Infertility is a significant problem and has a considerable impact on the lives of couples, especially in social and cultural contexts. It is very hard on couples and in India, is often regarded as a curse. Most of the couples try everything under this planet from quacks to alternative systems of medicine and often resort to astrologists and tantriks performing blank magic to become fertile. The Western system of medicine did not have much to offer earlier. However, in the 1970s and 1980s, infertility was considerably treatable and thus liberated the couples from the limited options available at the point of time (like adoption using donor insemination or becoming reconciled to childlessness). Fortunately. Over the last few decades our understanding of infertility. Its cause diagnosis and management have taken major strides forward. Couples with infertility began to see new hopes with the advent of in vitro fertilization (IVF). This technique is also known as “test-tube baby” as life is created outside the body with the union of sperm and egg in the laboratory and then transferred into the womb to grow until delivery. An array of assisted reproduction techniques (ART), each designed for treating different causes of infertility were then developed.
Launch of IVF
The technique of IVF was developed in the United Kingdom by Patrick Steptoe and Robert Edwards. The first ‘test-tube baby, Louise Brown, was born in Oldham. Greater Manchester, England. On July 25, 1978, amidst intense controversy over the safety and morality of the procedure. In India, Subash Mudhopadhyay became the first physician, and the second in the world to perform the procedure and produced the test tube baby ‘Durga’ on October 3. 1978. However, unfortunately, and paradoxically, instead of reorganization, the social ostracism, insult, reprimand, and refusal of the Indian Government to allow him to attend international conferences led him to commit suicide in 1981. Subsequently, major pioneering developments in IVF have occurred and IVF has exploded in popularity with as many as 1% of all births now being conceived in vitro, and since then 3 million babies have conceived through IVF.
Evolution of IVF
The introduction of fertility drugs and the ovarian stimulation process led to the concomitant increase in eggs recovered and embryos transferred. However, multiple eggs and embryos production necessitated the development of suitable embryo freezing techniques ( cryopreservation) which enabled the preservation of embryos for subsequent use by the IVF patients. Improvements in culture media, ovarian stimulation, and the introduction of oocyte maturation in IVF led to the sustenance of IVF pregnancies.
New techniques for egg and embryo donation were developed. Embryo donation was integrated into ART and helped to establish pregnancy in infertile or sterile women who had no ovarian function (sterile and older women usually> 40 years), worldwide. While IVF was considered a potential benefit for the treatment of male and idiopathic infertility, the development of Intracytoplasmic sperm injection (ICSI) in 1992 was a breakthrough in managing male infertility. In this technique, a single sperm is injected into the egg under microscopic guidance to ensure fertilization of the egg even with few sperms. Subsequently, ICSI has been adopted as the treatment of choice for all categories of male infertility, provided some sperm can be recovered from ejaculation or from testes.
Glimpses of Statistics
Infertility defined as the inability to conceive after one year of unprotected intercourse affects approximately 10% of couples. This is due to the fact that the probability of conception in one reproductive cycle is typically 20- 25%. And in One year is approximately 90%. There are various male and female factors leading to infertility; however, regardless of the cause of infertility, the treatment that leads to the highest pregnancy rate per cycle is IVF. There has been a remarkable increase in the number of IVF cycles worldwide since its inception in 1978. And success rates have increased every year approximately 1 in 50 births in Sweden. 1 in 60 births in Australia and 1 in 80- 100 births in the USA now result from IVF. In 2003 more than 1000,000 IVF cycles were reported from around 400 clinics in the USA. Resulting in the birth of > 48,000 babies.
Indications of IVF
Several groups of patients in which IVF treatment is useful to include women with blocked, damaged fallopian tubes or removal of fallopian tubes after ectopic pregnancies along with women with endometriosis cervical mucus problems. Men with infertility problems, men or women with immunological infertility, and couples with unexplained infertility are also groups in which IVF is beneficial. Even though the original indication for IVF was tubal damage, it is now used for a wide range of disorders such as unexplained infertility, endometriosis, male factor infertility, failure to conceive after successful ovulation induction, and failure to conceive after intrauterine insemination (IUI). In the case of severe male infertility, IVF is converted to ICSI. However, in the total absence of sperm and eggs, donor samples are used.
In spite of such a revolution in infertility management, until recently, the majority of infertile couples anywhere unable to get the benefits of IVF and ICSI. This is largely due to centers offering such treatments were few and the cost of procedures was beyond the reach of the majority.
