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Having trouble conceiving? There are many things that can affect your fertility. India is facing a rising problem of infertility, and some of the leading factors behind it include late marriages, stress, pollution, obesity, high junk food intake, smoking, alcohol, and drug addiction. No need to worry, you can conceive via assisted reproductive technology (ART), like in vitro fertilization (IVF). Science combined with human touch has made it possible for infertile couples to achieve their parenthood dream.
In vitro fertilization (IVF) is one the most popular fertility treatment options. In this procedure, mature eggs are collected from ovaries and combined with sperm in a lab. The fertilized egg (embryo) or eggs (embryos) are then transferred to a uterus. This can be done using the couple's own eggs and sperm or taking the eggs and/or sperm from a donor. Here, picking the best embryo is crucial for a successful IVF treatment. The embryologists consider several factors while choosing an embryo for transfer.
Here, Dr Sujatha Ramakrishnan, Head- Embryology, Nova IVF Fertility, has shed light on the various factors involved in embryology for a successful IVF treatment, including the crucial techniques employed by embryologists to pick the best embryo in IVF. Keep reading
How embryologists pick the best embryo for transfer
According to Dr Ramakrishnan, the following are some of the crucial techniques that help embryologists pick the best embryo for a successful IVF pregnancy. These are:
AI-based embryo selection: Artificial intelligence (AI) along with a manual check by the embryologists, AI-based embryo selection helps to fine-tune and select the best embryos. This allows for improving the success rate for couples as only the best embryo is transferred into the uterus. The automatic sperm analysis technology will be beneficial during IVF treatment. This technology will look for things that the human eye can't spot.
Advanced IVF Lab: The efficiency of the embryology laboratory is associated with IVF success. It is the lab that mimics a woman's womb in this artificial reproductive technology. Therefore, we safeguard the egg and sperm and fertilize them in the lab by creating the best artificial environment. Since embryos are around 200 to 300 microns in size and invisible to the naked eye, they need special care. If not handled properly, embryos will lose their viability and will not result in pregnancy. Keeping all of these factors in mind, conditions are stringently monitored for the growth of embryos, such as air quality, CO2 level in the incubator, temperature, humidity, liquid nitrogen levels, freezing, and thawing conditions to ensure embryos are not damaged. Hence, a well-equipped lab makes a lot of difference. Exposure to dust, pollutants, and smoke in the air, tends to interfere with the IVF process and lowers the success rates. Thus, IVF labs should stay as sterile as possible. An IVF clinic should have separate sterile and non-sterile areas. Areas, where the patient interacts with doctors and staff, are non-sterile areas and should be isolated from the lab areas where the embryos are developed so these pollutants do not enter the lab.
The human embryo is very sensitive to the presence of chemically active compounds, volatile organic compounds, smells, etc. Hence, IVF labs are recommended to have 500- 1,000 ppm in the air. So, there should be a modular clean room that uses a combination of an HVAC air-conditioning system and PUF panels. The HVAC system controls temperature and filters harmful compounds thus controlling the level of particulate matter in the air. From the time the eggs are harvested till the time the embryo is transferred to a catheter to be inserted in the woman's uterus, all procedures must take place in this clean room. Thus, this clean room is the most important part of the IVF clinic.
Blastocyst stage: Blastocyst means a cluster of dividing cells created by a fertilized egg. It's the early stage of an embryo. It is one step among many that help a woman to get pregnant. A blastocyst forms about five to six days after a sperm fertilizes an egg. Layers of cells in the blastocyst divide and separate. So, the day of egg retrieval is considered Day 0 (IVF or ICSI is done after egg retrieval), the pronuclear stage on day 1 (embryologist checks as to how many eggs have successfully fertilised), the two to four-cell stage on Day 2, the eight-cell stage on day 3, the morula stage on day 4 and the blastocyst stage on day 5 or day 6. For patients with multiple failed IVF: Performing a blastocyst culture on a patient with a history of failed IVF with day2/3 embryo transfer, can yield more information related to the growth of the embryos and aid in improving the pregnancy rate. To eliminate multiple pregnancies: Blastocyst culture allows the possibility of transferring the single best embryo and thereby reducing the chance of multiple pregnancies.
Hands-on Training for Embryologists: When couples are unable to conceive on their own, they tend to approach fertility clinics. In many cases, IVF is advised as the best form of fertility treatment for them. This involves extracting healthy eggs and sperm from both parents, using them to create embryos in a lab, and then reintroducing them to the uterus. This is a very delicate lab procedure that must be done only by a trained embryologist. An embryologist is involved in egg retrieval, the introduction of sperm to the egg, and embryo transfer. For the egg retrieval, the doctor harvests the follicular fluid containing a viable egg from the ovary and gives it to the embryologist who is responsible for separating the egg from the fluid. For the creation of the embryo, the embryologist must make very small, delicate movements to help the sperm fertilize the egg. This is known as micromanipulation. During the embryo transfer, it is the embryologist who inserts the embryo into the catheter. Embryologists also play a key role in freezing spare embryos and thawing them for use at a later date.
Other forms of assisted reproductive techniques include Gamete intrafallopian tube transfer (GIFT) and Intracytoplasmic sperm injection (ICSI. Sometimes a combination of IVF and GIFT is used to help couples get pregnant. There also other techniques such as Zygote intrafallopian tube transfer and transfer of frozen embryos to a surrogate mother.
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