In Vitro Fertilization
In vitro fertilization, IVF is a form of assisted reproductive technology used to treat and facilitate issues with fertility and surrogacy. Ivf, also known as test-tube fertilization, refers to the fertilization of the male sperm and female ova or egg, in vitro, or outside the body. The fertilized embryo is allowed to divide outside the body and is then implanted either into the maternal uterus or surrogate uterus, depending on the patients’ preference. However, it is important to note that IVF is not a commonly used form of ART as it is a tedious and expensive process, compared to other methods of assisted reproductive techniques.
History of IVF
Many attempts have been made to help make IVF a successful option for the treatment of infertility but it wasn’t until 1978 that a cycle of IVF produced the first-ever successful result due to the efforts of three pioneering doctors; Edwards, Steptoe, and Purdy. Louise Brown was born in July of 1978 and was the first child born successfully after maternal treatment with IVF (1).
Sixty-seven days after the birth of Louise in Oldham, England, Durga was born in Kolkata, India. She is the second child born successfully after maternal treatment with IVF. Since then, many women have resorted to IVF to help treat infertility. IVF has also helped many women with uterine problems to have children of their own through the surrogacy route.
Ivf has allowed infertile women or women with inferior partners, and menopausal women to become pregnant. In fact, IVF treatment helped Adriana Iliescu, a 66-year-old woman to become pregnant and give birth in 2004.
Advancements in the technique of IVF
IVF is a long process consisting of many steps that are responsible for the high-cost and high-effort nature of the procedure. Researchers have been trying to make the process not only more affordable but also readily available. A new multidisciplinary approach to IVF namely, microfluidics technology, has shown potential to improve the overall process while also making it cost-effective and highly available.
The application of microfluidics has created the IVF on a chip technology which allows for the best sperm to be chosen for intra cytoplasmic sperm injection or ICSI, the most important step of IVF (2). The chip contains a simulated cervical and uterine environment that the sperm would have had to go through to fertilize the egg if traditional methods of fertilization were applied. The chip uses the same features as a real uterine environment to choose the best sperm that can be used to fertilize the egg. This makes the entire process of sperm selection and ICSI easier and affordable.
Another issue with IVF technology is that once the embryo is implanted into the uterine cavity, the medium cannot be controlled and this has shown to have a negative impact on live birth rates, especially in women above the ages of 35 years. However, recent advancements in the field of IVF have allowed researchers to find a solution to this specific problem. EmbryoGen is a new type of medium that improves the cell-to-cell communication between the mother and the fetus, hence, improving live birth rates. The EmbryoGen medium is used for the development of the embryo in vitro and it is also applied during the implantation process (3). This allows for the uterine environment to be controlled and monitored compared to the standard medium, hence, facilitating the implantation process, the failure of which is one of the most common reasons for the failure of an IVF cycle.
Current research and clinical trials
Despite recent advancements in technology, IVF is still not as accessible and successful as one would hope. Researchers have continued to study the different steps of IVF in detail to improve the technology, one step at a time. Some of the current studies aiming to improve and enhance the success rates of IVF include:
- Role of Lactobacillus in luteal phase support and eventually, live birth rates
A study is being performed with the purpose of identifying the role of Lactobacillus in luteal phase support and the result of its presence in vaginal and cervical flora on live birth rates following IVF. Generally, the absence of Lactobacillus, a common microbe in the natural flora of the female reproductive tract, is related to Bacterial Vaginosis, an infection commonly associated with miscarriages, premature birth, and low birth weight infants.
For the purpose of this study, researchers will be dividing participants, all of whom have undergone the implantation procedure post-IVF cycle, into two groups where one group receives lactobacillus pills whereas the other group, or the control group doesn’t. The effects of this will be then studied to see if there is a difference in live birth rates between the control group and the interventional group.
- GnRH supplementation as a means of luteal support post-implantation during an IVF cycle
Implantation after a successful IVF cycle is often followed by progesterone injections to improve the endometrial lining and facilitate the implantation and maturation of the embryo. A recent study has found that an injection of GnRH at the time of embryo transfer for implantation can further facilitate the process, and significantly improve the live birth rates.
A clinical trial is being conducted to test the hypothesis where participants, all of whom have undergone IVF cycles, are divided into the control group and the interventional groups. The interventional group will be given the GnRH injection while the control group will be given a placebo and the results will be analyzed according to the difference, if any, between the live birth rates between the two groups.
- Johnson M. H. (2019). A short history of in vitro fertilization (IVF). The International journal of developmental biology, 63(3-4-5), 83–92. https://doi.org/10.1387/ijdb.180364mj
- Nosrati, R., Graham, P. J., Zhang, B., Riordon, J., Lagunov, A., Hannam, T. G., Escobedo, C., Jarvi, K., & Sinton, D. (2017). Microfluidics for sperm analysis and selection. Nature reviews. Urology, 14(12), 707–730. https://doi.org/10.1038/nrurol.2017.175
- Rose, R. D., Barry, M. F., Dunstan, E. V., Yuen, S. M., Cameron, L. P., Knight, E. J., Norman, R. J., & Hull, M. L. (2020). The BlastGen study: a randomized controlled trial of blastocyst media supplemented with granulocyte-macrophage colony-stimulating factor. Reproductive biomedicine online, 40(5), 645–652. https://doi.org/10.1016/j.rbmo.2020.01.011