Over 2 decades and still sailing : Anu Test Tube Baby Centre
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The document discusses the advancements and challenges in in-vitro fertilization (IVF) techniques, including the early history of embryology and significant milestones in the field. It highlights issues such as ovarian hyperstimulation syndrome (OHSS) risks, the development of individualized treatment protocols, and innovations in genetic testing and cryopreservation methods. Additionally, it touches upon evolving ethical considerations, including donor anonymity and the advent of genetic testing for ancestry and health information.
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Over 2 decades and still sailing : Anu Test Tube Baby Centre
- 1. Dr. Anuradha Katragadda ANU TEST TUBE BABY CENTER
- 5. Search for „would – be – embryologist‟ Dr. Prasad, “a gift” Slaughter house – for sheep ovaries Hands on training at MFS Visit to other IVF centres
- 7. The „Night mares‟ Fertilization checks – night outs Procuring / bringing over; Drugs Ham‟s – F 10 powder Cleaning solutions „In – house‟ prepar-ations- Culture medias Flushing medias etc.
- 8. Present „scenario‟ Conferences, work-shops, courses, fellow ships Companies setting up labs, equipment, Availability of prepared culture medias Flying physicians & embryologists
- 9. Visit by Mr. Andy Walker, Sue Barlow Self-analysis / Quality-check
- 10. The most awaited event
- 12. The „I - IVF Baby‟ (early days of IVF) Birth of Louis Brown – July, 1978 „Steptoe & Edwards‟, the pioneers of In-Vitro-Fertilization (IVF) Result of a single oocyte retrieved in a natural cycle laparoscopically Performed for tubal factor
- 13. Time-line of major Mile Stones Initial experience with unstimulated cycles - Yielded on average 0.7 Oocytes / retrieval - Overall PR of 6 % / initiated cycle Stimulated IVF cycles with HMG - Extensively studied at Jone‟s Institute (1982) - 1980 – 83; - Recovery of 2.1 – 2.6 Oocytes / retrieval - PR 23.5 – 30 %
- 14. Conventional IVF (GnRH – analogue cycles) Prevalent problem - 20 % of IVF cycles cancelled; - Premature LH surge & ovulation Pituitary desensitization - Administration of GnRH-a (1984) - Incidence of premature ovulation 2 % - However, raise in incidence of potentially „life- threatening‟ OHSS (Nugent et al, 2000) GnRH – antagonist (1990‟s) -More friendly protocol
- 16. Stimulation Regimens – „What Terminolgy‟ „International society for mild approaches in Assisted Reproduction‟(ISMAAR)
- 17. COS - Complications Multiple Pregnancy Increased incidence of heterotopic pregnancies OHSS
- 18. Ectopic & Heterotopic Pregnancies Incidence of ectopic – 1.5 - 2 % With Ovulation Induction - 3 % With ART - 5 % Incidence of Heterotopic Pregnancies – 1 in 30,000 With Ovulation Induction & ART – 1 % Surgical treatment – viable option 1/3rd spontaneous miscarriages A high index of suspicion required
- 20. OHSS ‘ Loss of control over COH ’ Only after overstimulated ovaries ‘ exposed to hCG inj ’ C U L P R I T HMG HCG
- 21. Ovarian Hyperstimulation An iatrogenic complication Significant increase globally Incidence of moderate cases ≈ 5 % Incidence of cases requiring admission hospitalization ≈ 2 % Devastating consequence of OHSS is a serious threat to life – 3 maternal deaths 100,000
- 22. OHSS - FUTURE Design individualized treatment protocols In-Vitro maturation of oocytes Artificial ovary „ Mild ‟ stimulation for IVF Single embryo transfer (SET)
- 23. An OHSS – Free Clinic Segmentation – of – IVF treatment
- 24. Segmentation of IVF OHSS can be „erased‟ by applying ovarian stimulation using a combination of GnRH-antagonist with GnRH-agonist trigger - freeze all
- 25. Agonist - Trigger Possibility of luteal phase defect Reduced pregnancy rates 1. Rescue of luteal phase 2. „Freeze all‟ – a safe alternative
- 26. The Patient-friendly Protocol Segmentation of IVF – - Freeze-all & Frozen embryo cycle „The balance between the desire for pregnancy and patient‟s safety is a top priority‟.
