Topic: In-vitro Fertilization

Prepared by:ABHISHEK M
 CERTIFICATE

This is to certify that Abhishek M of class 12 has

successfully completed the Investigatory
Project under the guidance of Gita Shau (PGT
BIOLOGY) Prescribed by All India Senior
Secondary Certificate Examination (AISSCE) for
academic year 2019-20

Signature of Teacher:

Signature of Principal:

Signature of Examiner:
 CONTENT

 Introduction
 Why IVF?
 Process of IVF
 Medications given for IVF Patient
 Cost of IVF
 Role of Surrogate Mother
 Success Rate of IVF
 Bibliography
 Acknowledgements

I sincerely thank Mrs.Gita Sahu Ma’am for

guiding to complete this project and special
thanks for Dr.Amrita (geynocologist) for
supporting and thank my father for helping
me to complete the project successfully
Introduction
 Assisted Reproductive Technology (ART)
ART are medical procedures used primarily to address infertility. It includes
procedure such as in vitro fertilization. It may include intracytoplasmic sperm
injection (ICSI), cryopreservation of gametes or embryos, and/or may involve the
use of fertility medication. When used to address infertility, it may also be
referred to as fertility treatment. ART mainly belongs to the field of reproductive
endocrinology and infertility.

 What is IVF?
IVF is the process of fertilization by extracting eggs, retrie ving a sperm
sample, and then manually combining an egg and sperm in a laboratory dish. The
embryo(s) is then transferred to the uterus

 . Discovery of IVF
In 1977, Steptoe and Edwards successfully carried out a pioneering conception
which resulted in the birth of
the world’s first baby to be
conceived by IVF, Louise Brown
on 25 July 1978, in Oldham
General Hospital, Greater
Manchester, UK.

 First in-vitro baby

Born July 25, 1978, in Oldham,
England. Louise Joy Brown is best known as the world’s first “test-tube baby.” Her
birth by Caesarian section shortly before midnight on July 25, 1978, at
Oldham General Hospital in England, made headlines around the world.
WHY 'IVF'?
It is to treat infertility in case of Blocked or damaged fallopian tubes. Male factor
infertility including decreased sperm count or sperm motility. Women with
ovulation disorders, premature ovarian failure, uterine fibroids.

What Causes of Infertility Can IVF Treat?

When it comes to infertility, IVF may be an option if you or your partner have been
diagnosed with:

 Endometriosis
 Low sperm counts
 Problems with the uterus or fallopian tubes
 Problems with ovulation
 Antibody problems that harm sperm or eggs
 The inability of sperm to penetrate or survive in the cervical mucus
 Poor egg quality
 Genetic disease of mother or father
 An unexplained fertility problem

Process of IVF
Techniques may differ depending on the clinic, but IVF usually involves the
following steps:

1. Suppressing the natural menstrual cycle

The woman receives a drug, usually in the form of a daily injection for about 2
weeks, to suppress their natural menstrual cycle.

2. Super ovulation

Fertility drugs containing the fertility hormone follicle stimulating hormone (FSH)
are given to the woman. FSH makes the ovaries produce more eggs than usual.
Vaginal ultrasound scans can monitor the process in the ovaries.
3. Retrieving the eggs

The eggs are collected through a minor surgical procedure known as "follicular
aspiration." A very thin needle is inserted through the vagina and into an ovary.
The needle is which is connected to a suction device. This sucks the eggs out. This
process is repeated for each ovary.In 2011, researchers suggested that
collecting 15 eggs from the ovaries in one cycle gives the highest chance of a
successful pregnancy.Frozen or donated eggs may also be used.

4. Insemination and fertilization

The eggs that have been collected are placed together with male sperm and kept
in an environmentally controlled chamber. After a few hours, the sperm should
enter the egg.Sometimes the sperm is directly injected into the egg. This is known
as an intracytoplasmic sperm injection (ICSI).
Frozen sperm, retrieved through testicular biopsy, may be used. This is believed
to be as effective as fresh sperm in achieving a successful pregnancy.The fertilized
egg divides and becomes an embryo.

 At this point, some centres offer pre-implantation genetic diagnosis (PGD)

which can screen an embryo for genetic disorders. This is somewhat
controversial and is not always used.One or two of the best embryos are
selected for transfer.The woman is then given progesterone or human
chorionic gonadotropin (hCG) to help the lining of the womb receive the
embryo.

5. Embryo transfer

Sometimes, more than one embryo is placed in the womb. It is important that the
doctor and the couple wishing to have a child discuss how many embryos should
be transferred. Normally, a doctor will only transfer more than one embryo if no
ideal embryos are available.

