INDEX

SL.NO TOPIC
1. INTRODUCTION
2. HISTORY OF IVF
3. INDICATIONS
4. STEPS IN IVF
5. INITIAL EVALUATION
6. SUPPRESSION
7. OHSS SYNDROME
8. COLLECTION OF OOCYTES
9. EMBRYO TRANSFER
10. PERCENTAGE OF SUCCESS
11. CASE STUDY I
12. CASE STUDY II
13. CONCLUSION
14. BIBLIOGRAPHY
 Case study i
Couple triumphs over infertility through IVF
Long ago, Riya and her husband Sumeil were trying to
have a baby. A few months later, she was diagnosed
with Endometriosis (blocked fallopian tubes), where the
tissue from uterine lining extends outside towards the
fallopian tubes and neighbouring organs. It is not a
severe condition but causes great pain and many side
effects. It is also a common factor of infertility in women.
This is why, Riya opted for surgery to cure
endometriosis. In 2010, she and her husband had begun
trying for a baby. For four years, they failed to start their
family. At last, feeling frustrated, losing all hope and out
of options, Riya made an appointment at our clinic
International Fertility Centre (IFC) located in New Delhi.
At her first few visits, she learnt about the fertility issues
she was facing.
Riya says, “When I first spoke to Dr Rita Bakshi, she
was very patient and understanding. She confirmed that
endometriosis was likely the main reason behind my
inability to conceive, despite the surgery. She also
explained me in detail, why the odds of becoming
pregnant through natural means were less for me. She
had a well-defined treatment plan for me.”
From that point, Riya’s full one-year treatment began at
IFC. We advised her to undergo In-vitro fertilization.
“It was a very pleasant experience. They didn’t make me
feel uncomfortable in any way and I felt like they were
truly there to help me. Dr Rita Bakshi is the best doctor
for me as she was very supportive, compassionate,
understanding and motivating, Riya said.”
IVF treatment for endometriosis
The team at IFC decided Riya’s best chance for
pregnancy was In-vitro Fertilization. It is a simple
procedure that involves fusing of male parent’s sperm
and female parent’s eggs in a laboratory dish outside
the human body and then transferring into the female
parent’s uterus.
Riya added that “Dr Rita Bakshi was helpful and she
wished me good luck. It was the little things that the
doctors, nurses and other staff did at the clinic that
made my journey at IFC unforgettable.”
Patience, determination and success
A few months later, Riya and Sumeil had a successful
pregnancy.
“It was fortunate that we had a successful IVF in 2nd
cycle itself. I feel that the only Dr Rita Bakshi could have
helped us win over endometriosis and thus, helped us
conceive,” said Riya.
Riya and Sumeil gave birth to a baby girl in June 2015.
Closing Thoughts
My biggest piece of advice is to just relax. You should
have faith and you have to make your own future. I
would advise couples to try for pregnancy in the early
childbearing age before it’s too late.
 Case study ii
Poor Quality Eggs/Embryos in Young Women With Good
Ovarian Reserve: – A Fertile Couple Undergoing IVF with
PGD/Gender Selection

