Technological advancement: In vitro fertilization (IVF)

 

Dakshita Snud Sharma1, Sandip J Sutariya1, 2, Harmanpreet Kaur1, Hitendra A Somani 2, Amit Gupta1

1Department of Biotechnology, Graphic Era (Deemed to be) University, Dehradun.

2Nirmala Hospital IVF test tube baby center, Bhavnagar, Gujarat.

*Corresponding Author E-mail: dr.amitgupta.bt@geu.ac.in

 

ABSTRACT:

Due to its tremendous success ratio of in vitro fertilization (IVF) in India has gained boundless momentum. This is mainly applied and designed pertaining to overcome the infertility ratio and produce or cause a pregnancy which is mainly due to direct intervention. Generally, most of the aspiring parents either from rural or urban areas have taken the aid of IVF to full their desire to have children. IVF is welcoming as it is an extremely safe and result driven procedure. India is slated to be the world’s youngest country by 2020 and this has led India to become more liberal, advanced and there has been a huge change in lifestyle. This technique is more acceptable and recognizable in terms of artificial reproductive procedures. Now a day, IVF success rate is still staggering (nearly $829.5 million till 2023) according to the report of Allied Market Research. Due to its success rate in terms of advanced technologies, various people coming from rural areas also started to opt for this technique i.e. IVF and allied types of procedures (infertility) which is mainly not involved or depending any demographics and socio-economic background of an individual.

 

KEYWORDS: IVF, Rural areas, Children, Infertility.

 


INTRODUCTION:

In developing countries (e.g. India) where science and technology played an important part and crucial role in order to bring some social and economic transformation of our country, especially seen in rural areas. In rural developmental areas, where utilization and its protection of products, education and enhancement with respect to natural, physical along with human resources which are more essential to make long term improvements especially seen in rural living conditions1-3. The science and technology has a great significance related to IVF in urban as well as rural areas, it mainly provides jobs and income opportunities for the rural people as well while maintaining and protecting the environment4,5. The vast majority of the populations of the developing countries reside in the rural areas and therefore the increasing interest in rural development has been noticed, the main reason is to provide and necessary services to create better type of living conditions mainly within the rural areas.

 

There have been major objectives of rural development; to improve the living conditions by providing food, provide good medical treatment to improve health condition, shelter clothing, employment and education, to eliminate poverty and to enhance productivity in rural areas. Overall, IVF is more recognizable and vital in terms of science and technology4-6.

 

In India, surrogacy regulation bill firstly introduced in 2016 and proposed them only to permit heterosexual couples (minimum time required 5 years after marriage with infertility problems and banning commercial surrogacy). Further, this bill was reintroduced in year 2019 and mentioning about woman who gives birth to a child for an intending couple (hand over the child after the birth to the intending couple). This bill prohibits commercial surrogacy and does not involve any type of monetary compensation given to the surrogate mother excluding medical expenses along with insurance coverage during the pregnancy. The government has played a vital role in making our country more advanced and accepting in terms of science and technology. In 2020, Union Cabinet approved historic bill i.e. Assisted Reproductive Technology (ART) Regulation and it’s totally focused on women welfare in the country. In addition, this bill was also approved from Medical termination of pregnancy Amendment. These regulation bills are mainly involved in order to protect women's reproductive rights.

 

In short, this will regulate the Assisted Reproduction Technology services in India. In other words, infertile married couples will be more confident in terms of ethical practices applied in assisted reproductive technology bill throughout India. IVF’s affordable cost and the availability of installment payment have also increased its viability amongst needy couples. Overall, global IVF market size (USD 15 billion, 2017) and expected to grow at a CAGR of around 10 percent.