The transfer of the embryo is done using a thin tube, or catheter. It enters the
womb through the vagina. When the embryo sticks to the lining of the womb,
healthy embryo growth can begin.

Medications given for IVF patient

 Types of IVF medication overview

1. Medication is the primary treatment for women with ovulation disorders

and an important part of in vitro fertilization (IVF).
2. Typically, a patient will start an IVF cycle by taking birth control for a
number of days, then injectable medication to stimulate ovaries and
produce eggs, followed by a trigger shot and egg removal; this process
allows the doctor to control the menstrual cycle during treatment.
3. IVF medications used to prepare the uterus and to stimulate the ovaries are
not known to carry any long-term risks of cancer of the ovary unless there
is a family history of ovarian cancer.
 How do IVF medications work?
Medication to stimulate ovulation is the primary treatment for women with
ovulation disorders. Several other types of medication, in addition to ovulation
stimulants, are an important part of in vitro fertilization (IVF). Fertility drugs work
by causing the release of hormones that either trigger or regulate ovulation.
Typically, a patient will start an IVF cycle by taking birth control for a number of
days to prevent ovulation from happening too early in the treatment cycle. Then
the patient will administer injectable medication to stimulate ovaries and produce
eggs, followed by a trigger shot. When eggs are ready to be collected, the
physician will perform an egg retrieval.

 What are the common IVF medications?

There a number of different types of fertility drugs used in the IVF process, some
taken orally and others injected. The exact type and medication amount used
during IVF will depend on the woman’s age, test results and the stimulation
protocol prescribed by her doctor.
A typical IVF treatment will involve a mix of the following medications.
Birth control pills: The pill helps regulate menstrual cycles and prepare the
reproductive system for IVF.
Prenatal vitamins: We recommend taking a vitamin with at least 400mg of folic
acid when a woman begins the process to actively conceive. Please avoid herbal
supplements.
Lupron (#1): This medication enables the body to produce a higher number of
quality eggs.
Antagon (Ganirelx): Ganirelx helps prevent premature ovulation.
Follicle stimulating hormone (FSH): These injections increase the growth of
follicles in the ovaries. We often prescribe the following types of FSH: Gonal-F
(#2), Follistim (#4) or Menopur.
Doxycline: An oral antibiotic used to treat infections, such as reducing bacteria in
sperm. It also reduces the risk of infection following aspiration of the follicles at
the time of egg retrieval.
Novarel: A synthetic human chorionic gonadotropin (hCG) injection used to
trigger ovulation. Novarel is often used when other medications have been taken
to induce ovulation.
Prednisone: Used to treat patients with antisperm antibodies and repeated
pregnancy loss.
Progesterone: A steroid that synchronizes preparation of the uterine lining with
the treatment cycle to ensure the uterus is ready for embryo implantation.
Estrace (estrogen): Estrace is used to supply estrogen and comes in tablet form
used orally or vaginally.
Valium: A muscle relaxing, anti-anxiety medication offered prior to embryo
transfer.
Microdose Lupron: A medication initially used to stimulate the ovaries before
suppressing them, which also prevents ovulation.

Cost of IVF
Fertility medications can be expensive. We have found a wide range of prices
charged by different pharmacies for the same medications. Therefore,
comparison shopping can work to your advantage.
For example, mail-order specialty pharmacies or Costco are often cheaper than
other options. Be sure to check for generic versions of the medication and see if
your insurance will cover any of the costs.
Cost of IVF in India:
The average IVF cost in India is approximately Rs. 150000.00 - Rs. 250000.00. This
is not fixed, as it is possible that the rate can go up as high as Rs. 4,50,000 for one
cycle of the treatment. If you want detailed information about the cost then click
on the adjoining link ClinicSpots

Cost of IVF in India is based on many factors such as the amount of medicine
required, technology used, expertise of the specialist and your location. However,
the IVF cost in India is affordable and you can choose the clinic which is best
suited to your requirement. IVF cost in India may increase slightly if donor sperms
are required. Many a time’s patients may have to undergo several IVF cycles
before they are able to conceive. This also adds up to your cost.

 IVF cost at lower cost clinics:

 Tests – approx Rs. 12000.00
 IVF procedure – Rs. 60000.00 – Rs. 75000.00
 Drugs – Rs. 40000.00 – Rs. 600000.00
 Miscellaneous – Rs. 12000.00
 IVF cost in high cost clinics:
 Tests – approx Rs. 22000.00
 IVF procedure – Rs. 200000.00 – Rs. 300000.00
 Drugs – Rs. 75000.00 – Rs. 90000.00
 Miscellaneous – Rs. 18000.00 – Rs. 20000.00

However, the cost of IVF treatment may vary from cities to cities within the
country. IVF treatment in cities like Mumbai, Delhi, Bangalore are higher when
compared to other cities like Kolkata, Pune, Ahmedabad,etc.

