Pick up any celebrity magazine and you’ll find all the makings of anti aging.  And most women of this generation DO feel and look younger than previous generations thanks to all the creams, injections, and lifestyle choices we have.  All it takes is a trip down memory lane to our grandmother’s era and we seem to have learned some anti aging secrets.

Except that our ovaries keep us honest.

As good as science has been to us where our looks are concerned, the ovaries remain true to Mother Nature’s initial design.

Our reproductive years begin around age 9 – 15.  From about age 16 – 30, it is considered to be our most fertile time.  It’s been said that peri-menopause starts about age 30 and our fertility progressively declines from there.  The “ticking clock” sounds more like a fire alarm about the time we turn 39.  Menopause ‘transition’ starts around 40 with the onset of the real deal coming in our late 40’s or early 50’s.

I remember seeing a comic of a middle aged, well dressed woman standing at her executive desk, and the caption read, “Oh my God, I forgot to have children”.

Thanks to the reproductive sciences, we are given some last minute hope. Fertility medicine, in vitro fertilization, egg donors, surrogates; these give us the opportunity to have children when our natural options have run out. And in many cases, there is success!  Often times, the success comes in packages of two or three.  (Not to say that EVERY twin comes from assisted reproductive therapy.)

Our grandmother’s may have had more grey hair and a few more lines around their eyes, but maybe they knew that yes, you can have it all…. You just need to start earlier

Today, there are modern and advanced technologies to help women overcome infertility. In vitro fertilization is one such procedure. The harsh fact of the matter is there are over 6.1 million individuals who are troubled by some type of infertility.

Some of these concerns can be solved with minor surgeries or by taking medicine orally; however, other types of procedures may be needed if the problem is more severe. In 1981, IVF was successfully completed in the United States for the first time.

Since then, well over 250,000 babies have been born as a result of using this procedure. IVF has allowed multiple women who have not been able to conceive a baby in the past, to get pregnant and have a baby of their own.

IVF is a procedure where a mans sperm is put in to the womans egg in a laboratory dish where it is then fertilized, for about 40 hours. After about 40 hours the eggs are checked to see whether or not they are fertilized.

This IVF process is one way of doing infertility treatments and is also known as an assisted reproduction. After the womans eggs have been fertilized, the embryo is then transferred into the womb and allowed to develop naturally. When the implanting process takes place, 2 to 4 embryos are normally put into the uterus or womb.

During the early years of in vitro fertilization and sometimes still today, the children born of this technique are known as “test tube babies.” The first test tube baby was born in England in 1978. IVF is normally used as a treatment when a woman has blocked tubes, damaged tubes or has no fallopian tubes whatsoever.

Nevertheless, it can also be used when the person trying to conceive has endometriosis or if the male involved has a low sperm count. Another time when IVF is used is when other fertility methods did not work.

In vitro fertilization has made it possible for women, who once thought they could never become pregnant, to become mothers of their naturally born children. Even women the age of 40 and up have a success rate of about 13% with IVF. It should be noted that reproductive health is not all that has to be thought of when dealing with assisted conception.

If the female faces other medical issues, this could bring about a problem. Many factors such as age, overall physical health
and medical history should be considered before IVF or any other infertility procedure is done or practiced.

Q:
What options are there for paying for fertility treatments?

A:
The first step is to see if you have insurance benefits that offer fertility coverage.  Your employer decides whether or not fertility is a covered benefit.  Some coverage may be for diagnostic testing only, while others will offer varying degree’s of coverage from no benefits through donor and/or surrogate coverage.

If there are no benefits provided by insurance, most clinics offer a ‘cash courtesy’ rate, which provides a discount on some or all of the physician services and/or procedures.  Payment of these services can be made by various means.  Credit cards offer the opportunity to earn points or miles. If you own a home, utilizing your equity line is recommended as the interest can be used as a tax deduction.

There are also some financial institutions who offer a personal loan or specifically ‘patient’ financing, (Google ‘infertility financing programs’).

In most cases payment for the treatment cycle is due prior to medication beginning. It is important to have the stresses of the financial aspect resolved so that the focus can be on treatment and a positive outcome.

Female age is very major in consideration of the possibility for getting pregnant. The real problem is the egg number and quality - which translates over to embryo quality after fertilization. Increased infertility with age is a well documented problem and very obvious in modern society. As women wait longer to have children, a larger percentage of couples have fertility problems due to the quality of the eggs, and other points that affect fertility and are more common in older women.