 

IVF procedures are bifurcated based on the usage of own egg and sperm or the use of a donor egg and/or sperm.  In India, collection of sperm banks are now available in various metro-cities attracting youngsters especially college students pertaining to donate their sperms in exchange of money6-8. Even the egg donation market is also booming due to the financially backward women are taking part in a huge scale, there are many agents who are supplying donors for the egg donation to the IVF clinics all over the India. Due to career focus or being not ready to carry a child in early or late twenties, the females are doing cryopreservation of their eggs for the future use and thus egg cryopreservation banks are also opening in numbers now a day6-9. As growth is more evident and provides a lucrative market, most of the business personalities are willing to invest in various chains of fertility clinics. This has brought a series of benefits for the IVF aspirants, as there have been sharing best practices, payment facilities are catered as per customer’s choice and they are at the receiving end of quality service.

 

For only those parents who are mainly deprived of parenthood owing to infertility issue, IVF may be giving some smiles to their faces. Basically, IVF centers helped couples with respect to its genetic or hereditary ailments which normally giving birth to healthy babies by the way of using pre-genetic diagnosis (PGD) and Pre-genetic testing (PGT). When we look into the history of IVF, Louise Joy Brown, the world’s first baby to be conceived via IVF (dated 25th July 1978) is born in Oldham and District General Hospital in Manchester, England, to parents Lasley and Peter Brown. On the day of 3rd October, 1978 created history by any Indian physician Dr. Subhash Mukhopadhyay to perform the first ever IVF (test tube baby named as Durga, popularly called as Kanupriya Agarwal). Now a day, India now stands as a very competitive IVF market for the world and is only growing stronger7-9.

 

Infertility:

A couple’s inability to conceive after 1 year of planned regular unprotected intercourse clinically defines as infertility, a condition which affects nearly 15% of the reproductive-aged population. In general, contributing male factor may exist or found in over half of cases with up to 40% of those being secondary to male factors alone. Male factor infertility is often characterized by abnormalities on semen analysis such as low sperm count, absent of sperm in semen sample, low motility and abnormal morphology of the sperms. Female fertility is checked by the AMH (Anti-mullerian Hormone) level. Infertility might be because of the male factor, female factor or some time its unexplained infertility.To overcome the infertility issue first started with medication, then intrauterine insemination (IUI), then conventional IVF, IVF-Intracytoplasmic Sperm Injection (ICSI), Intracytoplasmic morphologically-selected sperm injection (IMSI), ICSI-Testicular /Epididymal sperm aspiration or extraction (TESE)etc. procedures are developed over the time respectively6-9.

 

Modern IVF treatment has given hopes to many infertile couples worldwide. India has a leading role in an IVF treatment. Science and technology have played vital role in treating infertile couples over the time. Rural areas are also widely benefiting from infertility treatment now days but still the couples from rural areas are hesitating to visit a hospital for the treatment due to lack knowledge about the procedure. Government hospitals and IVF hospitals should take initiative to provide a proper knowledge about the procedure and council them thoroughly for the same.

 

Difficulties in providing fertility treatment for rural women:

Due to regional hospitals, less in numbers is reported in the rural areas and showing limited or less facility which is available and even though, doctors are not available or servicing full-time and this gap should be fulfilled. Obviously, such type of clinics has given some priorities at a large scale and fulfills their needs as soon as possible. In contrast, infertility along with treatment advice comes low as reported in rural areas. Most importantly, knowledge about IVF is very less or not aware where majority of people either thinks about the baby is made up of donor egg and sperm and not from their own. So, this myth keeps them away from taking an IVF treatment. In this treatment, infertility care and also monitoring revolves around several visits, adopted various specialized type of laboratory procedures and also given access to monitor and ultrasound its pelvic region and this is crucial both for diagnosis and treatment. The most familiar example is seemed in gonadotrophin-based assays where patients are ready to access and providing ‘helpline’ with a nurse coordinator10-12.