1. The approximate cost of IVF Treatment in Mumbai is as follows:

 IVF/ICSI - Rs.90000.00 + Medicines(Approx Rs. 70000.00 - Rs. 80000.00)

 IUI -Rs. 10000.00 - Rs. 20000.00
 Blood Tests/Scans -Approx. Rs. 15000.00 - Rs. 25000.00
 Lap/Hysteroscopy - Approx. Rs. 18000 -Rs. 25000.00
  IVF treatment in Mumbai is world class as it has top hospitals and medical
centers which are fitted with state-of-art medical facilities, having high
quality medical services and experienced and dedicated IVF experts.

2. The approximate cost of IVF Treatment in Delhi is as follows:

 IVF/ICSI - Rs. 80000.00 + Medicines(Approx Rs. 65000.00 - Rs. 80000.00)

 IUI -Rs. 15000.00 - Rs. 20000.00
 Blood Tests/Scans -Approx. Rs. 18000.00 - Rs. 25000.00
 Lap/Hysteroscopy - Approx. Rs. 15000.00 -Rs. 25000.00
 Frozen Embryo Transfer - Rs. 40000.00 - Rs. 50000.00

Delhi, the capital of India is considered as the medical hub and has some of the
biggest and best medical institutes and hospitals in the country. The IVF
treatment in Delhi has high success rate.

3. The approximate cost of IVF Treatment in Bangalore is as follows:

 IVF / ICSI – Rs. 70000.00 – Rs. 90000.00

 Drugs – Rs. 50000.00 – Rs. 75000.00
 Blood Test – Rs. 15000.00 – Rs. 25000.00
 Hysteroscopy – Rs 35000.00 - Rs. 55000.00
 The approximate cost of IVF Treatment in Chennai is as follows:
 IVF - Rs. 100000.00 – Rs. 160000.00
 ICSI - Rs. 125000.00 – Rs. 200000.00
 IUI - Rs. 15000.00 – Rs. 2000000
 Embryo Freezing - Rs. 30000.00 – Rs. 50000.00
 The infrastructure and technology at the IVF centers in Chennai is on par
with the developed countries. They provide affordable IVF treatment
packages and have highly qualified doctors and support staff.
 The approximate cost of IVF Treatment in Hyderabad is as follows:
 Tests – approx Rs. 15000.00
 IVF procedure – Rs. 50000.00 – Rs. 80000.00
 Drugs – Rs. 40000.00 – Rs. 700000.00
 IUI – Rs. 10000.00 - Rs. 15000.00

IVF centers in Hyderabad have reputed and experienced doctors and technicians
who are supported by the most advanced technologies and equipment.
Role of surrogate mother
Surrogacy has been around since the 1980s, but in the early years it was often
shrouded in secrecy and legal red tape. These days, advances in medicine, law,
and public awareness have allowed IVF surrogacy to become a routine option for
many people who might otherwise never have the chance to have a baby who
shares their genetic heritage.

Thousands of healthy babies have been born through IVF surrogacy in recent
years, and celebrities such as Sarah Jessica Parker and Nicole Kidman have been
open about choosing this way of building their families. Patients often have
questions about how surrogacy works and whether it might be the right choice
for them.

1. What is IVF surrogacy?

IVF surrogacy uses a third party “gestational surrogate” to carry the pregnancy
when a patient is unable to carry a baby to term herself. The gestational
surrogate may also be called the “gestational carrier” or “gestational mother.”
The gestational surrogate signs a contract with the intended parent or parents to
undergo an embryo transfer procedure using embryos created through IVF and to
carry the resulting pregnancy.

For heterosexual couples, this generally means using embryos created using the
eggs and sperm of the client couple. This means that, if the pregnancy is
successful, the couple can bring home a baby who is 100% related to both
partners, just as if they had been able to conceive and carry the pregnancy on
their own. Single women opting for IVF surrogacy may use their own eggs and
donor sperm. LGBT couples may also choose to use IVF surrogacy, using the eggs
of one partner and donor sperm, if neither partner can carry the pregnancy
themselves.

