TEST TUBE BABY Test tube baby (In vitro fertilization IVF) is a revolutionary treatment for those couples who can't have a baby on their own because of various types of infertility. First developed by Drs. Patrick C. Steptoe and Robert G. Edwards of Great Britain (where the first "test tube baby was born under their care in 1978), the technique was devised for use in cases of infertility when the woman's fallopian tubes are damaged or the man's sperm count is low. It is also now used to enable prospective parents with other reproductive problems (e.g., inability to produce eggs, poor sperm quality, or endometriosis) to bear a child. What is a Test Tube Baby? A test tube baby is the term that refers to a child that is conceived outside the woman's body. The process is referred to as "in vitro" (outside the body) fertilization. Simply put, eggs are removed from the mother's ovary and incubated with sperm from the father. After fertilization, the "pre-embryos"are allowed to divide 2-4 times (in a "test tube", hence the name) and then returned to the mother's uterus where they can develop normally. Through these procedures, women with otherwise untreatable infertility problems have given birth to healthy babies. In vitro fertilization IVF During IVF, a physician collects ova from the woman at the time of her ovulation, using a high-tech procedure called laparoscopy. In the next step the man's sperms and woman's egg are combined in a laboratory dish, where fertilization occurs. The resulting embryo is then transferred to the woman's uterus, for normal development in the uterus, or frozen for later implantation. Eggs can also now be frozen and fertilized later. The basic steps in an IVF treatment cycle are super ovulation (stimulating the development of more than one egg in a cycle), egg harvest, fertilization, embryo culture, and embryo transfer. Even though conceived differently than most, the baby does not look any different and, in fact, is no different from other babies. How is I.V.F. carried out? During superovulation, drugs are used to induce the patient's ovaries to grow several mature eggs rather than the single egg that normally develops each month. The idea is that if one has several follicles available for egg retrieval, then if more than one egg is successfully fertilized and transferred back into the uterus, the odds are greater that at least one of them will successfully implant. The progress of the growth of the follicles is closely monitored either by blood and urine tests or by ultrasound measurement of the follicles. Once the follicles are ready for ovulation, Human Chorionic Gonadotropin (H.C.G) of 5,000 units is given. The eggs are retrieved 33-36 hours following the H.C.G. injection. There are two methods, which clinics may use for egg retrieval. 1. Ultrasound-guided aspiration. In this method the ultrasound probe is inserted through the vagina, which emits high-frequency sound waves, which are translated into images of the pelvic organs and displayed on a monitor, so that the mature follicles can be seen as black bubbles on the screen. The doctor guides a needle through the vagina into each mature follicle. The follicular fluid containing the egg is then sucked out through the needle into a test tube, and all the follicles are aspirated, one by one. 2. Laparoscopy. This is carried out under general anesthetic. The eggs are retrieved from their follicles using a very fine suction needle. However, this method is rarely used today, because the vaginal-ultrasound guided method is much quicker, easier and safer. 3. T.U.D.O.R. This stands for Trans-vesical, Ultrasound Directed Oocyte Recovery. This is an outpatient procedure performed under a local anesthetic. In this method, a suction probe is guided by ultrasound control through the bladder. This technique also has the advantage of being able to retrieve eggs from an inaccessible ovary even if it is covered by adhesions. The eggs are now incubated for 4-24 hours in a specially prepared culture medium in order to ensure that adequate maturation has occurred. 100,000-1,000,000 specially prepared progressively swimming sperms are then added to the incubated eggs. Fertilisation takes place within the next 24 hours. 2-3 days later the embryo transfer takes place. This is a painless procedure and no anesthetic is required. For whom is I.V.F. advisable Candidates for I.V.F. are usually those women with irreparably damaged tubes, endometriosis; immunological problems; unexplained infertility and male factor infertility. I.V.F. can also be the treatment of last resort in the case of problems like oligospermia, major cervical mucus hostility factors and certain cases of unexplained infertility. A woman's age must be considered. Older women feel additional pressure as they feel their biological clocks are ticking and time is running out. However, there is no upper age limit at which IVF should not be done, - and in fact, for older women, it might represent their only chance of success. It's not really the age of the woman, which is the limiting factor - it's the quality of her eggs. Patients who stand a very poor chance of success with IVF include the following. Older women, whose ovaries are failing. However, there is no upper age limit at which IVF should not be done, and, infact, for older women, it might represent their only chance of success. It's not really the age of the woman, which is the limiting factor; it's the quality of her eggs. Men whose sperm count are very low. Again, IVF may be the only option these men have to father their own biological child, and, therefore, there is no " magic" number of sperm, which a man must have before considering IVF for him. Women with a damaged uterus (for example, because of healed tuberculosis) because the chance of successful implantation of the embryo in the uterus becomes very poor. Tips for greater chances of I.V.F success For Women…….. No smoking or alcohol use. Studies show both can result in lower pregnancy rates and a greater risk of miscarriage. No more than two caffeinated beverages per day. Avoid change in diet or weight loss or fad diets during IVF cycle. A healthy well balanced diet works best. Refrain from intercourse three to four days prior to egg retrieval and following embryo replacement until pregnancy determination is made. Normal exercise may continue unless enlargement of your ovaries produces discomfort. Avoid hot tubs or saunas. For Men…….. Drugs, alcohol, and cigarette smoking should be avoided for three months prior to treatment and at all times during the ongoing IVF treatment cycle to get the best results. Sitting in hot tubs and saunas is not recommended. Even a single episode in the hot tub can adversely effect sperm function. Please refrain from this for at least three months prior to treatment. Abstain from intercourse for at least three days, but not more than seven days prior to collection of semen for egg collection and during treatment. Fever greater than 100.4o one to two months prior to IVF treatment may adversely affect sperm quality. Consult your doctor immediately. What is the cost of one IVF treatment cycle? The cost of a single IVF treatment cycle varies widely from approximately Rs 30,000 to more than Rs 75,000 depending on the program and the items included in the fee. The number of treatment cycles needed to achieve pregnancy will, of course, determine the final cost. What is the success rate of I.V.F? The success rate of pregnancy associated with this treatment ranges between 15-30%. Therefore it is also not advisable to go in for IVF treatment without trying simpler treatment options first. IVF is a complex procedure involving considerable personal and financial commitment, so other treatments are usually recommended first. GIFT GIFT stands for gamete intrafallopian transfer. Specialists generally agree that pregnancy rates are higher for GIFT than for IVF- in fact, GIFT is about twice as successful as IVF. A gamete is a male or female sex cell - a sperm, or an egg. During GIFT, sperm and eggs are mixed and injected into one or both fallopian tubes. After the gametes have been transferred, fertilization can take place in the fallopian tube as it does in natural, unassisted reproduction. Once fertilized, the embryo travels to the uterus by natural processes. As in IVF, a GIFT treatment cycle begins with ovulation enhancement, which is followed by egg harvest, usually by means of laparoscopy. During this same laparoscopy procedure, which takes about an hour, eggs are mixed with sperm and the gametes are transferred.