Womens liberation has brought many benefit to women. However, as women increasingly hold up childbearing, our society has done a very poor job of training people about the drop in female fertility with increasing age. Many couples learn about the impact of age when it could be too late for them already. Several couples end up needing advanced treatments such as IVF to help overcome the age related decline in egg quality. If they had tried to have a baby years sooner, good old-fashioned “sex in the bedroom” could have built the family. Dr. Mark Rispler said, “As women postpone childbearing, there is now an unrealistic expectation that medical science can cancel the effects of aging”.

We certainly try our best to overcome the effects of raising female age with advanced fertility treatments such as IVF. Women usually ask whether there is an age limit on having in vitro fertilization. All clinics will have some age limit which they will not perform in vitro fertilization with the womans own eggs. The age limit is around 42 and 45 in the US. The majority of IVF clinics permit a woman to be a recipient of donor eggs through the age of about 50.

Successful pregnancy outcome with IVF are very much related to a females age - when using the womans own eggs. When there are donor eggs being used, the age of the egg donor is the significant issue. With egg donation, the age of the recipient woman does not seem to modify the chance for success. Which means that the age of the egg is very important, but the age of the uterus is not.

The age of the male partner does not seem to matter nearly as much. This is related to the fact that all of a womans eggs are present at birth. They can not be divided or be “resupplied”, whereas sperm is produced constantly after puberty in men. Eggs age over time, while new sperm is constantly coming off the production line. Sperm from older men does not usually have a substantially decreased fertilizing potential as compared to sperm from younger men. However, older men often have less interest in regular intercourse, which can be a factor in chances for conception.

Many people are not informed of the decrease in fertility as the age of the female partner increases.

In Vitro Fertilization (IVF) is a procedure where the eggs of women are taken from the ovary. Then they are fertilized with sperm in a laboratory method, and then the fertilized embryo is returned to the womans uterus. Dr. Mark Rispler ( http://www.innovativefertility.com ) uses extensive diagnostic testing to determine a patients chances for successful IVF

In Vitro Fertilization is a procedure in which the connecting of eggs and sperm takes place outside of the womans body. A woman may be given fertility drugs prior to this procedure so that several eggs mature in the ovaries at the same time. A long, thin needle is used to remove the eggs from the woman. The physician gets a passage to the ovaries using one of two possible procedures. One of the procedures involves inserting a needle through the vagina (transvaginally). The physician guides a needle to the location of the ovaries with the help of an ultrasound machine. In the other procedure, called laparoscopy , a small thin tube with a viewing lens is implanted through an incision in the navel. This allows the physician to see inside the patient and find the ovaries on a video monitor.

Once the eggs are removed, they are processed with sperm in a laboratory dish or test tube. (This is the origin of the term test tube baby.) The eggs are observedlooked at for several days. Once there is proof that fertilization has happened and the cells have begun to divide, they are then returned to the womans uterus.
In the procedure to remove eggs, a sufficient amount may be gathered to be frozen and saved (either fertilized or unfertilized) for further IVF attempts.

In Vitro Fertilization has been used successfully since 1978, which is when the first child to be conceived by this method was born in England. Over the past 20 years, thousands of couples have used this method of ART or similar procedures to become pregnant.  Of the approximately 62 million women of reproductive age in 2002, about 1.2 million, or 2%, had an infertility-related medical appointment within the previous year, and 8% had an infertility-related medical visit at some point in the past. (Infertility services include medical tests to diagnose infertility, medical advice and treatments to help a woman become pregnant, and services other than routine prenatal care to prevent miscarriage.) Additionally, 7 percent of married couples in which the woman was of reproductive age (2.1 million couples) reported that they had not used contraception for 12 months and the woman had not become pregnant.

The In Vitro Fertilization method for conception of a human embryo outside the mothers body works like this-Many ovas, or eggs are withdrawn from the mothers body and put into special laboratory culture dishes called Petri dishes; sperm from the father are then added, or in several cases sperm is inserted directly into an ovum, a method known as intracytoplasmic sperm injection.

If the fertilization succeeds, a fertilized ovum (or several fertilized ovums), later undergoing several cell divisions, is either transported to the mother or a surrogate mothers body for normal development in the uterus, or frozen for following implantation. The eggs could also be frozen and then be fertilized later on. In Vitro maturation is when the ova are taken out and then grown in a laboratory before they are fertilized.