In all cases, the gestational surrogate has no genetic ties to the baby she carries.
Gay couples often use a gestational surrogate, but as they will use donor eggs or
the eggs of the surrogate herself (also known as “traditional surrogacy”) this
process is not usually referred to as IVF surrogacy.
 2. Why IVF surrogacy?
The main draw of IVF surrogacy for most couples is the ability to have a child who
shares the genetics of both the mother and father, even when pregnancy is not
possible for the woman. While we know that a biological link is not necessary for
family bond, the natural desire to share your genetic heritage with your child is
strong.

Some women are medically unable to carry a child to term, but are still able to
produce healthy eggs. For some women, this is because they have a congenital
problem with their uterus, or because it has been damaged by injury or disease,
or removed by a hysterectomy. Some choose IVF surrogacy because they have
undergone several unexplained pregnancy losses. Others may have been advised
against attempting pregnancy due to other medical issues such as diabetes,
hypertension, or heart disease. Whatever the specific circumstances of a case
may be, using an IVF surrogate can offer hope for patients who have suffered
repeated heartbreaking miscarriages or when other ART methods have failed.

Gestational surrogacy with IVF is less legally complex than traditional surrogacy
because the surrogate is not genetically related to the baby, which makes it a
more accessible and easy choice for many couples.

3. How are surrogates selected?

Choosing a surrogate is obviously a very important decision. Some fortunate
patients have a close friend or family member who has offered to carry a
pregnancy for them. Others advertise privately for a gestational surrogate, but
most clients decide to go through an agency. A reputable agency can provide you
profiles of carefully screened potential gestational surrogates, and guide you
through the process of choosing the right surrogate. They should also be able to
inform you of any legal considerations in your state concerning surrogacy, and
even introduce you to a lawyer who can prepare the necessary contracts and
paperwork.

Surrogates undergo strict screening to ensure that they are physically, mentally,
and emotionally healthy enough to carry a pregnancy for a client couple without
undue risk. The exact standards used may vary between agencies, but generally
the attributes of an ideal gestational surrogate include:
  Between the ages of 21 and 40
 Healthy lifestyle (no smoking, substance abuse problems, healthy diet, etc)
 Has had at least one successful pregnancy, preferably with no
complications and an easy delivery
 Has passed medical and psychological tests

4. How does IVF surrogacy work?

At the beginning of the IVF surrogacy process, the biological/intended parents
and the gestational surrogate will go through an assessment and laboratory tests
with your clinic to make sure that you are all healthy and prepared both mentally
and physically, and that there are no sexually transmitted diseases that could
damage potential embryos or be given to the surrogate during the embryo
transfer. From here the process is relatively simple:

 The biological mother (who is providing the eggs) and the gestational
surrogate will take medication to synchronize their menstrual cycles.
 Once the cycles are synchronized, the egg provider will begin her IVF
protocol to stimulate her ovaries for egg production.
 The egg provider will undergo an egg retrieval procedure.
 Her eggs will be taken to the lab and mixed with her partner’s (or donor)
sperm and cultured for 3 to 5 days.
 At the same time, the gestational surrogate will begin taking supplemental
progesterone to prepare her uterine lining for pregnancy.
 When the embryos are ready, one or more will be transferred to the
surrogate’s uterus.
 In two weeks, the surrogate will take a pregnancy test to determine
whether implantation was successful.
 If pregnancy occurs, the surrogate will be monitored by the IVF clinic until
the pregnancy is 10 to 12 weeks along, at which point her care is
transferred to an OB.
 When the pregnancy is complete, the surrogate delivers the baby.
 The baby goes home with its intended, biological parents.

Sometimes, the biological mother undergoes her IVF cycle some time before, and
the resulting embryos are frozen for later transfer to the gestational surrogate, in
which case the timelines can differ.
Success Rates of IVF
Success rates for IVF depend on a number of factors, including the reason for
infertility, where you're having the procedure done, and your age. The CDC compiles
national statistics for all assisted reproductive technology (ART) 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. The most recent report from 2016
found:

 Pregnancy was achieved in an average of 27.3% of all cycles (higher or lower

depending on the age of the woman).
 The percentage of cycles that resulted in live births was 22.2% on average (higher
or lower depending on the age of woman).

Bibliography
 https://www.webmd.com/infertility-and-reproduction/guide/in-vitro-
fertilization
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486566/
 https://www.google.com/search?q=ivf+process&oq=ivf+process&aqs=chrome..6
9i57j35i39j0l6j69i60.8933j0j7&client=ms-android-meizu&sourceid=chrome-
mobile&ie=UTF-8
 https://lomalindafertility.com/treatments/ivf/types-of-ivf-medication/
 https://ivf-worldwide.com/ivf-history.html