmann W, Neuer A (2006). "Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study". Fertil. Steril. 85 (5): 1347–51. doi:10.1016/j.fertnstert.2005.09.062. PMID 16616748. 
  14. ^ Collins J (2006). "The play of chance". Fertil. Steril. 85 (5): 1364–7; discussion 1368–70. doi:10.1016/j.fertnstert.2005.10.064. PMID 16600221. 
  15. ^ Domar AD (2006). "Acupuncture and infertility: we need to stick to good science". Fertil. Steril. 85 (5): 1359–61; discussion 1368–70. doi:10.1016/j.fertnstert.2005.10.063. PMID 16600220. 
  16. ^ Boutron I, Tubach F, Giraudeau B, Ravaud P (2003). "Methodological differences in clinical trials evaluating nonpharmacological and pharmacological treatments of hip and knee osteoarthritis". JAMA 290 (8): 1062–70. doi:10.1001/jama.290.8.1062. PMID 12941679. 
  17. ^ Kaptchuk TJ (2001). "Methodological issues in trials of acupuncture". JAMA 285 (8): 1015–6; author reply 1016. PMID 11209166. 
  18. ^ BBC Hypnosis 'doubles IVF success'
  19. ^ Ayers C (2004). "Mother wins $1m for IVF mix-up but may lose son". Timesonline. [1]. 
  20. ^ Parks, Jennifer A. (1996). "A closer look at reproductive technology and postmenopausal motherhood.". CMAJ 154 (8): 1189-91. PMID 8612255. 
  21. ^ Catechism of the Catholic Church section 2376

British English (BrE, BE, en-GB) is the broad term used to distinguish the forms of the English language used in the United Kingdom from forms used elsewhere in the Anglophone world. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links

This article is about human pregnancy in biological females. ... The term conception can refer to more than one meaning: Concept Fertilisation This is a disambiguation page — a navigational aid which lists pages that might otherwise share the same title. ... Assisted reproductive technology (ART) is a general term referring to methods used to achieve pregnancy by artificial or partially artificial means. ... Obstetric sonogram of a fetus at 16 weeks. ... A modern pregnancy test A pregnancy test is a test to determine whether or not a woman is pregnant. ... Prenatal diagnosis is the diagnosis of disease or condition in a fetus or embryo before it is born. ... The amniotic sac is a tough but thin transparent pair of membranes which holds a developing embryo (and later fetus) until shortly before birth. ... A drawing of the amniotic sac from Grays Anatomy. ... Amniocentesis (also referred to as amniotic fluid test or AFT), is a medical procedure used in prenatal diagnosis of genetic risk factors, in which a small amount of amniotic fluid, which contains fetal tissues, is extracted from the amnion or amniotic sac surrounding a developing fetus, and the fetal DNA... Chorionic villus sampling (CVS) is a form of prenatal diagnosis to determine genetic abnormalities in the fetus. ... // Routine Problems of Pregnancy Back Pain Common, particularly in the third trimester when the patients center of gravity has shifted. ... Miscarriage or spontaneous abortion is the natural or spontaneous end of a pregnancy at a stage where the embryo or the fetus is incapable of surviving, generally defined in humans at a gestation of prior to 20 weeks. ... Molar pregnancy, sometimes simply referred as mole is a rare abnormal medical condition, a complication of pregnancy inside the category of gestational trophoblastic diseases. ... The Lamaze Technique is a prepared childbirth technique developed in the 1940s by French obstetrician Dr. Fernand Lamaze as an alternative to the use of medical intervention during labor. ... Parturition redirects here. ... // Midwifery is the term traditionally used to describe the art of assisting a woman through childbirth. ... Home birth is childbirth that occurs outside a hospital or birthing center setting, usually in the home of the mother. ... Labor and Delivery, a labor ward or a labour ward is a department of a hospital devoted to childbirth. ...

  Results from FactBites:
 
In vitro fertilisation: Definition and Much More from Answers.com (5180 words)
IVF may be an option if there is a blockage in the fallopian tube or endometriosis in the woman, or low sperm count or poor quality sperm in the man. There are other possible treatments for these conditions, such as surgery for blocked tubes or endometriosis, which may be attempted before IVF.
As in IVF, the fertilization of the eggs occurs in a laboratory dish.
IVF is a major treatment in infertility where other methods of achieving conception have failed or is preferred by the couple based on their individual circumstances.
  More results at FactBites »

 
 

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