This technique was devised for use in circumstances of infertility when the womans fallopian tubes are harmed or the mans sperm count is low. It is also used to allow prospective parents with other reproductive problems (e.g., inability to generate eggs, poor sperm quality, or endometriosis) to bear a child, and can be used in combination with embryo biopsy, or preimplantation genetic diagnosis, to allow parents to have a child who is released from some inheritable defects or diseases.

In embryo donation (also called embryo adoption), frozen embryos that are not used by the mother are distrubited for implantation to a woman or couple who are infertile but wish to have children and are capable of bearing children.

The use of In Vitro Fertilization has made the outcome of more than a million babies births.

There is now proof from a study published suggesting that babies conceived by IVF have a 1 in 10 risk of birth defects, double the risk of babies born naturally. These faults involve holes in their hearts, one kidney instead of two, brain abnormalities, and cleft lips and palettes. Researchers found out that IVF children have a sixfold increase in Beckwith-Wiedemann syndrome, a rare hereditary disorder which causes abnormality and cancer.

As all of these concerns are brought up, fertility experts have hurried to caution that the studies are small and not enough research has been done or that the problems could be caused by genetic problems in the woman that stopped her from getting pregnant in the first place or the use of fertility drugs before IVF is attempted. Others suggest that because IVF babies are closely watched, the defects are detected sooner than they might be seen in babies that are born naturally.

In short, there are both pros and cons that must be weighed when considering in vitro fertilization as a possible option for finally achieving parenthood.

In Vitro Fertilization, is a helpful reproductive technology in which one or more eggs are fertilized outside a females body. This system has been used widely in animal embryological research for decades, but only since 1978 has it been successfully used to human reproduction. The human reproduction process requires stimulation of the growth of multiple eggs by a daily injection of hormone medications. It is also possible to conduct IVF with none of the hormone medications; one egg would mature and be recovered. The eggs are obtained by one of two methods: sonographic egg recovery, the more common one of the two, that uses ultrasound guidance to obtain the eggs, oocytes, or laparoscopic egg recovery, in which retrieval is done through a small incision in the abdomen.

After the eggs have been retrieved, they are put in something called fluid medium, once the semen has been washed and produced it is put together with the eggs for approximately 18 hours.

Then the eggs are taken out, routed into a special growth medium, and then inspected about 40 hours later. If the eggs have been fertilized and developed normally, the embryos are transferred to the woman or a surrogants uterus.

Usually, many embryos are transferred to enlarge the possibility of pregnancy. If more than four eggs form into embryos, the donor can have the option of cryopreserving the remaining embryos for thawing and replacement in a following IVF cycle. (Cryopreservation is used to decrease the risk of many gestations [twins, triplets, etc.] if more than four embryos are replaced.) After the egg transfer, progesterone injections may be given daily to the recipient. The possibility of viable pregnancy is about 20 percent with one IVF process.

Similar techniques are also obtainable. In gamete intrafallopian transfer, is similar to doing IVF, but the harvested eggs and sperm are placed straight into the fallopian tubes, with fertilization happen in the womans body. In zygote intrafallopian transfer, the procedure is like to gamete intrafallopian transfer, but the beginning-stage embryos (zygotes) are positioned directly in the fallopian tubes. With super ovulation uterine capacitation enhancement (SOURCE), the woman can get daily hormone medications to stimulate the growing of multiple eggs. Once the eggs have reached the right step, intrauterine inseminations are done by using the partners specifically treated sperm. In some places the donor oocyte programs are available; the donated eggs are used by women unable to use their own eggs to get pregnant. The assisted reproductive technology is used to retrieve eggs from donors and mend embryos in the recipient.

Innovative Fertility Center Props Open Window of Opportunity

Forty may be the new 30, but when it comes to reproduction, ovaries don’t lie. “The physiological truth about starting a family is that women who are in their late 30s have a much more difficult time conceiving than do younger women,” says Dr. Mark Rispler, an infertility specialist at the Innovative Fertility Center (www.innovativefertility.com) in Manhattan Beach, California. “Unfortunately, many women don’t realize that their window of opportunity is closing, and are shocked when they discover that they need advanced treatment, such as in vitro fertilization (IVF) treatment.”

