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Following the path of Nobel laureate…

British scientist Robert G. Edwards, who co-developed in vitro fertilization therapy along with gynecologist Patrick Steptoe, has just been awarded this year's Nobel Prize in Medicine. With his help, the first "test tube baby" was born in 1978, and since then, about four million babies have been conceived using. The process known as IVF, has till date facilitated millions of couples in experiencing and realizing their dream of parenthood. The process basically helps infertile couple, who are suffering from an ailment that prevents natural fertilization in enjoying the joy of parenthood.

As early as the 1950s, Edwards had the vision that IVF could be useful as a treatment for infertility. He worked systematically to realize his goal, discovered important principles for human fertilization, and succeeded in accomplishing fertilization of human egg cells in test tubes (or more precisely, cell culture dishes). His efforts were finally crowned by success on 25 July, 1978, when the world's first "test tube baby" was born. During the following years, Edwards and his co-workers refined IVF technology and shared it with colleagues around the world.

Approximately four million individuals have so far been born following IVF. Many of them are now adult and some have already become parents. A new field of medicine has emerged, with Robert Edwards leading the process all the way from the fundamental discoveries to the current, successful IVF therapy. His contributions represent a milestone in the development of modern medicine.

When it was introduced, the procedure was a hot-button issue that raised religious, moral, and scientific concerns. Now it is more scientifically accepted, and long-term studies of IVF children confirm that they are as healthy as other children (it's been noted that many have since gone on to have children of their own).

In a short span of 32 years, IVF has become the cornerstone of reproductive medicine, and IVF clinics today routinely perform techniques that were thought to belong to the realm of science fiction a generation ago!

Following the path laid by Edwards, the first in vitro fertilization centre of costal Karnataka was established as Manipal Assisted Reproduction Centre (MARC) at Kasturba Hospital, Manipal in 1990. Till now more than 15000 infertile couples have received treatment in Manipal Assisted Reproduction Centre (MARC) for various fertility issues. The centre is backed by the experience of expert doctors who have taken specialized training abroad and have been working with subfertility problems since several decades. The pioneering technological improvements make MARC one of the most advanced centers for the treatment of infertility in India.

What is test-tube baby technology

Test-tube baby technology is a general term for in vitro fertilization or IVF which is the basic assisted reproduction technique, in which fertilization occurs in vitro (in vitro is Latin for "in glass"). The man's sperm and the woman's egg are combined in a laboratory dish, and after fertilization, the resulting embryo is then transferred to the woman's womb.

How are patients benefited by test tube baby technique

Test tube baby techniques are the treatment option for couples with various types of infertility problems, since it allows the doctor to perform in the laboratory what is not happening naturally - we no longer have to leave everything up to chance! Initially, IVF was only used when the woman had blocked, damaged, or absent fallopian tubes (tubal factor infertility). Today, IVF is used to circumvent infertility caused by different problems like endometriosis; immunological problems; unexplained infertility; and very poor sperm quality like low sperm count or motility which can inhibit sperm from fertilizing an egg on its own. The microsurgical procedures like Intracytoplasmic sperm injection (ICSI) is helping the couple when there are few sperm or no sperm in the semen. Depending upon the clinical conditions, the sperm could be collected from the testis or epididymis (where sperm are stored before ejaculation) by a biopsy and a healthy sperm is picked up and then it is forcefully injected into the egg. It is a final common pathway, since it allows the doctor to bypass nature's hurdles and overcome its inefficiency, so that doctors can give nature a helping hand!

Various steps in IVF treatment

The major basic medical steps involved in an IVF treatment are superovulation (stimulating the development of more than one egg in a menstrual cycle), removing the eggs from the ovary just before ovulation, fertilizing with various methods depending upon the nature and quality of egg and sperm, growing the embryos in the incubator, and transferring the embryos to the womb after 3-5 days, in 9 months, the delivery of a healthy baby, a test-tube baby!!

Stimulation of the ovaries

In a natural menstrual cycle, a woman produces only one egg, but in order to increase the chances of pregnancy in IVF it is desirable to stimulate the ovary to produce several eggs. This is done by giving medication as injection for about three weeks to control natural cycle then additional injections (purified hormones) are given for about 10 days to make the eggs grow and these eggs are monitored. The eggs need to be exactly "ripe" at the time of their collection and so their development must be carefully monitored using blood tests and ultrasonography. Once the follicles have ripened the eggs are collected directly from the ovary.

Egg collection

The procedure is carried out in the fertility center’s operation theatre and takes about 15-30 minutes. During the procedure all that a woman is generally aware as there is no anesthesia required. A small needle is attached to an ultrasound probe and then inserted into the vagina. The eggs are collected from the follicles and then identified and assessed for their quality before it is used for fertilization.

Fertilization

After collection, the eggs are put into the incubator (a chamber which functions like mother’s womb) for a short time. Good quality sperm are separated from husband’s semen and then added to each egg. Out of thousands of sperm surrounding the egg, only one healthy sperm enters the egg and fertilizes it. If the sperm quality is very poor, fertilization is achieved by injecting a sperm directly into the egg. After 16-18 h, the fertilization is checked in the eggs.

Embryo development in the laboratory and transfer

The fertilized eggs are allowed to develop for 2-3 days in an incubator under the specialized condition and their development is monitored. The healthy embryos are selected and transferred to the womb of the patient by a simple painless technique.

Embryo freezing

Due to ovarian stimulation, the chances of getting more eggs and embryos are quite common in IVF treatment. But is not possible to transfer more than 3 or 4 embryos as it can cause multiple pregnancy. In such situation, the extra embryos are stored for future use by cryopreservation technique. If the patient fails to conceive in that cycle, the stored embryos can be transferred to the womb of the patient after 2-3 months. If she conceived, the same embryos can be used to get second child after few years as the embryos can be stored safely for several years. Transferring these embryos avoids initial phase of treatment like ovarian stimulation and oocyte collection etc and also reduces the cost.