Hadawale N. M. et al.

IRJP 2 (7) 2011 22-25

INTERNATIONAL RESEARCH JOURNAL OF PHARMACY ISSN 2230 – 8407

Available online http://www.irjponline.com
Review Article
IN VITRO FERTILIZATION
Hadawale N. M *, Thorat R. M.1, Gaikwad D. D.2, Jadhav S. L.2
1
1
Vishal Junnar Seva Mandal Institute of Pharmacy, A/P Ale, Tal-Junnar, Pune, M.H., India
2
Vishal Institute of Pharmaceutical Education And Research, A/P Ale, Tal-Junnar, Pune, M.H., India

Article Received on: 12/05/11 Revised on: 23/06/11 Approved for publication: 14/07/11

*Miss. Nilam M. Hadawale, Vishal Junnar Seva Mandal Institute of Pharmacy, A/P Ale, Tal-Junnar, Dist-Pune-
412411, M.H., India, E-mail: [email protected], [email protected]

ABSTRACT
First written document dealing with infertility may be found in the Kahoun papyrus (oldest Egyptian medical text), dated to 2200-1950 BC.
The early attribution of infertility to women persisted for centuries and was often considered divine punishment.
Infertility means 1 year of well-timed, unprotected intercourse without a pregnancy. The study shows about 10-15% of population is infertile.
And 15-20% of couple have unexplained infertility (work-up is negative). Normally women are born with their lifetime egg supply, the
Fertility initially declines at age 27.Significant decline at age 37-38. The chances of pregnancies are rare after age 44 besides this defect in
female ovary, fallopian tube, uterus, and fibroid tumour causes infertility in female.
Abnormality in sperm production and abnormality in sperm function causes infertility in male.
To overcome the infertility egg are harvested from womens ovary and fertilized in laboratory with the sperm the embryos are then transfer
into uterus known as In Vitro Fertilization.
KEYWORDS: Infertility, IVF, Assisted hatching, Surrogacy.