Although everyone’s experience is unique, some women delay childbearing until they can juggle both work and family, while others wish to have children with their second husbands. “Often, a woman believes that, because she leads a healthy lifestyle and is fit, she’ll be able to get pregnant,” says Dr. Rispler. “It’s important for women to understand that the ovarian biological clock has a much shorter lifespan than the rest of the body, and that they have to take an aggressive approach.”

Although the Centers for Disease Control estimate that 7.3 million women and couples are affected by infertility, the American Society of Reproductive Medicine notes that a third of the time, infertility is the result of male factors, another third can be ascribed to female factors, and the remainder are caused by either a combination of male and female factors or is unexplained.

Innovative Fertility Center begins your journey with comprehensive testing to determine what treatment is needed. The Center offers patients a variety of treatment options, and is recognized for their IVF success. “Artificial insemination, combined with ovarian stimulation, is often a viable alternative for many younger women and couples with fertility issues, but because time is of the essence for women in their mid- to late-thirties, IVF is often the necessary option,” says Dr. Rispler.

Board certified in Reproductive Endocrinology and Infertility as well as in Obstetrics and Gynecology, Dr. Rispler first uses extensive diagnostic testing to determine a patient’s chances for successful IVF. The actual IVF process is complex, and involves a committed team of experts. Generally speaking, the woman is given medication to stimulate follicle growth, and then egg development is monitored. Her eggs are then retrieved and sent to a laboratory, where they are fertilized. The embryos are then transferred to her uterus, and she is closely monitored and supported. If she becomes pregnant, Dr. Rispler continues to monitor and test her progress through her first trimester.

Throughout the process, Dr. Rispler recognizes that each woman is on her own individual journey, and emphasizes treating the whole woman – not just her reproductive tract. “Because our practice is small and our goal is to create families, we are able to provide a patient with a variety of services and referrals to support her throughout a very difficult time,” he notes. “Our relationships with our patients and continuity of care are of primary importance.”

To that end, Dr. Rispler and his staff have a roster of professionals that help support patients, including a dietician, an acupuncturist, a psychologist, and a group that focuses on mind-body wellness. They also have relationships with stellar egg donor agencies – and even adoption agencies and attorneys. “We support creating families – in whatever form they take,” concludes Dr. Rispler.

In Vitro Fertilization, is it for you? Here is some information to help you decide.

Millions of Americans are affected by infertility in their reproductive lives.

Infertility difficulties can be overcome, now that there are many options available for treatments because of advancements in medical technology.

Preliminary treatments for fertility involve prescriptions or cycle therapies.

More Sophisticated procedures target patients with more serious health condidtions, including  in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). These are both primarily methods made for women with reproductive complications due to fallopian tube damage or blockage.

The In Vitro Pregnancy offers readers resources and in-depth articles pertaining to in vitro fertilization techniques and success rates. You can become more familiar with this topic, basic questions about in vitro fertilization we will answer.

In Vitro fertilization, what is it?

In the phrase In Vitro Fertilization, The word vitro comes from a Latin word which means “in the glass”.

English context refers to performing an experiment in a test tube, or outside of an organism in a controlled environment. Where the female egg is fertilized outside of the woman’s body is a procedure that is in vitro fertilization. Then it is implanted in the woman’s uterus where it develops naturally.

Who could be a candidate for in vitro fertilization?

Dr Mark Rispler considers numbers of parameters when judging your candidacy. General good health and under 35 years old is considered an ideal patient, but older patients are not excluded. If the male partner can produce healthy active sperm, that also is very important.

What is involved and how is the IVF procedure accomplished?

Before the procedure, fertility medication is given to the woman to help produce several eggs. Those eggs are subsequently removed from the ovary using a needle or laparoscopic surgery. Then the eggs are transported to a laboratory, they are then combined with the sperm of the partner. The joining process of the sperm and egg is known as in vitro fertilization. Once the  fertilization is confirmed, newly formed embryos incubate in test tubes for 2 to 3 days. Many embryos are then transferred to the woman’s cervix using a catheter. The weeks immediately after the implantation, the patient is placed on a hormone therapy to promote attachment to the cervix. If all is successful, a pregnancy test will prove out the results.

What is the rate of success with in vitro fertilization?

Women who are healthy and under the age of 36 have the same pregnancy success rate as those who conceive by natural means. These statistics also bear out when considering instances of miscarriage. Therefor, when pregnancy is achieved through IVF, the success rate normally will fall within the same parameters as a natural pregnancy.

