In vitro fertilization

The fecundation in vitro ( FIV ) is a technique of Procréation médicalement assisted and transfer of embryo ( fivete ). In 2007 whereas approximately 15% of the couples difficulties have of making children, approximately 2% babies of the rich countries result from in vitro fertilization, imagined and developped at the point in the Seventies and operational as from the years 1980.

History

the technique was developed in Great Britain by the doctors Patrick Steptoe and Robert Edwards. The first “test-tube baby”, Louise Brown, was born the July 25th 1978.
the first FIV in India, the second in the world, gave rise to Durga and was carried out with Calcutta by the doctor Subhash Mukhopadhyay the October 3rd 1978.
the first FIV with the the United States gave rise to Elizabeth Carr took place in 1981. Since this date, one estimates at 1% of the birth the number of new-born babies designed by this technique.
the first FIV in France gave rise to Amandine the February 24th 1982 with the Hôpital Antoine Béclère of Clamart (Hauts-de-Seine). It was carried out thanks to the collaboration of the biologist Jacques Testart and the gynecologist Rene Frydman.
the first FIV in New Caledonia gave rise to Céline Lepigeon the September 13rd 1990 with the Clinique Magniat with Noumea

Operational principles

Fecundation

The Sperm of the man, prepared technically to improve spermatic quality, is put in contact with the ovocytes of the woman, in sterile boxes containing of the wells. If there is fecundation with appearance of Pronucléi, the Embryon develops by cellular division. Two or three days after the day of the Fecundation, one or more embryos are reimplanted in the Utérus of the woman. The culture can be however thorough up to 5 to 6 days, where one obtains Blastocyste S.

The ovary S of the woman are stimulated in order to cause the Ponte several ovules. Generally, of the injections day laborers necessary, are supervised with multiple blood tests, and echography. Injections of hormone also make it possible to control the course of the maturation of the ovocytes. An injection intended to accelerate the ripening of the ovules is carried out 36 hours before the puncture ovocytaire. The puncture of the ovocytes is generally carried out under light or local general anesthesia in hospital medium for a hospitalization lower than 24 hours. Sperm is collected day of puncture of ovocytes (sometimes front if it were frozen), it “is then cleaned” of its plasma seminal and prepared in order to recover the most mobile spermatozoa and most typical (normal). Approximately: 100000 spermatozoa are put in contact with each ovocyte collected. Fecundation takes place in a dozen hours. It is current to obtain from 5 to 6 embryos on average, although this number can go to about thirty. The embryos are put in culture 48 hours at 6 days.

The embryos are classified according to their cellular quality, namely: their number of cells, their regularity (sizes of different cells or not), and of their fragmentation. The embryos used in priority are those whose chronology of the cellular division is respected, with quite regular cells and without fragmentation, because they give the best chances of pregnancy. The embryos are very irregular.

Transfer

Immediate

The embryos are usually transferred as of obtaining from the first divisions. Beyond, the culture medium used for the FIV is not adequate any more to ensure their growth.

Delayed

The transfer can be later and the phase of culture is prolonged five to six days after fecundation. The embryos are maintained in culture until the stage Blastocyste. These prolonged cultures require the recourse to special mediums. The advantage of the transfer at the stage blastocyste is to allow a control of the beginning of the embryonic growth, critical stage of the development where occur of many stops. The blastocystes have a better rate of establishment.

Differed

The embryos not transferred at the fresh state can be preserved by congelation, for replacement later, in the condition however which they are of a sufficient quality. The embryos which were frozen beforehand during the first transfer, are defrosted and selected the day before or the day the transfer, which takes place according to the same protocol. The rate of establishments successful after transfer of frozen embryos is slightly lower. However this technique remains interesting, because it makes it possible to increase the number of transfers (and thus the chances of pregnancy) starting from one only puncture.

Generally two to four embryos are transferred in the uterus. According to the quality of the other embryos obtained, those can be frozen for a later transfer. Those could be re-used in the event of failure or if the parents wish to have another child. This technique is called transfer of frozen embryos .

Establishment

After this transfer, approximately 12 days are required to have the insurance that a Grossesse develops. It is indeed the time necessary so that appears in blood, with detectable concentration the β-HCG, the Hormone secreted by the embryo which is used as diagnosis with the pregnancy.

• If the rate of β-HCG is definitely higher than 50 mUI/ml after 10 days, it is the sign of a beginning of pregnancy.

• If the rate of βhCG is lower than 50 mUI/ml: it can be a question of a residual rate of hormones related to stimulation. It is advisable to remake a proportioning of control 48 hours in order to check later if the rate increases or on the contrary decreases.

Intracytoplasmic injection of spermatozoa

The intracytoplasmic injection of spermatozoa ICSI is a technique which tries to cure the cases where the spermatozoa cannot fertilize the ovule spontaneously. It occurs in vitro and consists in directly injecting a spermatozoon in the ovule. The transfer of the embryos obtained is then identical to that of a FIV.

Artificial insemination

Related techniques

It happens that the establishment of the embryo fails. To increase the chances of pregnancy, the medical team can propose to replace between 1 to 3 embryos, this according to the clinical and biological parameters in their possession and after discussion with the couple.

Ethical aspects

The techniques of procreation médicalement assisted can be put into practice according to two formulas:

with a gift of cells (it is what indicates the letter “D” after “IA” in “IAD”: “artificial insemination with sperm of a donor”);
with the cells of both joint exclusively (it is what indicates the letter “C” after “IA” in “IAC”: “artificial insemination with sperm of the spouse”).

The ethical problems involved in the FIV are numerous:

Handling of the life as of its beginning: temptation of Eugénisme
Congelation of the embryos: legal status and moral of the embryo. To become Embryo frozen. Twins born several away years…
Risk of multiple births, therefore of prematurity.
embryonic Reduction, posing the same ethical problems as the Abortion.
Possibility for a very old woman of putting at the world: responsibility for the life.
Confusion of the concept of paternity: woman carrying the child of his daughter, donor of sperm, donneuse of ovule: Who is the father? Who is the mother?
Possibility of Traffic of embryos.
That to make not reimplanted embryos?
should be tested the embryos to be reimplanted in certain cases? (family with hereditary disease, therapeutic embryo)

Legal framework (Swiss)

In order to profit from a FIV or a ICSI (Intra Cytoplasmic Sperm Injection), the following conditions must be filled:

There does not exist/more other means of treatment.
the couple could have a complete maintenance on the chances and the risks of a FIV or a ICSI and to have had the possibility of requiring a psychological support.
the couple signed an assent with the treatment and the congelation of the zygotes.
One month of reflection ran out between the signature of the assent and the beginning of the treatment.
In Switzerland, the FIV and the ICSI can be proposed only with capable heterosexual couples capacity to assume a child.

Note

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