INTRODUCTION containing sperm where the oocytes undergoes

The infertility is one year well timed unprotected, fertilization4.
intercourse without a pregnancy. The factors which According to the American Society for Reproductive
cause infertility are; Female infertility the inability to Medicine (ASRM), Age, Smoking, Sexually Transmitted
conceive, occur in about 10%of all women of Infections, and Being Overweight or Underweight can all
reproductive age .It may be caused by ovarian disease affect fertility.
obstruction of uterian tube. Male infertility (sterility) is Smoking
an inability to fertilize a secondary oocytes; it does not Smoking is harmful to the ovaries, and the degree of
imply erectile dysfunction. Male fertility require damage is dependent upon the amount and length of time
production of adequate quantity of viable , normal sperm a woman smokes. Nicotine and other harmful chemicals
by testis unobstructed transport of sperm through the in cigarettes interfere with the body’s ability to create
duct the satisfactory deposition in vagina The estrogen, a hormone that regulates folliculogenesis and
seminiferous tubules are sensitive to many factor x-ray, ovulation. Also, cigarette smoking interferes with
infection, malnutrition, higher than scrotal folliculogenesis.
temperature1,3. Sexually transmitted infection
Many fertility expanding techniques now exist for Sexually transmitted infections are a leading cause of
assisting infertile to couples to have a baby the birth of infertility like Fallopian Tubes Infection
Louise Joy Brown on July 12,1978.near Manchester (Chlamydia).Infection Caused by both bacteria and
,England was first recorded case of in vitro fertilization viruses and usually transmitted sexually, these infections
(IVF) .it is a fertilization in a laboratory dish .in IVF a commonly cause inflammation resulting in scarring and
mother –to-be is given follicle-stimulating hormones damage. A specific example is Hydrosalpnix, a
(FSH)soon after menstruation so that several secondary condition in which the fallopian tube is occluded at both
oocytes will be produced when several secondary ends and fluid collects in the tube.
oocytes rather than single will be produced called super Body weight and eating disorders
ovulation .when several follicles have reaches Twelve percent of all infertility cases are a result of a
appropriate size ,a small incision is made near the woman either being underweight or overweight. Fat cells
umbilicus and the secondary oocytes are aspirated from produce estrogen, in addition to the primary sex organs.
the stimulated follicles and transferred to a solution Too much body fat causes production of too much
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 Hadawale N. M. et al. IRJP 2 (7) 2011 22-25
estrogen and the body begins to react as if it is on birth 2. Assisted zona hatching (AZH)
control, limiting the odds of getting pregnant. Too little It is performed shortly before the embryo is transferred
body fat causes insufficient production of estrogen and to the uterus. A small opening is made in the outer layer
disruption of the menstrual cycle. Both under and surrounding the egg in order to help the embryo hatch
overweight women have irregular cycles in which out and aid in the implantation process of the growing
ovulation does not occur or is inadequate. embryo.
Other factors 3. Intracytoplasmic sperm injection (ICSI)
I. Ovarian factors ICSI is beneficial in the case of male factor infertility
a. Polycystic ovary syndrome where sperm counts are very low or failed fertilization
b. Anovulation occurred with previous IVF attempt(s). The ICSI
c. Diminished ovarian reserve, also see Poor Ovarian procedure involves a single sperm carefully injected into
Reserve the center of an egg using a microneedle. This method is
d. Premature menopause also sometimes employed when donor sperm is used.
e. Menopause Autologous endometrial coculture is a possible treatment
f. Luteal dysfunction for patients who have failed previous IVF attempts or
g. Gonadal dysgenesis ( Turner syndrome ) who have poor embryo quality. The patient's fertilized
h. Ovarian cancer eggs are placed on top of a layer of cells from the
II. Vaginal factors patient's own uterine lining, creating a more natural
a. Vaginismus environment for embryo development.
b. Vaginal obstruction 4. Zygote intrafallopian transfer (ZIFT)
III. Genetic factors In Zygote intrafallopian transfer, egg cells are removed
Various intersexed conditions, such as androgen from the woman's ovaries and fertilized in the laboratory;
insensitivity syndrome MRKH, or Mayer-Rokitansky – the resulting zygote is then placed into the fallopian tube.
Küster - Hauser Syndrome, is a condition involving Cytoplasmic transfer is the technique in which the
primary amenorrhea and an underdeveloped uterus. contents of a fertile egg from a donor are injected into
Women with MRKH are biologically female and are the infertile egg of the patient along with the sperm.
believed to occur in 1 in every 5,000 females. Egg donors are resources for women with no eggs due to
IV. Hormonal Problems surgery, chemotherapy, or genetic causes; or with poor
These are the most common causes of anovulation. The egg quality, previously unsuccessful IVF cycles or
process of ovulation depends upon a complex balance of advanced maternal age. In the egg donor process, eggs
hormones and their interactions to be successful, and any are retrieved from a donor's ovaries, fertilized in the
disruption in this process can hinder ovulation. There laboratory with the sperm from the recipient's partner,
are three main sources causing this problem5-7 and the resulting healthy embryos are returned to the
IN VITRO FERTILIZATION recipient's uterus.
Egg cells are fertilized outside the woman’s body. The A gestational carrier is an option when a patient's
process involves hormonally controlling the ovulatory medical condition prevents a safe pregnancy, when a
process, removing ova (eggs) from the woman's ovaries patient has ovaries but no uterus due to congenital
and letting sperm fertilise them in a fluid medium. The absence or previous surgical removal, and where a
fertilised egg (zygote) is then transferred to the patient's patient has no ovaries and is also unable to carry a
uterus with the intent to establish a successful pregnancy to full term.
pregnancy1. 5. Preimplantation genetic diagnosis (PGD)
Expansions of IVF Preimplantation genetic diagnosis involves the use of
The following are techniques involved in, or requiring, in genetic screening mechanisms such as Fluorescent In
vitro fertilization. In vitro fertilization does not Situ Hybridization (FISH) or Comparative Genomic
necessarily involve each technique. Hybridization (CGH) to help identify genetically
1. Transvaginal ovum retrieval (OCR) abnormal embryos and improve healthy outcomes.
It is the process whereby a small needle is inserted Embryo splitting can be used for twinning to increase the
through the back of the vagina and guided via ultrasound number of available embryos.8
into the ovarian follicles to collect the fluid that contains 1. Assisted Hatching
the eggs. These technologies help provide infertile couples with
tools to bypass the normal mechanisms of gamete
transportation. Probability of pregnancy in healthy

