The last few decades have seen revolutionary developments in the field of Assisted Reproduction. IVF is over 40 years old. It took hundreds of experiments on animal and human eggs and sperm before Louise Brown was born in Oldham, the UK in 1978. Scientific advancement calls for a healthy interaction of colleagues, scientific bodies and the media.

After much discourse, IVF received scientific and societal acceptance ultimately resulting in the Nobel Prize for Bob Edwards in Medicine or Physiology in 2010 for work leading to the birth of Louise Brown. However, scientific ignorance can thwart major discoveries. Dr Subash Mukhopadhyay created Indias first and the worlds second test-tube baby. Durga was born just 67 days after Louise Brown. The scientific climate did not allow Dr Mukhopadhyay his claim to fame. This resulted in a crushing halt to the spread of ART in India for almost a decade.

The earlier decades saw a plateau in success rates with IVF techniques. Several factors have made IVF a household name making it the standard of care for many infertile conditions.

The introduction of the hormones like LH (Luteinizing Hormone) & FSH (Follicle-stimulating Hormone) to bring about the formation of multiple eggs was a major step to improving success, as there were more eggs and embryos to choose from. Besides, efforts were made to better understand the microenvironment of the embryo. This resulted in nutrient medium satisfying the need for embryos at various stages of development thereby enhancing pregnancy rates.

A major breakthrough occurred for males with very low or no sperm counts, with the introduction of Intracytoplasmic Sperm Injection in 1992 by Dr Palermo & Dr Andre van Steirtegheim in Brussels. This caused a major paradigm shift in treating male infertility. In 1994, our team created Luv Singh the first ICSI baby in South-East Asia. The technique gave a major boost to the success of Assisted Reproduction in India.

The early 90s saw an interest in looking at genetic disorders in couples who were otherwise fertile. Handyside & his group described pregnancies after biopsy of human preimplantation embryos in cases of sex-linked diseases. Techniques were refined over the years so that instead of only 5 chromosomes being checked, today we have the ability not only to check for all 46 chromosomes but to also detect minor variations in the structure and placement of chromosomes by powerful platforms like Next Generation Sequencing.

The technique of Pre Implantation Genetic Testing (PGT) also applies to couples with inheritable mutations for genetic diseases like Thalassemia, Sickle Cell Disease, Duchennes Muscular Dystrophy, and Huntingtons Chorea. This technology has been a boon for couples who would otherwise be at risk of having a genetically compromised baby.

There has been a constant endeavour to enhance pregnancy rates for couples facing fertility issues. The endometrium i.e. the inner lining of the uterus may sometimes be ineffective in helping the process of implantation. We devised a co-culture technique called Cumulus Aided Transfer (CAT) for the first time in the world, in which cells surrounding the oocyte (Cumulus Cells), are used as a feeder layer on which the embryos can grow. This has resulted in better pregnancy chances.

Immunological competence and its vagaries are now better understood. Modulating the womans immune system can prevent the block from implantation.

Today we are witnessing diminishing fertility potential globally due to the presence of different types of pollution affecting the ovaries and testes, thus decreasing egg and sperm counts prematurely. Our team has successfully carried out Ovarian Rejuvenation by instilling Platelet Rich Plasma in the ovaries of such women.

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Better Success Rates of IVF Treatments - Health Files by Dr Firuza R. Parikh - ETHealthworld.com

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