When I met Mary she was 34 years old. Both she and
her husband had proven fertility. They had over a
period of 5 years spontaneously and without
difficulty achieved three (3) full term natural
deliveries of healthy boys. Thereupon, they
desperately wanted to have a little girl and
sought the services of their local Reproductive
Endocrinologist (RE) to help them achieve their
dream. Her RE put her on clomiphene citrate and
performedintrauterine insemination (IUI) with
husband’s sperm which was first processed in an
attempt to bias the odds of their propagating
female embryos.
After four (4) back-to back failed attempts to
achieve a pregnancy, they were advised to
consider IVF. Fertilization would be achieved by
injecting each mature egg (MII) by intracytoplasmic
sperm injection (ICSI) with female gender biased,
processed sperm sample and thereupon to have the
resulting embryos subjected to preimplantation
genetic diagnosis (PGD) and karyotyped to identify
female embryos as well as to screen
forchromosomal integrity (“competence”) using
fluorescence in situ hybridization (FISH). They would
then selectively transfer one or more of the
“female” embryos to her uterus.
Mary had perfectly normal ovarian reserve (day-3
blood FSH/LH/ [E2]/AMH= 6.5MIU/ml/2.7
MIU/ml/47pg/ml/ 4.3 respectively) and accordingly
underwent three (3) successive IVF attempts using a
modest long pituitary protocol of controlled
ovarian stimulation (COS). She responded well, and
following 9 days of stimulation, she developed 14
follicles, 9 of which measured between 18 and 21mm
in diameter. at this point she was “triggered” with
250mg of Ovidrel [a DNA-recombinant form of hCG
(hCGr)].
She yielded ten MII eggs at egg retrieval, all of
which were successfully fertilized by ICSI. They went
on to divide (cleave). However on day 3 post-ICSI, all
showed a significant degree of fragmentation
(>20%), suggesting that they were of questionable
quality. By this time, one (1) embryo had reached the
8 cell stage of cleavage, one (1) was 6 cells and the
remaining two (2) were less than 6 cells. All four
embryos were all subjected to PGD followed by 12-
probe FISH to assess chromosomal integrity
(karyotyping).
For FISH to be effective, at least one (1) cell
(blastomere) must be removed (biopsied) intact and
sent to a reproductive genetics laboratory
for karyotyping and gender identification. In this
case, biopsies of two (2) of the four (4) embryos
failed to yield an intact cell suitable for
karyotyping. Accordingly, a 2nd cell had to be
biopsied (a rather traumatic development).
Karyotyping subsequently revealed that three (3)
of the four (4) embryos were female and one (1) was
male. Unfortunately, all had numerical
chromosomal abnormalities (aneuploidy) and none
developed into expanded blastocysts. Thus no ET was
performed.
Two (2) months later, a second In Vitro
Fertilization attempt was undertaken. The
same ovarian stimulation protocol was used, this
time yielding five (5) embryos that as in the 1st IVF
cycle were again significantly fragmented. Only
two (2) of the embryos had cleaved to the 6 -8 cell
stage. These two (2) embryos went on to develop in
to blastocysts. One was diagnosed as being a
chromosomally normal, female embryo and
subsequently developed into an expanded
blastocyst. this embryo was transferred to mary’s
uterus, but no pregnancy resulted.
The 3rd and final IVF attempt was conducted using
the same protocol (with a slightly higher dosage of
gonadotropins) and yielded five (5) embryos that
were once again fragmented. Three (3) were female
embryos and two were male. All three (3) female
embryos made it to the blastocyst stage but only
one (1) was deemed to be karyotypically normal
based upon pgd/fish. it was transferred to mary’s
uterus. once again…no pregnancy followed.
Mary was a young patient. She and her husband both
had proven fertility. Accordingly, her failure to
conceive with four (4) clomiphene-IUI attempts
coupled with the fact that 3 IVF attempts
consistently produced poor quality embryos
requires explanation
 bIBLIOGRAPHY
1.NCERT BIOLOGY BOOK CLASS 12
2.TRUEMAN ELEMENTARY BIOLOGY
CLASS 12
3.WWW.GOOGLE.COM
4.WWW.WIKI.IVF.IN
5.WWW.SIKINDIA.CO.IN
6.WWW.DOCFOC.COM
 CONCLusion
IVF is an artificial and unnatural procedure
whereby human beings are scientifically
manufactured in a test-tube. In the process,
countless human lives are thrown away and
systematically destroyed.

At the same time, this technology poses a threat

toward the health of women, along with the future
well-being of the children created. Not everything
is known about IVF, and to this day, these women and
children remain subjects of volatile
experimentation.

Taken from the words of the founding fathers

themselves, IVF is more than an infertility
treatment. It is a stepping stone toward further
manipulation of human beings for research purposes
and the selective creation of “designer” children.

In Vitro Fertilization threatens and disregards the

dignity and value of the human person. We do not
encourage nor support its use.