IVF Training in India: Overview
Wiki Article
In this article, we're going to
describe how in vitro fertilisation works. Let's first begin by recapping the
female menstrual cycle. Here is the brain and two important parts of the brain
involved in the menstrual cycle is the hypothalamus and the pituitary gland.
Due
to Covid, Medline Academics, which runs the top courses for
gynaecologists in the country - teaching and training programme came to a
standstill. But without loss of time, we got motivated to see that one of the
PAN India universities is willing to associate with us. The hybrid IVF Fellowship Training is for 12 months. Here we will be
giving 120 hours of clinical postings in addition to the 5 days simulation
training, exposing them with the different faculty members. Now coming to live
classes, it will be conducted twice in a week and will cover the topics from
basic to advanced topics in ART. During the practical training session, they
can meet their faculty in person.
For students pursuing the Best IVF Fellowship in India,
understanding controlled ovarian stimulation is fundamental to mastering the
IVF process. The first step is controlled ovarian stimulation and this is using
gonadotropin releasing hormone agonists or gonadotropin releasing hormone
antagonists plus gonadotropins such as follicle stimulating hormone and then
finally human chorionic gonadotropin or HCG. These three injections are used in
the first step of in vitro fertilisation and their role is to essentially
stimulate follicle development. So here is the hypothalamus and the pituitary
gland again and here is the ovary again containing many follicles ready to
develop. Normally as we have learned the hypothalamus produces gonadotropin
releasing hormone at day one of the menstrual cycle. Gonadotropin releasing
hormone stimulates the release of follicle stimulating hormone from the
pituitary gland. Follicle stimulating hormone will travel to the ovary to
stimulate follicle development.
Controlled ovarian stimulation using
gonadotropin releasing hormone agonists begin at day 20 of the previous
menstrual cycle the time when the corpus luteum is slowly degenerating and
gonadotropin releasing hormone agonists is continued until day 10 of the new
menstrual cycle. Gonadotropin releasing hormone agonists prevent spontaneous
follicle rupture due to luteinizing hormone surge and promotes follicle
development. At day one of the menstrual cycle gonadotropins are introduced.
Gonadotropins are there to stimulate
follicular development. When ultrasound monitoring indicates that the eggs are
mature human chorionic gonadotropin is injected to induce final follicle
maturation and development and subsequently ovulation. This is about day 10 of
the menstrual cycle.
Gonadotropin releasing hormone
agonists stimulates gonadotropin releasing hormone activity. Gonadotropins
mimic follicle stimulating hormone stimulating follicle development and human
chorionic gonadotropin stimulates the final follicle development. Another
initial drug that can be used for controlled ovarian stimulation is
gonadotropin releasing hormone antagonists. Again the hypothalamus produces
gonadotropin releasing hormone which stimulates the pituitary to release
follicle stimulating hormone. Follicle stimulating hormone stimulates the
development of some follicles from the ovaries. In this method at day one you
start gonadotropins to stimulate follicular development. The careful and
correct application of Gonadotrophin Releasing Hormone Agonists and Antagonists
along with the use of Gonadotrophins and Human Chorionic Gonadotrophins is
important to achieve a positive ovarian response. At Dr Kamini Rao Hospitals
the doctors individually tailor the stimulation protocol depending on the age
of the patient, ovarian reserve, hormonal profile and history of past treatments
so that a higher number of follicles may be harvested while lowering risks
associated with the treatment. Dr Kamini Rao Hospitals is an establishment
known for its evidence-based fertility treatment and IVF Treatment in Bangalore.
At day six gonadotropin releasing
hormone antagonists are introduced to prevent spontaneous follicle rupture due
to the luteinizing hormone surge and to promote follicle development. When
ultrasound monitoring indicates that the eggs are mature human chorionic
gonadotropin is injected to induce final follicle development and ovulation at
about day 10. The ova or egg is then collected about 36 to 38 hours after the
human chorionic gonadotropin injection.
This brings us to step two of in
vitro fertilisation which is oocyte retrieval. Here again is the lower female
reproductive tract, the vagina, the uterus, the fallopian tube and the ovary.
The ova or eggs are collected about 36 to 38 hours after the human chorionic
gonadotropin injection.
Oocyte retrieval is performed using a
long hollow needle introduced via the vagina under ultrasound guidance. Here
the needle is retrieving the egg from the mature follicle. Eggs are then placed
in culture media and incubated before being fertilised.
And this brings us to the third step
of in vitro fertilisation which is fertilisation. And fertilisation here occurs
in the laboratory. The oocyte which has been retrieved are fertilised with the
male sperm collected and this is day zero.
By day one the first cell divisions
take place in the laboratory. Cell division continues and by day three to five
the embryos will be transferred back into the uterus. And this is step four,
embryo transfer.
Here again we have the female uterus
and its structures. During embryo transfer one or more embryos are transferred
back into the uterus about three to five days after the oocyte has been
collected. Once transferred the embryo can then implant into the inner lining
of the uterus called the endometrium.
Once this occurs the final step of in
vitro fertilisation which is luteal phase support takes place. And this
essentially involves progesterone. Luteal phase if you remember is the phase of
the menstrual cycle where progesterone is normally produced.
And this is exactly what this step
involves. Progesterone is given to help support and maintain the pregnancy. The
embryo as mentioned is carefully put back inside the uterine cavity where it
will implant in the endometrium of the uterus.
This process is called implantation
and will lead to pregnancy. And as mentioned progesterone here helps maintain,
helps support the pregnancy. Let us recap now the five important steps in in
vitro fertilisation.
·
Number
one was controlled ovarian stimulation. And this was with gonadotropin
releasing hormone agonists or gonadotropin releasing hormone antagonists plus
gonadotropins plus human chorionic gonadotropin.
·
The
second step is oocyte retrieval.
·
The
third is fertilisation in the laboratory. Four is embryo transfer into the
uterus. And five is a luteal phase support using progesterone.