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 Hadawale N. M. et al. IRJP 2 (7) 2011 22-25
couples is 30-40% per cycle by assisted hatching 3. Surrogate motherhood
technique, live birth rate 25%.but the rate is depend on In the United States, the issue of surrogacy was widely
varies. publicized in the case of Baby M, in which the surrogate
Embryo transfer and biological mother of Melissa Stern ("Baby M"), born
Embryos are graded by number of cells, evenness of in 1986, refused to cede custody of Melissa to the couple
growth degree of fragmentation. with whom she had made the surrogacy agreement. The
The age of the woman other health and diagnostic courts of New Jersey found that Mary Beth Whitehead
factors. A maximum of two embryos are transferred was the child's legal mother and declared contracts for
except in unusual circumstances. The embryos judged to surrogate motherhood illegal and invalid. However, the
be the "best" are transferred to the patient's uterus court found it in the best interests of the infant to award
through a thin, plastic catheter, which goes through her custody of Melissa to her biological father William Stern
vagina and cervix. Several embryos may be passed into and his wife Elizabeth Stern, rather than to the surrogate
the uterus to improve chances of implantation and mother Mary Beth Whitehead. There have been cases of
pregnancy. Embryos are graded by the embryologist clashes between surrogate mothers and the genetic
based on the number of cells, evenness of growth and parents when unexpected complications with the fetus
degree of fragmentation. The number to be transferred makes the genetic parents ask for an abortion even
depends on the number available, the age of the woman though the surrogate mother is opposed. Commercial
and other health and diagnostic factors. In countries such surrogacy is legal in India, as recognized by the Supreme
as Canada, the UK, Australia and New Zealand, a Court of India in 2002.11 India is emerging as a leader in
maximum of two embryos are transferred except in international surrogacy and a destination in surrogacy-
unusual circumstances. In the UK and according to related fertility tourism. Indian surrogates have been
HFEA regulations, a woman over 40 may have up to increasingly popular with fertile couples in industrialized
three embryos transferred, whereas in the USA, younger nations because of the relatively low cost. Indian clinics
women may have many embryos transferred based on are at the same time becoming more competitive, not just
individual fertility diagnosis. Most clinics and country in the pricing, but in the hiring and retention of Indian
regulatory bodies seek to minimize the risk of females as surrogates. Clinics charge patients between
pregnancies carrying multiples. As it is not uncommon $10,000 and $28,000 for the complete package,
for more implantations to take than desired, the next step including fertilization, the surrogate's fee, and delivery of
faced by the expectant mother is that of selective the baby at a hospital. Including the costs of flight
abortion. The embryos judged to be the "best" are tickets, medical procedures and hotels, it comes to
transferred to the patient's uterus through a thin, plastic roughly a third of the price compared with going through
catheter, which goes through her vagina and cervix. the procedure in the UK. The Hon'bl Supreme Court of
Several embryos may be passed into the uterus to india has given the verdict that the citizenship of the
improve chances of implantation and pregnancy9. child born through this process will have citizenship of
2. Egg donation its surrogate mother12.
IVF process is available for both know or anonymous. Surrogacy is a third party reproduction arrangement
Donor should have age above 35 years; donor should whereby a woman agrees to become pregnant for the
have standard controlled overian stimulation. and Egg purpose of gestating and giving birth to a child for others
retrieval. and recipient embryo transfer2 to raise. She may be the child's genetic mother or not,
Who are candidates to be an egg donor? depending on the type of arrangement agreed to.
- 21-35 years old (older if a friend or relative) A surrogate mother is a woman who carries a child for a
- FSH level should not exceed above 10 couple or single person with the intention of giving that
- Good health and genetic history child to that person / people once the being is born (also
- Preferably prior egg donation experience called surrogate pregnancy). The surrogate mother may
Who are candidates for egg donation ? be the baby's biological mother (traditional surrogacy) or
- Premature ovarian failure she may be implanted with someone else's fertilized egg
- Ovarian insufficiency (e.g. FSH>15 ) (gestational surrogacy) 3, 10.
- Physiologic menopause
- Maternal age over 43
- History of poor egg/embryo quality or multiple
IVF failures2

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Fig 1. Assisted zona hatching Fig.No.2: IVF Procedure

Fig. No. 3: Intracytoplasmic Sperm Injection

Fig.No.4: Egg donation

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