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A good IVF programme needs laboratory services of a high standard to ensure that the eggs, sperm, and embryos are maintained in an optimal environment in vitro, and this has been the major stumbling block for most IVF programmes. The major limiting factor with providing IVF services has been the availability of IVF laboratory expertise. The method of transport IVF offers a very attractive solution to this problem. Basically, this means that egg pickups are performed in peripheral clinics and hospitals; and the husband transports the follicular fluid (with the eggs) to the central IVF laboratory using a specially designed incubator which runs off the car battery. All IVF laboratory procedures, and later the embryo transfer, are carried out in the central laboratory.
This method allows gynecologists to take an active part in their patients’ treatment, ensure high quality, since all laboratory procedures are performed in a central IVF laboratory, and also allows one IVF laboratory to obtain the necessary experience and expertise that is so important for maintaining high pregnancy rates.
Making IVF culture medium in which the eggs and embryos are nourished in vitro is a major problem. Not only is very expensive equipment needed to produce this medium, but scrupulous quality control and testing is needed to ensure that each batch can maintain embryo growth. With the recent commercial availability of quality-controlled and tested culture medium - for example from Medicult and Scandinavian IVF, IVF programmes no longer need to make their own culture medium, as this can now be bought ‘off the shelf’. This has helped to minimize one of the variables which used to reduce pregnancy rates for IVF programmes - toxic culture medium.
Incubating the eggs and embryos in vitro requires expensive CO2 incubators, which must maintain just the right environment for the embryos for long periods of time. The method of intravaginal culture (IVC), however, allows one to provide IVF services without using a CO2 incubator and is an extremely attractive alternative. Basically, in IVC5 the eggs and sperm are placed in culture medium in a sterile vial which is hermetically sealed and then placed in the woman’s vagina where it is held in place with a vaginal diaphragm. This means that the woman acts like her own IVF incubator and keeps her embryos at the right temperature -- 37° C . This method requires less handling of eggs and embryos and provides a fertilization rate comparable to that of conventional IVF - at much less expense.
Perhaps the ultimate simplification in IVF is the method of transcervical oocyte-sperm transfer. As the name suggests, this simply involves transferring the eggs (oocytes) and sperm back to the uterine cavity through the cervix after egg pickup. The rationale behind this method is that fertilization will take place in the uterine cavity and the resulting embryo will then implant here. While studies of this procedure have been very preliminary, much research work is going on in this area.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