- 28. Is antagon protocol- a universal protocol No-one-size Fits All
- 30. HMG GnRH ant. CC Mild IVF 0 7 14 Days 3 OR HCG F – 14 mm „ This method is likely to increase and possibly even replace the current conventional protocol in future‟.
- 32. Refinements in O.I drugs The initial regimens: Clomiphene citrate. Urinary gonadotropins Highly purified urinary Gonadotrophins In the late 1980s- early 1990s: addition of a GnRH agonist to achieve pituitary modulation. 1990s- Development of Recombinant Gonadotrophins, GnRH antagonists.
- 33. Refinements in techniques Moving away from operating room; Improvements in U/S Catalyzed evolution of modern oocyte-pick up Transabdominal / Transvosical (1982) Transvaginal U/S guided follicular aspiration (1987) Follicular aspiration – Using double lumen needle and follicular flushing Single lumen needle
- 34. Refinements in techniques Embryo Transfer Blind technique Under Trans-abdominal U/S guidance 3-D U/S guided Single Embryo Transfer
- 35. Addressing the needs of Infertile men Development of techniques to overcome fertilization problems PZD (Ist technique) SUZI ICSI (Ist pregnancy reported in 1992) Increasingly applied Created a new possibility for azoospermic men; MESA/PESA/TESE Nov, 1998
- 36. Cryopreservation Sperms Oocytes Young women with cancer, before chemo or radiotherapy To circumvent advancing age (social egg freezing – oocyte banking) (ASRM declared egg freezing - „no longer experimental‟, 2012) Embryos Ist reported pregnancy, 1983
- 37. Cryopreservation Techniques • Slow freezing • Vitrification ‘Embryonomics’- (Science of handling frozen accounts) - For storage problems
- 38. IVF – advanced techniques of Genetic analysis PGD / PGS – performed at DNA / chromosome level - PCR – Ist technique to detect single-gene-mutations chromosomal imbalances & mitochondrial mutations - FISH – to screen aneuploidy & chromosomal translocation - Both have high false Positives or Negatives Newer diagnostic methods – Improved clinical efficiency outcome a- CGH Karyomapping NGS Non-Invasive technology - „Time-lapse-imaging‟
- 39. Oocyte / Embryo Donation Gamete donation - The first sperm donor insemination-Philadelphia, in 1884 - First oocyte donation- Monash IVF centre, 1983 - Over last 2 decades, predominant indication for oocyte donation has shifted „Cross –Border Reproductive care‟. - gametes & embryos moving across borders - individuals travelling to different countries
- 41. The End Of Donor Anonymity Genetic testing Direct-to-consumer (DTC) Formation of large international genetic geneology databases DTC genetic testing- (commercial co.) „Family tree DNA‟- Offers Y-DNA matching database „The 23 and Me‟- Autosomal DNA test for males & females -to solve unknown parentage cases
- 42. End Of Donor Anonymity „uncovering secrets‟ Donor anonymity not guaranteed May drive gamete donation out of business
- 43. Change in the approach Increase in medico legal problems Video counselling Increased expectations Frills / website Patient – client Practice - Business Fast- track treatment
- 44. Changes which made greater impact on treatments Choosing safer O.I protocols Aiming for single follicle in O.I IVF - Antagon cycle with Agonist trigger and freeze all OHSS free clinic Individualising treatment protocols Improvement in OR, ET & lab. Techniques Blastocyst transfer, use of emb. glue Reducing no. of embryos transferred Increase in no. of frozen embryo cycles Availability of HP & recombinant drugs Refinements in fertility enhancing surgeries Robotic surgeries Use of versa point for hysteroscopic procedures Increasing incidence of PCO, endometriosis Low ovarian reserve Male infertility
- 45. Academics
- 47. Robert Edward – (Nov, 2002) James Catt – 2010 Robert Shaw – 2012 Dr. Fukuda - 2013 Other celebrity visitors Knowledge Sharing
- 48. Ways fertility treatments could change in the near, and far, future HLA – typing for stem cell donation Approaches to obtain stem cell from siblings „Designer – Babies‟ - Genetic make up has been artificially selected by genetic engineering combined with IVF (to ensure absence or presence of particular gene or characteristics) - British scientists granted permission by HFEA; Feb, 2016 Egg freezing -More women will freeze their eggs „Three-parent‟ embryos – To prevent passing on mitochondrial diseases