World IVF Day: How medically assisted reproductive technologies can address infertility

Infertility is a significant concern worldwide, and India is no exception. In recent years, infertility rates have been on the rise due to various factors like changing lifestyles, delayed marriages, stress, pollution, sedentary lifestyles and medical conditions including low sperm count, poor sperm motility or morphology in the male and hormonal imbalances, genetic disorders, endometriosis, tubal blockages, ovulation problem or polycystic ovary syndrome (PCOS) in the female.  

According to a recent World Health Organisation (WHO) report, infertility affects nearly one in six adults worldwide, or about 17.5 per cent of all adults. Moreover, a recent survey of 7,000 respondents in major Indian metropolitan cities found the incidence of infertility in women above the age of 30 to be as high as 46 per cent. Also, infertility often creates one of the most distressing life crises that a couple faces. Coping with the multitude of medical decisions and the uncertainties that infertility brings can create great emotional upheaval for most couples. Many couples experience anxiety, depression, and feelings of being out of control or isolated.

With recent advancements in assisted reproductive technologies, and the expansion of other biological options, it has become easier to conceive today as compared to 20 years ago and with current success rates with IVF, almost 90% of infertile couples can hope to realise their dreams.

The various medically assisted reproductive technologies include:

• In vitro fertilization (IVF): The world’s first IVF baby, Louise Browne, was born 45 years ago and since then IVF has become the most successful method for treating almost all forms of infertility. It entails hormonal injections for the female partner, extraction of her eggs by a minor procedure, fertilization of these eggs with her husband’s sperm “in vitro” in a petri dish and replacement of the resulting embryos back into the female partner’s womb.

The commonest causes of a failed IVF cycle are suboptimal sperm or poor egg quality, an unreceptive uterus, rejection of implantation owing to immunologic factors, hormonal imbalances and sometimes unexplained. It is therefore important to remember that a full trial of IVF often entails 3-5 cycles with a proactive change of protocols for ovarian stimulation and other measures such as the application of frozen instead of fresh embryo transfer, testing of sperm DNA fragmentation, genetic studies, endometrial scratching, intrauterine Platelet-rich plasma, vaginal sildenafil, heparin, blastocyst culture, preimplantation genetic testing (in indicated cases) and finally third party reproduction. These “add-ons” need to be judiciously selected and applied as per the individual patient for optimal outcomes. “Individualized patient care and protocols” and “evidence-based practice” are essential to optimize the time to pregnancy for every patient.

Safety of IVF: As per available data and research, IVF babies seem to be just as healthy as naturally conceived babies. Abnormalities, if any, are more related to maternal age at the time of conception rather than the IVF technique used to achieve conception. Also, with good clinical practices, repeated attempts of IVF are safe and there are no long-term side effects on the health of the mother.

• Intracytoplasmic sperm injection (ICSI): For close to 15 years post the birth of the first IVF baby, scientists were struggling with male factor infertility (poor sperm quality) as fertilization rates with conventional IVF were very low. In 1992, the second major milestone was achieved with the discovery of Intracytoplasmic sperm injections (ICSI) wherein a single sperm is loaded in a micropipette and directly injected into the female egg. As a result of this technique, men with very poor sperm counts and quality and even those with zero sperm counts (where sperm can be directly retrieved from the testes in almost 50% of cases) can now have their own biological offspring. Success rates with IVF and ICSI are around 40-50% per cycle and it is important for the couple to be aware that IVF often entails multiple rounds and cycles of treatment.
• Preimplantation genetic testing (PGT) of the embryos is another recent advance which can benefit some patients with a history of recurrent miscarriages, hereditary disease or advanced maternal age.

• Vitrification: The third major advance in the field of ART (after IVF and ICSI) was the vitrification technique for freezing of eggs, sperms and embryos which ensures almost 99% survival of the frozen gametes / embryos and also helped introduce techniques of sperm banking, social egg freezing and freezing of surplus embryos in IVF cycles. Frozen embryo transfer often results in higher success rates for indicated cases. Cancer patients going in for chemotherapy or radiotherapy now have the option of preserving their fertility with egg / sperm freezing.
• Third party reproduction: Women of advanced maternal age, poor egg quality and recurrent IVF failures often need methods such as egg donation or gestational surrogacy for achieving their goals. So also, there are some men who despite repeated cycles of ICSI do not get success and might need to resort to the services of a semen bank.

The government is also making efforts and trying to make the healthcare system more accessible. Also, legislation (ART and Surrogacy acts of India) were introduced in 2021 to ensure better quality and regulation of treatment.

• Intrauterine insemination (IUI): Intrauterine insemination is a less intrusive and cost-effective choice for reproductive treatment especially for young couples with minor causes of infertility such as polycystic ovarian disease or unexplained infertility. Here the woman is given mild ovarian stimulating drugs, the ovulation is well monitored and at the time of actual ovulation, processed sperm is introduced into the uterine cavity using a fine catheter. This method enhances egg quality and ensures perfect timing of egg meeting good quality sperm.

IUI is also useful for donor sperm insemination for single women who wish to be mothers.

• Egg freezing: Egg freezing is a process that enables young women to store their eggs for potential use in the future. This process begins with hormone stimulation to encourage the production of multiple eggs. After that, the eggs are removed and preserved by vitrification which involves rapid freezing to avoid the formation of ice crystals. This technique is a huge boon to single women who have yet to find a suitable partner or are planning a late marriage and delayed childbearing for personal or career reasons. So also, for same-sex couples, egg freezing offers security and flexibility by enabling them to hold onto their fertility options until they are ready to start a family.

Advancements in medical science and technology, coupled with increased awareness and support, have provided hope for couples facing infertility in India. Same-sex female couples can achieve their aspirations of parenthood and build families with the help of modern techniques such as egg freezing, sperm donation and IVF. Single women have the option of freezing their “fertility in time” with social egg freezing. So also, embryo freezing is an option for married couples opting to postpone childbearing for various reasons.

Advancements in conceiving options provide renewed hope for those who are yearning to embrace parenthood, irrespective of their sexual orientation and age. If an individual is facing infertility, it is recommended to consult with a qualified healthcare professional for personalized guidance and treatment options.

The author is Infertility Specialist, Kamala Polyclinic – Grant Road, Mumbai. Views expressed in the above piece are personal and solely that of the author. They do not necessarily reflect Firstpost’s views.

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