IVF and Assisted Reproduction: Understanding the Latest Technology Advancement

Infertility is becoming an increasingly common problem as marriages and childbearing are delayed. These changing scenarios have added more indications for which IVF is needed. One of these is the indication for egg freezing- it helps preserve fertility as the egg count of women gradually decreases with age, leading to an absence of eggs at an older age. It is accessible to women delaying childbearing because of their careers. The eggs are extracted from the ovaries and frozen in liquid nitrogen. The eggs can be thawed and fertilized later for a pregnancy.

The options for the infertile male with absent sperm have also increased with the introduction of microtese. The sperm is sourced from the testis, which is surgically opened and examined under the operating microscope to identify isolated regions where sperm production may occur in such small quantities that they are not ejaculated. The sperm is then injected into eggs to form an embryo, which is then transferred to the womb of the woman.

There is hope for couples where one or both partners have genetic diseases which they do not want to pass on to the child. Pre-implantation genetic testing is a method wherein a single cell is extracted from an embryo formed with IVF, and the material is sent for genetic analysis. Once the report comes, the embryo with a normal genetic composition is transferred to the uterus, ensuring the birth of a normal baby. It is also indicated in cases where there is repeated IVF failure or abortions to rule out a genetic basis.

There is also growing awareness of fertility preservation techniques in cancer patients. Chemotherapy and radiotherapy in cancer treatment may impact egg reserves and the ability to produce sperm. Before going in for such therapies, they are advised to undergo egg, sperm or embryo preservation, which patients can use for future pregnancies. These can be frozen for many years and used once the cancer is cured. Since having a family impacts the quality of life, it is essential to counsel these patients to go in for fertility preservation. 

Recently, ovarian tissue freezing has been recognized as an acceptable method of fertility preservation. The ovarian tissue is frozen in young women and preadolescent girls undergoing cancer treatment to preserve fertility. At a later time, when they want a family, this frozen ovarian tissue is thawed and transplanted back. Both natural and IVF pregnancies can occur after this procedure. Ovarian tissue freezing is the only technique available to preserve fertility in preadolescent girls where eggs cannot be extracted. It can be done immediately, unlike egg freezing, where 9-10 days of stimulation is required.

Another indication for assisted reproduction is in couples where one of the partners is HIV positive, Hepatitis B or Hepatitis C positive, as natural conception puts the partner at risk for infection and risks vertical transmission to the baby.

Assisted reproductive technologies have progressed over the last 40 years to give optimum success rates and options. Extended culture to day 5, known as blastocyst culture, is now the norm. Single embryo transfer to avoid multiple pregnancies is offered as an option, keeping in mind that twin pregnancies are high risk. Laser hatching of embryos in women with recurrent IVF failures is an option. Persistently thin endometriums are being investigated as a microbiome problem, and the treatment for the same is initiated in women whose endometrium does not reach the optimum thickness required for pregnancy. PRP, GCSF and stem cells are still evolving techniques of rejuvenative medicine for this condition. In women who have reached premature menopause or have repeated IVF failures due to poor egg quality, donor eggs are used. Surrogacy is an acceptable answer where there is a problem in bearing a pregnancy.

Today, IVF is an acceptable procedure with high success rates. It is now more easily accessible with a wider indication as, with time, its advantages have been given credit.