• Counselling Infertility
  • Our team
  • 22 years of Service (Since 1992)
  • In Vitro Fertilization
  • Celebrating 20 years of Service

Our location

Monday, June 25, 2012

Test-tube baby (In Vitro Fertilization)

                                                                                    Dr. Uma Shrivastava
                                                                                   Infertility & IVF specialist
                                                                               Infertility Centre

Now-a-days, talking about Test-tube babies has been a trend among people in Kathmandu. In Nepal many test-tube babies have been born to infertile couples by the use of Assisted Reproductive Technology (ART). These couples would not have conceived by any other way. These couples were longing to have a baby for years & were treated by various technologies both in the country & abroad. Some of these babies have been brought in the media & people have watched them just like the way they would watch the commercials of various noodles. I guess in a few days time, we may see every advertising agency having pictures of test-tube babies in every package like superstar Amitabh Bachhan in every Indian commercial. However, behind the scene success of test-tube baby should be really admired.

How do test-tube babies develop?
These babies are created by the laboratory scientists in the laboratories by mixing sperms & eggs for fertilization outside the human body (in vitro) with utmost care & difficulties.
During the process, the women are given different types of hormone injections for few weeks in order to develop many eggs in their ovaries. When these eggs ripen, they will have to undergo a small operation to remove these eggs. In the mean time, the sperm will be collected from the man & processed. The retrieved eggs properly identified with the help of a sterio-microscope are then mixed with these sperm & incubated in an incubator at the temperature close to body temperature & pressure etc. for fertilization. Because these embryos are fertilized outside the body in vessels & machines, scientists call the process In Vitro Fertilization (IVF). Thus, the fertilized embryos proceed for cell division. They are kept outside the body only for few days till proper cell division. They will be then transferred back to the uterus after few days for implantation, development of foetus & delivery of the baby.

 Challanges to the infertility specialist

Normally, couples visiting infertility clinics for treatment seek the guarantee of success with IVF treatment. But we cannot blame them, because IVF treatment is expensive. What is the meaning of guarantee? Nature has a very good control over fertility. Its own fertility rate is about 25% per cycle in normal fertile couples. Moreover, guarantee of success in infertile couples depends upon recovery of several defects in the couples. Will these defects be eliminated with one cycle of test-tube treatment?
Apart from all the ordinary defects, fertility of any couple is decided mainly by the following factors:
Ø  The man must be producing normal sperm count with good motility (count: 50-150 mln/ml & motility: >50%).
Ø  The woman must have normal menstrual cycle with the development of normal egg.
Ø  The woman should have normal uterine cavity with open fallopian tubes.

If one of the above goes wrong, fertility becomes impossible. It is the duty of every couple longing to have a baby to find out what their fertility defect is. Are they properly tested for the above outlined conditions of infertility? It is sad to say that some couples treated even for about ten years do not know their underlying defect because they were not tested properly. There are thousands of couples who have not been counselled for infertility treatment. Most of the couples are not checked even for their hormone levels, which, in fact, directly decide their eggs & sperm quality.  Some even undergo IVF for unknown reasons. Some ladies have been repeatedly operated with normal fallopian tubes and yet they do not know why they were operated due to illiteracy.   
Any couple seeking for fertility must check their problem & should be aware of the proper test they need. ECG, x-ray abdomen & blood count & biochemistry do not predict fertility. Only a few of their tests being normal do not decide their fertility.
The age of the female is another predictor of fertility. Women above 35 years of age have difficulty to conceive for the first time, mainly due to two factors. The first one is that their ovaries do not regularly produce quality eggs & the other factor is that the uterus does not easily implant the embryo.

Who need test-tube baby treatment?

If properly tested & diagnosed, the patient will definitely recover fertility with conventional infertility treatment. These are 80% cases of infertility. About 5% of them have no treatment, and the only way for them is Adoption.
The remaining 15% of infertile couples who need IVF (test-tube baby) are:
Ø  Women with blocked fallopian tubes on both sides
These women cannot pass the sperm to the ovaries where there is a possibility of meeting with the egg for fertilization i.e. In Vivo Fertilization or Fertilization inside the body. These are the women who have no option, but to go for IVF treatment.
Ø   Men with low or nil sperm count & motility
IVF is also done for men who produce less sperm with low motility either by improving the quality of the husband's sperm or by using donor's sperm
Ø   Women with poor ovarian capacity to develop eggs
Ladies who are lately married after the age of 37 do not produce good quality eggs due to poor ovarian reserve. Their estrogen hormone level is decreased. They may have babies with egg donation by their sisters or relatives.
Ø  Couples with no significant abnormalities after all investigations & treatment
 If a couple is properly investigated & real problem of infertility has not been identified are also occasionally benefited by this treatment. Ladies who are lately married after the age of 37 do not produce good quality eggs due to poor ovarian reserve. They may have babies with donated eggs by their sisters or relatives.
 In Nepal, till now, there is no specific law regarding Assisted Reproduction which uses these donor eggs & sperm. 
As outlined above, the cause of infertility varies from couple to couple. There was an anecdote in one of the foreign newspapers a few years ago, regarding a child who was born with the help of three couples. In the first couple, the male had no sperm production, and the female had good ovaries, good egg production but both her tubes were blocked & also her uterus contained fibroid tumour causing a bad site for implantation of foetus. What they had for fertility was only good ovaries with good eggs. Of the second couple, the male had normal sperm count & motility, but the female had poorly developed ovaries for egg production & her uterus was also ill developed. The chances of ovulation & implantation of embryo was almost impossible in her uterus. This couple had only good sperm for fertility. The male of the third couple had no sperm production and the female had developed some tumours in the ovaries & did not have good egg production, but her uterus was perfect for implantation of embryo. Finally, the IVF specialist gathered these three couples, counselled about their situation & explained about the only possibility of a contributory child. The first couple gave their eggs, the second couple gave their sperm, and the third couple carried the child (surrogate) till term & finally delivered a healthy test-tube baby.
Similar situations are encountered by the Infertility specialists, but they do so with a properly written consent from the couple who have every right to accept any sort of technical challenges for the sake of a child in their family. The child when born proves to be a great relief, rather a medium of shelter for further living.
In all these scientific talks, we should not forget the role of religion, which plays a major role in a society like ours. In this country, if a woman does not conceive after certain period of marriage, she is only blamed although there is equal role of the man for their fertility. An infertile woman lives in the family with great difficulty, sometimes isolated from the society suffer from depression, shame, guilt, anger & fear of polygamy. All this proves very hard for her survival. Some even commit suicide. Under these circumstances, religion comes secondary to survival. Joint family infertile woman has to face a torture each day by her in-laws. If she is lucky, one good day, a well-wisher, family member or friend, may help her find the treatment, either conventional infertility treatment or IVF.  .
The pain of whole treatment becomes negligible, as soon as the fertility returns & they have a child in the family.
At some stage every child asks his mother how he/she was born. Grandmothers were lying that they were found in the bushes. And now, parents who went for a modern treatment for having a child should have no hesitation in boldly acknowledging that yes our baby is an IVF baby or again should we go back to the bush story?