Survey on In Vitro Fertilization-A Cure or Complications?

Today, in vitro fertilization (IVF) is practically a household word. But not so long ago, it was a mysterious procedure for infertility that produced what were then known as "test-tube babies." Louise Brown, born in England in 1978, was the first such baby to be conceived outside her mother's womb. Unlike the simpler process of artificial insemination in which sperm is placed in the uterus and conception happens otherwise normally. In vitro fertilization is a process of fertilization where an egg is combined with sperm in vitro. The process involves monitoring and stimulating a woman's ovulatory process, removing an ovum or ova from her ovaries and letting sperm fertilize them in a culture medium in a laboratory.

IVF is a complex and expensive procedure only about 5% of couples with infertility seeks it out. However, since its introduction in the U.S. in 1981, 1.9% of all babies in the U.S. are born through IVF and other assisted reproductive technologies (ART).

The first step in IVF involves injecting hormones so you produce multiple eggs each month instead of only one. You will then be tested to determine whether you're ready for egg retrieval.

Prior to the retrieval procedure, you will be given injections of a medication that ripens the developing eggs and starts the process of ovulation. Timing is important; the eggs must be retrieved just before they emerge from the follicles in the ovaries. If the eggs are taken out too early or too late, they won't develop normally. Your doctor may do blood tests or an ultrasound to be sure the eggs are at the right stage of development before retrieving them. The IVF facility will provide you with special instructions to follow the night before and the day of the procedure. Most women are given pain medication and the choice of being mildly sedated or going under full anesthesia.

During the procedure, your doctor will locate follicles in the ovary with ultrasound and remove the eggs with a hollow needle. The procedure usually takes less than 30 minutes, but may take up to an hour.

Immediately following the retrieval, your eggs will be mixed in the laboratory with your partner's sperm, which they will have donated on the same day.

While you and your partner go home, the fertilized eggs are kept in the clinic under observation to ensure optimal growth. Depending on the clinic, you may even wait up to five days until the embryo reaches a more advanced blastocyst stage.

Once the embryos are ready, you will return to the IVF facility so doctors can transfer one or more into your uterus. This procedure is quicker and easier than the retrieval of the egg. The doctor will insert a flexible tube called a catheter through your vagina and cervix and into your uterus, where the embryos will be deposited. To increase the chances of pregnancy, most IVF experts recommend transferring up to three embryos at a time. However, this means you could have a multiple pregnancy, which can increase the health risks for both you and the babies.

Success rates for IVF depend on a number of factors, including the reason for infertility, where you're having the procedure done, whether eggs are frozen or fresh, whether eggs are donated or are your own, and your age. The CDC compiles national statistics for all assisted reproductive technology procedures performed in the U.S., including IVF, GIFT, and ZIFT, although IVF is by far the most common; it accounts for 99% of the procedures.

Infertility problem involves many couples of reproductive age. The latest report, from 2018, shows that 50% of IVF procedures in women ages 35 and under resulted in a live birth. For women ages 42 and older, 3.9% of the egg transfers resulted in a birth. 

Chances of success:

The success rate of IVF depends on the age of the woman having treatment, as well as the cause of the infertility.

Younger women are more likely to have a successful pregnancy. IVF isn't usually recommended for women over the age of 42 because the chances of a successful pregnancy are thought to be too low.

In 2019, the percentage of IVF treatments that resulted in a live birth was:

• 32% for women under 35
• 25% for women aged 35 to 37
• 19% for women aged 38 to 39
• 11% for women aged 40 to 42
• 5% for women aged 43 to 44
• 4% for women aged over 44

Risks of IVF:

IVF doesn't always result in pregnancy, and it can be both physically and emotionally demanding. You should be offered counselling to help you through the process.

Here is also a number of health risks involved, including:

ü  side effects from the medicines used during treatment, such as hot flushes and headaches

ü  multiple births (such as twins or triplets) – this can be dangerous for both the mother and the children

ü  an ectopic pregnancy – where the embryo implants in the fallopian tubes, rather than in the womb

ü  ovarian hyper stimulation syndrome (OHSS) – where the ovaries overreact to the medicines used during IVF

Techniques that involve manipulation of oocytes outside the body are termed assisted reproductive technology (ART) with in vitro fertilization (IVF) as the most common form. The term ‘in vitro’ means outside a living organism as oocytes mature in vivo in the ovary and embryos develop into pregnancy in the uterus, but the oocytes are fertilized in a petri dish. Robert Edwards, Ph.D., and Patrick Steptoe, MD, reported the first live birth from IVF in July 1978 in England. This achievement would later earn Dr. Edwards the Nobel Prize in Medicine in 2010.  Since this major breakthrough in the treatment of infertility, the field of reproductive endocrinology/infertility (REI) has progressed rapidly.

Islamic jurisprudence states that any act is permissible unless prohibited by a text in the Quran. Islam affirms the importance of marriage, family formation, and procreation. According to Sunni Islam fatwas (religious opinions/rulings), all forms of assisted reproduction are allowed as long as the sperm and oocyte are those of the husband and his wife. A third party cannot be involved in the conception; that is, gamete or embryo donation is not allowed. Most Sunni Muslims accept surrogacy, provided that the gametes come from the prospective parents

Aims and Objective:

• Give brief Information About the “In vitro fertilization”.
• Discuss about the “Importance of In vitro fertilization”.
• Discuss about the “Cure of In vitro fertilization”
• To give awareness about “The risk of IVF”.
• Estimate the public awareness on about “what is in vitro fertilization”.
• Estimate the public Opinion “On Impact of In vitro fertilization”.    

  References:

      Choe, J., Archer, J. S., & Shanks, A. L. (2020). In vitro fertilization.

      Kim, M., Yi, S. J., & Hong, J. E. (2020). Experiences of women with male factor infertility under in vitro fertilization. International Journal of Environmental Research and Public Health, 17(21), 7809.

      Byers, K. A. (1997). Infertility and in vitro fertilization: A growing need for consumer‐oriented regulation of the in vitro fertilization industry. Journal of Legal Medicine, 18(3), 265-313.

      Johnson, M. H. (2019). A short history of in vitro fertilization (IVF). International Journal of Developmental Biology, 63(3-4-5), 83-92.

      Serour, G. I. (2013). Ethical issues in human reproduction: Islamic perspectives. Gynecological endocrinology, 29(11), 949-952.

      Biggers, J. D. (2012). IVF and embryo transfer: historical origin and development. Reproductive biomedicine online, 25(2), 118-127.