Unravelling In-Vitro Fertilisation and the Future of Fertility Medicine

Infertility refers to a set of disorders of the male or female reproductive system and can be the reason why pregnancy is not achieved. These disorders can cause issues with the morphology, viability, or motility of the egg or the sperm thus leading to improper fertilisation or impaired development of the embryo. 

Some of the causes of infertility could include: 

1. Impaired hormone levels in both males and females which can then affect the maturation of the sperm or the egg
2. Tubal defects where the fallopian tubes are blocked thus preventing the egg to travel to the uterus
3. Endometriosis characterised by thickened uterine walls leading to unsuccessful implantation of the embryo. 
4. Ovarian Dysfunction such as irregular menstruation and polycystic ovarian syndrome 
5. Age-related infertility where the viability of the eggs and sperms reduces as we age. 
6. Male-Factor infertility where the sperm count or motility is altered due to issues like oligozoospermia, azoospermia, or the presence of anti-sperm antibodies. 

In Vitro Fertilization (IVF) is the process by which an egg is fertilized with sperm outside of the body and in laboratory conditions. IVF has become one of the most sought-after treatments for infertility since its success in 1978 with Louise Brown being the first ‘test-tube’ baby. 

Dr. P.S.R. Murthy gave a clearer picture of the IVF procedure in a webinar conducted by MedPiper Technologies and Journomed on 28th August, 2021. Dr. Murthy is an embryologist and the Scientific Director at the Miracle Advanced Reproductive Centre, Chennai. He helped in initiating the very first IVF laboratories at Apollo Hospital in the year 1988. He has pioneered a new technique called In Vitro Maturation to help with treating infertility. 

Dr. Murthy gave an in-depth tour about the various steps involved in IVF which are as follows: 

1. Initial Evaluation: This step comprises the required screening procedures performed to ascertain the reproductive status of the couple. A series of blood tests are done to check hormone levels and the presence of proteins, semen analysis to check sperm count and activity, hysterosalpingogram to check if the fallopian tubes are blocked or closed and transvaginal ultrasound to evaluate the ovarian status. 
2. Ovarian Stimulation: This process involves stimulating the ovaries to produce multiple mature follicles rather than just one follicle that normally develops every month. It requires 8-14 days of stimulation and around 5-10 oocytes to be collected. Hormones like Follicle Stimulating Hormone (FSH), human chorionic gonadotropin (hCG) and luteinizing hormone (LH) are given to achieve this goal. Periodical scans are taken to monitor follicular development. 

This phase of the procedure has a number of side effects and Dr. Murthy stresses addressing them during counselling sessions. He mentions that the spouses have to be supportive and kind to each other as mood swings, pain and discomfort are likely to occur. A major side effect that could occur is Ovarian Hyperstimulation Syndrome (OHSS) where the ovaries swell up with fluid and leak into the abdomen. Mild and moderate cases are easily treatable whereas in severe cases the IVF procedure should be delayed as pregnancy may delay the healing time. 

1. 1. Collection of oocytes: A trigger shot of hCG is given before collecting the mature follicles. After aspiration, the surrounding tissues are enzymatically digested to expose the oocyte which is then observed for quality and placed in the IVF culture medium. 
   2. Preparation of sperm: Semen samples are collected from a male partner within 60-90 minutes of oocyte retrieval. Sperms may be collected from the testes or sperm duct if the semen does not contain enough sperms either due to an obstruction or lack of production.
   3. In-Vitro fertilisation:  The sperms are added into the IVF culture medium containing the oocyte. The embryologist will select a sperm, draw it into a microneedle and then inject it into the oocyte. This fertilisation is done under a high-powered inverted microscope. The injected oocyte is then allowed to divide and mature into an embryo in special incubators. During this time, a pre-implantation genetic diagnosis is done to ascertain the risk of any genetic disorders like Cystic Fibrosis or Thalassemia. 
   4. Embryo Transfer: The embryo divides and develops into a blastocyst, having around 200 cells, within 5 days. Between 2-5 days of blastocyst development, the embryo (that is in the culture medium) is transferred to the uterine cavity using a transfer catheter. 

The chances of successful embryo implantation depend on the age of the individual. The more the person’s age, the lower the rates of successful implantation. 

Dr. Murthy spoke about some of the newer techniques in fertility medicine which include In Vitro Maturation where immature oocytes are collected and allowed to mature in specialised conditions after which the fertilisation is performed. Fertility Preservation is a newer and more pliable technique where people have the option to freeze their oocytes or sperms for future use. 

In the wake of COVID-19, IVF is recommended only after both parties test negative for the SARS-CoV-2 virus. If the patients have suffered from a COVID-19 infection, they are asked to take up the procedure only after complete recovery as there is evidence that the virus is capable of affecting the formation of sperms and oocytes.

Author: Parvathi Nair