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Infertility is a common condition, with an increasing rate of incidence in society. According to the Indian Society of Assisted Reproduction, anywhere between 10 to 14% of the Indian population suffers from this condition meaning almost every one out of six Indian couples have had some form of infertility to grapple with. Even in absolute terms, this is a rather high number with over 27 lakh couples known to be actively trying to conceive but have to deal with infertility.
However, the good news is that over the last decade the advances that have been made in the field of assisted reproduction are massive and therefore, there is hope after all for those who harbour dreams of parenthood but might be suffering from some form of infertility. The advances that have been made include the ones to improve the quality of eggs, in older women as well as new stimulation protocols in younger ones. There is a better understanding and protocols now available regarding the number of mature oocytes to be retrieved and the time of Embryo Transfer during an IVF cycle. All of these have resulted in improved rates of pregnancy and a higher number of parenthood dreams coming true.
Currently, one can say that IVF is the gold standard of infertility treatment, and has changed the field of infertility over the decades. There have been constant improvements in the methods and technologies associated with it and this has meant that IVF is now much more simplified, uncomplicated, better understood and produces better results for expectant parents. In a country like India, the method is also an economically viable option, with its comparatively lower cost of treatment.
We live in an era of personalization, and personalized medicine is fast catching up in every sphere of our lives and IVF is no exception to the same. The advanced protocols being implemented as part of IVF are now specific to each individual to obtain an optimal number of eggs that can make enough healthy embryos to result in a positive pregnancy. However, what has remained consistent over time is the efficacy of IVF irrespective of the method used, IVF can and is personalized for each individual for best results. The personalized use of drugs and alteration of dosage has now further improved the possibilities of positive pregnancies as well as made the procedure safer.
Ultrasound scans play a vital role in the IVF treatment as it helps monitor the development of the follicles in the ovaries, measure the thickness of the endometrial lining, and others. The scans are also vital in the process of egg retrieval as they help navigate the vaginal walls to the ovaries.
Now the emergence of artificial intelligence is further revolutionising how ultrasound assessments are done, and how they help the IVF process.
While a transvaginal ultrasound scan is both cost-effective and highly beneficial to identify any possible challenges to the IVF cycle, the procedure can offer inconclusive result due to the great degree of inter obstruction & Intra obstruction variability. However, with the advent of artificial intelligence, these variations can be minimized.
Further advancements in IVF cycles include transvaginal oocyte retrieval (TVOR), or also known as ovum pick-up (OPU) which is egg collection from the ovaries. These methods allow for the removal of oocytes (OPU) from the ovaries of the donor female, to be fertilized outside the body and then transfer the same to the womb. This allows for much larger fertilized embryos to be available for implantation in recipient bodies per IVF cycle.
Transfer of the embryo to the recipient womb is the final step in the IVF process. Fertility experts employ various medications for the stimulation of ovaries which in turn causes the releasing of eggs which are then retrieved and fertilized in a laboratory. Following the fertilization, the embryos are transferred into the women's uterus for further development.
Improving protocols, equipment, and understanding of the procedures have now made this, even more, safer and offers a greater level of success per IVF cycle.
In addition to fertility experts, a successful IVF requires the help of embryologists who study the prenatal development of gametes, fertilization, and the development of embryos and fetuses. As stated earlier, during the course of IVF, mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab, which is then transferred to the uterus for further development.
A complete IVF cycle takes about three weeks to be accomplished and embryologists play a vital role in the same. They hold the mandate for the maintenance of the laboratory environment that is most conducive for embryos to flourish; for the actual egg retrieval; monitoring fertilization; incubation and monitoring of the preimplantation genetic testing; cryopreservation and the final embryo transfer.
Alongside, IVF, the improvement and advances in prenatal diagnostic testing has also made fertility treatments safer, cost-effective, and deliver improved results. PGT refers to testing at a genetic level, which before its advent had been a more visual analysis of the embryos.
PGT is accomplished by taking a very small but representative biopsy of an embryo and analysing it for genetic abnormalities. The advent of AI and time-lapse technologies have further revolutionized pregenetic testing.
The time-lapse methodology is an optimized culture system w minimized culture-induced stress, allowing for the evaluation of embryo development without any disturbance at the cellular level, a phenomenon that was impossible with traditional techniques. Automatic annotation of embryo development (cell stages and cell cycles), embryo grading, and embryo selection for implantation are all additional developments in the ecosystem facilitated by AI and adding to the improving rates of success.
Thus, major developments have been achieved for the improvement of the media used both in culture and vitrification (Freezing) in IVF. This means that we now have a near-natural culture environment for the developing gametes and the growing embryos. The vitrification has also neared perfection with close to 100% success rates.
(Authored by Dr. (Col) Sandeep Karunakaren, Clinical Head and Fertility Specialist, Oasis Fertility)
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