In Vitro Fertilization (IVF)

Most couples who want a child are able to have one naturally. Some cannot, even after trying for years. When a couple cannot conceive after trying for a long time, we say they face infertility. Sometimes doctors find a clear cause, such as a blocked fallopian tube or too few sperm. Sometimes every test comes back normal and the cause stays unknown.

Here is a case of the kind doctors meet often. A woman aged 38 and her husband aged 42 have been trying to have a child for five years. Tests for infertility show no cause. Her ovulation cycle is regular, which means her ovary releases a mature egg every month as it should. Her reproductive tract is also normal, as shown by hysterosalpingography. Her husband's sperm count is normal too. Still they have no child, and they are disappointed. In this situation the doctor advises them to adopt in vitro fertilization, or IVF.

Why would a doctor suggest IVF when every test is normal? In IVF the egg and sperm do not have to meet inside the woman's body at all. They are brought together in a laboratory, where the doctors can see for themselves whether fertilization has taken place. Whatever hidden problem is stopping conception inside the body, this gives the couple another way.

In normal conception, the father's sperm meets the mother's ovum (egg) inside her fallopian tube, so fertilization happens inside her body. In vitro fertilization is different. The words "in vitro" are Latin and mean "in glass". The name tells you where fertilization takes place: outside the body, in a glass dish in a laboratory.

IVF is a method of conception that differs from normal sexual intercourse. It is not one single act but a complex series of procedures. It is used to help couples with reduced fertility and couples with genetic problems. The medical methods that help such couples are together called assisted reproductive technology, and IVF is the most effective of them.

A child born through IVF is physically and mentally normal. IVF changes only the place where the egg and sperm meet. It does not change the child who grows from them.

The story of IVF begins in Manchester, England. A woman named Lesle Brown had suffered for many years because of a blockage in her fallopian tubes. The fallopian tube is the path an egg travels from the ovary to the uterus, and it is where sperm normally meets the egg. With her tubes blocked, egg and sperm could never meet, so she could not conceive.

The British gynaecologist Patrick Steptoe and the scientist Robert Edwards had been doing research on IVF for about ten years. In November 1977, Lesle Brown underwent the experimental IVF procedure. A mature ovum was taken out of her ovary and fused with her husband's sperm in a dish in the laboratory, forming an embryo. A few days later the embryo was transplanted into her uterus.

When the media found out about her conception, she faced intense investigation, because nothing like it had happened before. On 25th July 1978, Lesle Brown gave birth to a daughter by caesarean section. The girl was named Louise Joy Brown. She is the first child in the world to be born by in vitro fertilization.

In Nepal, IVF technology began in 2004, when an IVF centre was established at Om Hospital. On March 3, 2005, Rajendra Tamang and Sandhya Tamang had a baby through this process. The baby was named Om Mani Tamang, and is Nepal's first test-tube baby. Since then, couples in Nepal no longer have to travel abroad to try this method.

IVF is done in a sophisticated laboratory. The whole process follows the journey of one egg: out of the ovary, into a dish, and back into the uterus as an embryo.

The procedure goes in this order:

• A mature ovum (egg) is taken out of the woman's ovary. This is called egg retrieval.
• The ovum is kept in a petri dish in the laboratory.
• Sperm from the man are added to the dish, and the ovum and a sperm fuse. This is fertilization, and it happens outside the body.
• The fertilized ovum divides and becomes an embryo. It is kept in the laboratory for a few days.
• The embryo is transferred into the woman's womb (uterus). This is called embryo transfer.
• The embryo grows in the uterus just as in a normal pregnancy.

One complete IVF cycle takes about three weeks. It may take longer, depending on the nature of the couple's problem. Some couples need more than one cycle before a pregnancy begins.

A child's characters come from the ovum and the sperm that formed it. So whether an IVF child resembles its parents depends on whose ovum and whose sperm were used.

If the couple's own ovum and sperm are used, the child inherits characters from both of them, like any other child. But some couples have problems producing ovum or sperm. For them, an egg, sperm, or both can come from a donor, who may be known or unknown to the couple. A child formed from a donor's egg or sperm carries the donor's characters for that half. So the characteristics of a child born through IVF may or may not match those of the parents who raise it.

IVF has given children to many couples who had lost hope. Its main advantages are these:

• IVF is the best method of conception for couples who cannot conceive because of various problems related to conception.
• It allows conception using a couple's own sperm and ovum, or a donor's sperm and ovum.
• It is more successful than other assisted reproductive techniques.
• It helps to solve problems related to various chromosomal disorders in the child.
• Infertility and genetic problems can be solved by this technique.
• It increases fertility and reduces the risk of miscarriage.
• It increases the chance of having a healthy child.

Chromosomes are the structures in a cell that carry genetic information, and a fault in them is called a chromosomal disorder. In IVF the embryo is formed in the laboratory, so it can be examined before it is placed in the uterus. This is how the method helps couples with genetic problems to have a healthy child.

Useful as it is, IVF also has limits and risks:

• There is no guarantee of a successful IVF cycle. It may fail, and it may take more than one cycle.
• There may be various side effects associated with the use of IVF.
• The problem of multiple births at the same time can also occur.
• Adopting this technique may cause emotional stress in the couple.
• There is a chance that the embryo might be implanted outside the uterus.
• It is an expensive method.
• There is also a chance of premature birth of a baby with low weight.

Multiple births means having twins or triplets at one time. An embryo implanted outside the uterus cannot grow into a normal pregnancy, and this can be dangerous for the mother. Failed cycles, high cost and long waiting are what put stress on the couple.

Artificial insemination and IVF are both assisted ways of reproduction, so they are easy to confuse. The main difference is where fertilization happens.