Overall success rates for achieving pregnancy through IVF will vary by age, condition, and general health.
Approximately 37% of procedure cycles resulted in a live birth for US women under 36 years of age using fresh embryos from non-donated eggs.

There are other alternatives for in vitro fertilization, and Dr Mark Rispler can tell you if in vitro fertilization makes sense in your particluar case. There are other forms of artificial insemination, such as gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), and last of all embryo cryopreservation. Each of which has qualifying factors that must be talked over with Dr Rispler.

In vitro fertilization: IVF, a laboratory procedure in which sperm are placed with an unfertilized egg in a Petri dish to achieve fertilization. The embryo is then transferred into the uterus to begin a pregnancy or cryopreserved (frozen) for future use. IVF was originally devised to permit women with damaged or absent Fallopian tubes to have a baby. Normally a mature egg is released from the ovary (ovulated), then enters the Fallopian tube, and waits in the neck of the tube for a sperm to fertilize it. With defective Fallopian tubes, this is not possible. The first IVF baby, Louise Joy Brown, was born in England in 1978.

In vitro fertilization literally means “fertilization in glass.” A child born by in vitro fertilization is inaccurately known a “test tube baby.”

The term in vitro, from the Latin root meaning in glass, is used, because early biological experiments involving cultivation of tissues outside the living organism from which they came, were carried out in glass containers such as beakers, test tubes, or petri dishes. Today, the term in vitro is used to refer to any biological procedure that is performed outside the organism it would normally be occurring in, to distinguish it from an in vivo procedure, where the tissue remains inside the living organism within which it is normally found. A colloquial term for babies conceived as the result of IVF, test tube babies, refers to the tube-shaped containers of glass or plastic resin, called test tubes, that are commonly used in chemistry labs and biology labs. However in vitro fertilisation is usually performed in the shallower containers called petri dishes. (Petri-dishes may also be made of plastic resins.) However, the IVF method of Autologous Endometrial Coculture is actually performed on organic material, but is yet called in vitro.

Indications

Initially IVF was developed to overcome infertility due to problems of the fallopian tube, but it turned out that it was successful in many other infertility situations as well. The introduction of intracytoplasmic sperm injection (ICSI) addresses the problem of male infertility to a large extent.

For IVF to be successful it may be easier to say that it requires healthy ova, sperm that can fertilise, and a uterus that can maintain a pregnancy. Cost considerations generally place IVF as a treatment when other less expensive options have failed.

This means that IVF can be used for females who have already gone through menopause. The donated oocyte can be fertilised in a crucible. If the fertilisation is successful, the fertilised egg will be transferred into the uterus, within which it will develop into an embryo.

Method

Ovarian stimulation

Treatment cycles are typically started on the third day of menstruation and consist of a regimen of fertility medications to stimulate the development of multiple follicles of the ovaries. In most patients injectable gonadotropins (usually FSH analogues) are used under close monitoring. Such monitoring frequently checks the estradiol level and, by means of gynecologic ultrasonography, follicular growth. Typically approximately 10 days of injections will be necessary. Spontanenous ovulation during the cycle is prevented by the use of GnRH agonists or GnRH antagonists, which block the natural surge of luteinising hormone (LH).

Egg retrieval

Main article: Transvaginal oocyte retrieval

When follicular maturation is judged to be adequate, human chorionic gonadotropin (?-hCG) is given. This agent, which acts as an analogue of luteinising hormone, would cause ovulation about 36 hours after injection, but a retrieval procedure takes place just prior to that, in order to recover the egg cells from the ovary. The eggs are retrieved from the patient using a transvaginal technique involving an ultrasound-guided needle piercing the vaginal wall to reach the ovaries. Through this needle follicles can be aspirated, and the follicular fluid is handed to the IVF laboratory to identify ova. The retrieval procedure takes about 20 minutes and is usually done under conscious sedation or general anesthesia.

Fertilisation

In the laboratory, the identified eggs are stripped of surrounding cells and prepared for fertilisation. In the meantime, semen is prepared for fertilisation by removing inactive cells and seminal fluid. If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined, and it will be thawed ready for use. The sperm and the egg are incubated together (at a ratio of about 75,000:1) in the culture media for about 18 hours. By that time fertilisation should have taken place and the fertilised egg would show two pronuclei. In situations where the sperm count is low, a single sperm is injected directly into the egg using intracytoplasmic sperm injection (ICSI). The fertilised egg is passed to a special growth medium and left for about 48 hours until the egg has reached the 6-8 cell stage.

