Historical background
The development of reproductive technologies required decades of meticulous work. Basic principles and approaches to fertilization outside the human body began to be developed as early as the 1960s.
A key breakthrough in this field of medicine was achieved by British scientists — gynecologist Patrick Steptoe and physiologist Robert Edwards. It was their joint efforts that led to a historic event: in 1978, the world's first child conceived via the "test-tube" method was born in Great Britain. The scientific community highly appreciated this contribution to overcoming infertility, and decades later, in 2010, Robert Edwards was awarded the Nobel Prize in Physiology or Medicine.
Stages of the procedure
In vitro fertilization technology is a strictly regulated algorithm comprising eight consecutive steps:
- Hormonal stimulation. The patient is prescribed medications that induce superovulation. This is necessary to ensure that multiple oocytes mature in the ovaries rather than just one, as in a natural cycle.
- Oocyte retrieval. Specialists extract preovulatory follicles directly from the woman's ovaries.
- Sperm collection. Male germ cells are obtained either from the ejaculate or, if necessary, surgically (via testicular or epididymal puncture).
- Gamete preparation. Before fusion, a thorough quality assessment of the harvested male and female germ cells is performed.
- Fertilization. The prepared gametes are combined in laboratory in vitro conditions.
- Embryo culture. The embryos develop in a special medium for 2–3 days. The target stage at which culture concludes is the morula (at this stage, the embryo consists of 12–16 blastomeres).
- Selection. Embryologists evaluate the quality of all developing embryos and select the most viable and promising ones.
- Implementation (transfer). The selected embryos are gently transferred into the woman's uterine cavity for subsequent implantation.
Clinical features and indications
An important aspect of the procedure is controlling the number of transferred embryos. In modern practice, the standard is to transfer 2–3 embryos. Increasing this number to four or more does not increase the likelihood of pregnancy. On the contrary, it critically increases the risk of multiple pregnancy, which is often accompanied by severe obstetric pathologies and complications.
The main indications for the procedure are:
- Absolute female factor infertility. A condition where natural conception is impossible due to the complete absence of the fallopian tubes or their pronounced obstruction (typically as a consequence of previous inflammatory processes or major surgeries).
- Execution of complex reproductive programs. The method allows for the use of embryos derived from the eggs of women who, for health reasons, are unable to carry a pregnancy themselves.
Briefly: answers to topical questions
What are the medical indications for in vitro fertilization?
Medical indications and situations in which in vitro fertilization or ART with IVF is used according to sources:
- Tubal factor — absolute female infertility due to the absence or obstruction of the fallopian tubes.
- Ineffectiveness of IUI — if intrauterine insemination fails within 3–4 cycles, transitioning to ART, including IVF, is recommended.
- PCOS with anovulatory infertility — ART/IVF programs are classified as 3rd-line therapy after the failure of preceding treatment stages.
- Male factor — in cases of azoospermia, a combination of IVF + ICSI is used; spermatozoa are obtained surgically from the epididymis or testis.
- Resistant ovary syndrome — restoration of reproductive function is only possible via ART methods: IVF with a donor oocyte.
- HIV infection in discordant couples — ART is used as a safe method to achieve pregnancy while minimizing the risk of infection for the partner and the future child.
What complications can arise in a woman during and after IVF?
During and after in vitro fertilization, the following source-confirmed complications and related conditions may occur:
- Ovarian hyperstimulation syndrome (OHSS) — characterized by abdominal pain, nausea, and vomiting; ultrasound findings describe bilateral symmetric enlargement of the ovaries, multiple thin-walled cysts/follicles, free fluid in the abdominal cavity/ascites, or pleural effusion.
- Ovarian cysts — listed as a side effect of follitropin beta administration for superovulation induction in ART programs.
- Multiple pregnancy — the risk increases with the transfer of a greater number of embryos; transferring 4 or more embryos does not increase the probability of pregnancy but increases the risk of multiple pregnancy, which is associated with serious obstetric problems.
- Ectopic pregnancy — IVF is listed among the factors that directly or indirectly create an excess of progesterone, leading to slowed peristalsis of the fallopian tubes.
What is the difference between conventional IVF and ICSI (Intra Cytoplasmic Sperm Injection)?
The main difference between conventional IVF and ICSI lies in the technique of in vitro fertilization.
| Characteristic | Conventional IVF | ICSI (Intra Cytoplasmic Sperm Injection) method |
|---|---|---|
| Fertilization technique | Retrieved oocytes are placed in a special medium containing at least 100,000 spermatozoa | Micromanipulation-assisted introduction of a single spermatozoon under visual control into a mature oocyte at metaphase II of meiosis |
| Indications/clinical scenarios | Described as the standard IVF procedure | Presence of only isolated spermatozoa; in azoospermia, a combination of IVF + ICSI is used with spermatozoa obtained surgically from the epididymis or testis |
| Considerations in HIV | No cases of HIV transmission to the child or mother have been registered worldwide when using conventional IVF with sperm processing in serodiscordant couples | There is an opinion that ICSI is safer than conventional IVF due to the absence of prolonged contact between the oocyte and a large volume of sperm suspension, but there is no scientific evidence of the superiority of ICSI over IVF; the fundamental possibility of oocyte infection during ICSI with a probability of 0.00002% has been proven experimentally |
To quickly memorize the timelines and volumes in IVF, use the "rule of twos and threes": embryos are cultured in the laboratory for 2–3 days, after which strictly 2–3 of the best embryos are transferred into the uterine cavity.
Class and exam questions
At what stage of development is the embryo transferred into the uterine cavity?
Transfer is performed at the morula stage, when the embryo consists of 12–16 blastomeres. The embryo typically reaches this stage on the 2–3rd day of culture.
Why are 4 or more embryos not transferred simultaneously during the procedure?
A large number of transferred embryos does not increase the chance of a successful pregnancy, but sharply increases the risk of multiple pregnancy, entailing serious obstetric problems.
What is the primary indication for this technology?
The primary indication is absolute female infertility caused by the absence or obstruction of the fallopian tubes due to inflammation or previous surgeries.
What else to study on this topic
- Mechanisms of hormonal superovulation induction
- Surgical methods of sperm retrieval (testicular and epididymal puncture)
- Criteria for assessing gamete quality prior to in vitro fertilization
- Features of the cellular structure of the embryo at the morula stage
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