IVF

The First IVF Baby born on July 25 1978 (left)

IVF consists of collect the oocytes (eggs) after ovarian stimulation (see superovulation) to increase the number of eggs available. The oocytes are inseminated in culture with a prepared specimen of spermatozoa (sperm) and fertilisation and cleavge monitored before embryos are transferred to the uterus. Procedures which allow fertilisation outside of the body have been regulated in some countries by governments and have raised serious ethical, religious, legal and political questions.

Laparoscopy

Patrick Steptoe -looking down laparascope - & Jean Pudie (right)

The first IVF baby was born as a result of collecting an egg by laparoscopy. Patrick Steptoe had pioneered the use of the laparoscope in gynaecology - a procedure which is now used extensively but was considered in the late 1970's to be 'a dangerous procedure'. Patrick Steptoe and Robert Edwards achieved the first IVF birth on July 25th 1978, although they had achieved an ectopic pregnancy some time before that. That pregancy was the result of a single egg being collected.

The photograph on the right (taken by Patrick Steptoe down the laparascope) shows a single follicle as a shiny structure towards the bottom left of the ovary.

In the animated sequence of stills from a video (a loop which repeats itself) the needle can be seen entering the follicle at the bottom left of the ovary. Aspiration (sucking out the follicular fluid then takes place resulting in the a collapse of the follicle as the fluid enters the collection pot (right). The animation can be stopped by pressing ESC but can only be restarted by loading the page again. RELOAD. The collection pot/tube is then passed to the embryologist - insemination takes place after a short interval on the same day.

Ultrasound Directed Egg Recovery

Today egg recovery is seldom carried out by laparoscopy. Ultrasound directed methods were introduced in the 1980's - first by the abdominal route through the abdominal wall an a full bladder - then by the transvaginal route. Ultrasound directed method are far less invasive and can be carried out under sedation, pain relief, or anaesthetic.

The oocytes are inseminated (placed with the sperm) soon after egg collection. If fertilization takes place, 18-22 hours later two pronuclei can be seen - these fuse shortly afterwards and cleavage (cell division) commences. Embryos can be transferred at the early cleavage or blastocyst stages. Those embryos not transferred can be stored by cryopreservation. Embryo biopsy and preimplantation genetic diagnosis can be undertaken before embryo transfer to test for certain genetic disorders.