Selection

Laboratories have developed grading methods to judge oocyte and embryo quality. Typically, embryos that have reached the 6-8 cell stage are transferred three days after retrieval. In many American and Australian programmes^{[citation needed]}, however, embryos are placed into an extended culture system with a transfer done at the blastocyst stage, especially if many good-quality day-3 embryos are available. Blastocyst stage transfers have been shown to result in higher pregnancy rates.^[1]. In Europe, day-2 transfers are common.^{[citation needed]}

Embryo transfer

Main article: Embryo transfer

Embryos are graded by the embryologist based on the number of cells, evenness of growth and degree of fragmentation. The number to be transferred depends on the number available, the age of the woman and other health and diagnostic factors. In countries such as the UK, Australia and New Zealand, a maximum of two embryos are transferred except in unusual circumstances. For instance, a woman over 35 may have up to three embryos transferred. This is to limit the number of multiple pregnancies. The embryos judged to be the “best” are transferred to the patient’s uterus through a thin, plastic catheter, which goes through her vagina and cervix. Several embryos may be passed into the uterus to improve chances of implantation and pregnancy.

Success rates

According to a 2005 Swedish study published in the Oxford Journal ‘Human Reproduction’ 166 women were monitored starting one month before their IVF cycles and the results showed no significant correlation between psychological stress and their IVF outcomes. The study concluded with the recommendation to clinics that it might be possible to reduce the stress experienced by IVF patients during the treatment procedure by informing them of those findings. While psychological stress experienced during a cycle might not influence an IVF outcome, it is possible that the experience of IVF can result in stress that leads to depression. The financial consequences alone of IVF can influence anxiety and become overwhelming. However, for many couples, the alternative is infertility, and the experience of infertility itself can also cause extreme stress and depression.

Complications

The major complication of IVF is the risk of multiple births.[2] This is directly related to the practice of transferring multiple embryos at embryo transfer. Multiple births are related to increased risk of pregnancy loss, obstetrical complications, prematurity, and neonatal morbidity with the potential for long term damage. Strict limits on the number of embryos that may be transferred have been enacted in some countries (e.g., England) to reduce the risk of high-order multiples (triplets or more), but are not universally followed or accepted. Spontaneous splitting of embryos in the womb after transfer can occur, but this is rare and would lead to identical twins. A double blind, randomised study followed IVF pregnancies that resulted in 73 infants (33 boys and 40 girls) and reported that 8.7% of singleton infants and 54.2% of twins had a birth weight of < 2500 g ^[2]. However recent evidence suggest that singleton offspring after IVF is at higher risk for lower birth weight for unknown reasons.

Another risk of ovarian stimulation is the development of ovarian hyperstimulation syndrome.

If the underlying infertility is related to abnormalities in spermatogenesis, it is plausible, but too early to examine that male offspring is at higher risk for sperm abnormalities.

Birth defects

The issue of birth defects remains a controversial topic in IVF. A majority of studies do not show a significant increase after use of IVF. Some studies suggest higher rates for ICSI , while others do not support this finding.^[3]
Japan’s government prohibited the use of in vitro fertilisation procedures for couples, inwhich both partners are infected with HIV virus. Despite the fact that the ethics committees previously allowed the Ogikubo Hospital, located in Tokyo, to use in vitro fertilisation for HIV couples, the Health, Labour and Welfare Ministry of Japan decided to block the practice. Hideji Hanabusa, the Vice President of the Ogikubo Hospital, states that together with his colleagues, he managed to develop a method through which scientists are able to remove the AIDS virus from sperm. ^[4]

Cryopreservation

Main article: Cryopreservation

Embryo cryopreservation

If multiple embryos are generated, patients may choose to freeze embryos that are not transferred. Those embryos are placed in liquid nitrogen and can be preserved for a long time. There are currently 500,000 frozen embryos in the United States.[3] The advantage is that patients who fail to conceive may become pregnant using such embryos without having to go through a full IVF cycle. Or, if pregnancy occurred, they could return later for another pregnancy. Spare embryos resulting from fertility treatments may be donated to another woman or couple, and embryos may be created, frozen and stored specifically for transfer and donation by using donor eggs and sperm.

