The document provides information about the natural menstrual cycle and the in vitro fertilization (IVF) process. It describes the hormones involved in a normal cycle and explains that IVF involves extracting eggs from a woman, fertilizing them with sperm in a lab, and then transferring the embryo into the woman's uterus. The summary discusses the six phases of an IVF cycle, including suppressing the natural cycle with medications, stimulating egg production, triggering ovulation, retrieving eggs, transferring embryos, and providing hormonal support after transfer. It also notes some risks and limitations of IVF treatment.

2. Natural process
• In order to understand what happens in an IVF cycle, it is important to understand what happens in a normal menstrual cycle first.
• A gland in the brain releases the ‘Follicle Stimulating Hormone’ (FSH) which causes the follicle (the sac containing the egg) to grow until
eventually it can be seen as a black circle on an ultrasound scan
• In a normal cycle only one follicle and one egg develops
• When the follicle becomes mature, a second hormone called ‘Luteinizing Hormone’ (LH) is released from the gland in the brain
• This hormone triggers the egg to be released from the follicle and this is called ‘Ovulation’
• The follicle produces a hormone called ‘oestrogen’ which develops the lining of the womb which is called the ‘endometrium’
• After ovulation the follicle is called the ‘corpus luteum’.
• This produces another hormone called ‘progesterone’ which further develops the lining of the womb for implantation
• The tube picks up the egg and if sexual intercourse has occurred the sperm will swim up through the neck of the womb called the ’cervix’ and
through the uterus into the fallopian tubes to fertilise the egg
• The embryo will then travel to the uterus and implant if it has a good potential for development

3. Female reproductive system

6. What is IVF(Assisted Reproductive Technology
(ART)?
• In vitro fertilisation (IVF) literally means ‘fertilisation in glass’ giving
us the familiar term ‘test tube baby’.
• During the IVF process, eggs are removed from the ovaries and
fertilised with sperm in the laboratory. The fertilised egg (embryo) is
later placed in the woman’s womb.

7. IVF: History
• In vitro fertilization (IVF) is a fertility procedure which first
succeeded as recently as 1978 by Dr. Edwards ( an embryologist) and
Dr. Steptoe ( a gynecologist) in England. Since then the technology
has been further refined and developed by physicians and
embryologists, with over 20,000 babies born worldwide.

8. Reason for infertility
•
•
•
•
•
•
Tubes are blocked or damaged
Sperm do not swim well
Sperm are too few in number
The lining of the womb is affected
Ovaries do not produce eggs
Quality of eggs is compromised

9. Basic Principle of IVF
Hormonal
treatment
Female
Harvest
the ovum
Mature Ova
Mix in a test tube
Keep to
develop
embryo
Motile sperms
Collect semen
Natural
ejaculation
Male
Transfer
to mother

10. Modifications in an IVF or ICSI cycle
• Why do we need to make changes?
•
•
•
•
•
We need more than one egg in the cycle
Not all eggs fertilise or grow
Not all embryos have a good potential for development
We want to transfer 1-3 embryos for a good success rate
We do not want the gland in the brain to become confused in treatment

11. IVF CYCLE PROTOCOL
6 PHASES
1.
Suppression of the natural cycle
To switch off the gland in the brain so that it does not interfere in treatment
2.
Stimulation
Hormone injections to produce multiple eggs
3.
Ovulation trigger or HCG injection
4.
Egg collection
5.
Embryo transfer
6.
Hormonal support after the embryo transfer

12. Stage 1:Suppression of the natural cycle
Oral Contraceptive Pill
Prostap once a month injection
OR
Buserelin daily injection
OR
Nafarelin three times a day nasal spray
Side effects
headaches, hot flushes, night sweats, mood-swings, prolonged
period or second bleeding

13. Stage 2: Stimulation of the Ovary
Dose of stimulation is adjusted for:
Reserve of eggs in the Ovary (hormone levels and scan findings)
Age
Weight or Body Mass Index
Past history (infections, cyst removal)
Presence or absence of PCOS
Types:Menopur, Merional, Puregon,Gonal-F, Fostimon
All are subcutaneous injections

14. Stage 3: Ovulation Trigger
HCG injection
Pregnyl (commonest)
Ovitrelle
Recombinant LH
Timed 36 hours prior to egg collection

15. Stage 4: Egg Collection
Performed under ultrasound guidance
Fast acting sedation & analgesia
Duration 20 - 45 minutes

16. Egg Collection

17. Events after Egg Collection
 Sperm production
 Insemination of Eggs or Sperm injection into the
eggs
 Fertilisation check
 Observation of growth
 Selection of embryos for transfer

18. Stage 5: Intracytoplasmic Sperm
Injection
• During the process of ICSI, an embryologist isolates a
sperm cell, draws it up into a microscopic needle and
injects it inside an egg using a high power microscope.

19. Fertilization
• Once mature eggs have been retrieved, the sperm and eggs are
placed together in the laboratory and incubated in a
meticulously prepared culture medium at a temperature
identical to that of the woman’s body.

20. Embryonic Development
2 cells
Early day 2
4 cells
8 cells
Late day 2
Day 3
Morula
Blastocyst
Day 4
Day 5

21. Stage 6: Embryo Transfer
• Embryo transfer is not a painful
procedure and can be performed
without sedation.
• Usually up to three embryos are
placed together in a catheter ( a
tubular instrument) and
transferred, via the vagina, into
the uterus.

23. Success rate of IVF
• Varies from programme to programme.
• It is dependent upon correct diagnosis of patient, and age.
• Pregnancy rate is in the range of 25-30% per oocyte retrieval.
• The take home is about 15-20% per procedure.

24. Factors
• Increased risk of abortion.
• Multiple pregnancy.
• Ectopic pregnancy.
• Low birth weigh baby.
• Premature delivery.

25. Limitation of IVF
• Genetic defect in oocytes.
• Genetic defect in fertilizing sperm.
• Environmental mutagenesis.
• Inadequate supply of nutrients and hormones.
• Exposure to toxic agents and free radicals.