Oocyte cryopreservation

Cryopreservation of unfertilised mature oocytes has been successfully accomplished, e.g. in women who are likely to lose their ovarian reserve due to undergoing chemotherapy.^[5]

Ovarian tissue cryopreservation

Cryopreservation of ovarian tissue is of interest to women who want to preserve their reproductive function beyond the natural limit, or whose reproductive potential is threatened by cancer therapy. Research on this issue is promising.

Adjunctive interventions

There are several variations or improvements of IVF, such as ICSI, ZIFT, GIFT and PGD.

ICSI

(ICSI) is a more recent development associated with IVF which allows the sperm to be directly injected in to the egg. This is used where sperm have difficulty penetrating the egg and in these cases the partner’s or a donor’s sperm may be used. ICSI is also used when sperm numbers are very low. ICSI results in success rates equal to IVF fertilisation.

ZIFT

Eggs are removed from the woman, fertilised and then placed in the woman’s fallopian tubes rather than the uterus.

GIFT

Eggs are removed from the woman, and placed in one of the fallopian tubes, along with the man’s sperm. This allows fertilisation to take place inside the woman’s body. Therefore, this variation is actually an in vivo fertilisation, and not an in vitro fertilisation.

PGD

Main article: Preimplantation genetic diagnosis

PGD can be performed on embryos prior to the embryo transfer. A similar, but more general test has been developed called Preimplantation Genetic Haplotyping (PGH). But success rate of PGD is much lower. (source needed)

Acupuncture

An increasing number of fertility specialists and centers recognise the benefits of acupuncture and offer acupuncture as a part of their IVF protocol. Supportive^[6] evidence from clinical trials and case series suggests that acupuncture may improve the success rate of IVF and the quality of life^[6] of patients undergoing IVF and that it is a safe^[6] adjunct therapy. A Systematic review and meta-analysis published in British Medical Journal ^[7] Complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (odds ratio 1.65), ongoing pregnancy (1.87), and live birth (1.91).

Mechanism of acupuncture

Scientific literature lists four^[6] mechanisms of how acupuncture can improve IVF outcomes ; these include

• Neuroendocrinological modulations
• Increased blood flow to uterus and ovaries
• Modulation in cytokines
• Reducing stress, anxiety and depression

Electro-acupuncture in oocyte retrieval for IVF

Electro-acupuncture has a proven analgesic effect in oocyte retrieval for IVF^{[citation needed]}.

History

The first pregnancy achieved following invitro human fertilisation of a human oocyte was reported in The Lancet from the Monash team in 1973, although it only lasted a few days and would today be called a biochemical pregnancy. This was followed by a tubal ectopic pregnancy from Steptoe and Edwards in 1976, resulting from the successful partnership with Bob Edwards which resulted in the birth of Louise Brown in 1978, Courtney Cross, also in 1978, and another unnamed birth from Oldham, the world’s first IVF babies. This was followed by the birth of Candice Reed in Melbourne in 1980. It was the subsequent use of stimulated cycles with clomiphene citrate and the use of human chorionic gonadotrophin (hCG) to control and time oocyte maturation, thus controlling the time of collection, that converted IVF from a research tool to a clinical treatment.

This was followed by a total of 14 pregnancies resulting in nine births in 1981 with the Monash university team. The Jones team in Norfolk, Virginia, further improved stimulated cycles by incorporating the use of a follicle-stimulating hormone (uHMG). This then became known as controlled ovarian hyperstimulation (COH). Another step forward was the use of gonadotrophin releasing hormone agonists (GnRHA), thus decreasing the requirement for monitoring by preventing premature ovulation, and more recently gonadotrophin releasing hormone antagonists (GnRH Ant), which have a similar function. The additional use of the oral contraceptive pill has allowed the scheduling of IVF cycles, which has made the treatment far more user-friendly both for staff and patients.

The ability to freeze and subsequently thaw and transfer embryos has also significantly improved the effectiveness of IVF. The other very significant milestone in IVF was the development of the intra cytoplasmic sperm injection of single sperms by Andre van Steirtegham in Brussels,1992. This has enabled men with minimal sperm production to achieve pregnancies, sometimes in conjunction with sperm recovery, using a testicular fine needle or open testicular biopsy, with some men even with kleinfelter’s syndrome occasionally achieving pregnancy. Thus, IVF has become the final solution for most fertility problems, moving from tubal disease to male factor, idiopathic subfertility, endometriosis, advancing maternal age, and anovulation not responding to ovulation induction.