Infertility is not considered and believed to be a one-day visit, although most of the couples having lot of expectation, especially only when they will decide for going under an infertility treatment whatever it may be and it takes two days or several months. In normal circumstances, most of the partner should not be serious and showing less interest or somehow some partner only attend first visit. Now a day, our society is still aware and start thinking about infertility rate and this problem is not only for women but also man also faces equal infertility rate and such type of issues i.e. azoospermia (no sperm in semen sample); oligozoospermia (low sperm count); asthenozoospermia (low sperm motility) and teratozoospermia (low sperm morphology). In contrast, men should be ready for a seminal (motile cells) analysis sample and screening of these samples should be one of the biggest challenges especially reported in rural areas. Actually, those absent people with busy schedules and its lifestyles may be considered them as relevant infertility factor because of not having/planning a timely intercourse. In females, ovulation induction with FSH (follicle stimulating hormone) which is relatively managed and monitor and observe few cycles for timed intrauterine insemination. So, both partners may be responsible and need clear ‘road map’ and also prepared the timetable and monitor their progress if not received any quick result. Actually, plan should be properly executed in order to achieve a better result. Most of the studies where we find ovulation induction in females with gonadotrophins are fraught with some side effects. This may happen only due to the low-dose step-up regime and high order pregnancy rate is of major concern and its treatment length is totally unpredictable. So, valuable option i.e. in vitro fertilization (IVF) procedure is mostly reported in those couples where such types of situations are reported6-10.

 

Unfortunately, women do not take any believe of these types of effective contraception but that they have lot of missed conception. Now a day, idea of family planning starts thinks and trying at age group of 32 to 38. This is one of the biggest disappointment for a couple which leads to failure or not be able to fulfill their desires regarding children’s or somehow not be able to complete their family unit, even though when already successful the first time. So, we need to more focus and efforts should be taken in order to explain the benefits of childbirth in the early twenties. In general, many women suffers infertility problems at later stages so Assisted reproduction technology (ART) is only the last option but still it’s not considered as ending stage. Actually, this problem is more seen or reported in rural areas where they are totally unaware about this type of treatment11-15. In this regard, various efforts should be taken in order to open an IVF center especially seen in rural areas of India which is one of the difficult tasks till now. Recently, IVF centers are very less is seen in rural area because of lacking of knowledge especially reporting in the villages. Even though, such type of IVF centers are opened in rural area is so much expensive.

 

In villages, most of the ladies will hide their symptoms and causing various diseases. In this regard, IVF centre must be opened in rural areas and somehow tried to talk with villagers and provide some guidance related to IVF. In addition, OHSS female patients (enlarged ovaries where fluid buildup in the abdominal cavity) also reported in villages and immediately transferred to a major centre. We are highly thankful where antagonist protocols should be used and applied which may be able to lower the gonadotrophin dosage and also be able to declining in the incidence rate but cannot be claim to eliminate or diminished. While in case of assisted reproduction is somehow expensive but there are some effective ideas or methods which are cheap along with effective type of treatment which is mainly reported in the developing world e.g. Batch IVF Procedure, use of the generic/urinary base FSH rather than recombinant FSH. However, these techniques may not be able to affect the quality of the egg production13-18.

 

Overall, we may suggest or conclude that the referral process should be simplified now where some type of facility should be provided where it directly connects with the medical hospital and doing some initial assessment. So, these assessments should be highly helpful and passed or transferred this information in the form of data to the base hospital team where doctors/specialists including clinician, registrar, nurse coordinator and most importantly embryologist are also involved. All these types of appointments along with necessary investigations should be properly set up and also providing the facilities i.e. laparoscopy. If any couple visit in rural areas so it should be satisfy and performing all these tests should be done in more efficient and timely manner. So, such type of results are properly studied and reviewed continuously and further management person should discuss these things and planned accordingly.

 

CONCLUSION:

Good fertility care centre should be considered as one of the most profitable method for a nation where we needs people especially youngsters pertaining to look after ageing infertile couples with in the country who are hoping for their wishes to be fulfilled. Finally, those women are living in rural areas where we need the same chance and giving some opportunity in order to access the full range of reproductive care as urban and urbane women.

 

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Received on 29.07.2020            Modified on 13.01.2021

Accepted on 06.03.2021           © RJPT All right reserved

Research J. Pharm. and Tech 2021; 14(12):6721-6724.

DOI: 10.52711/0974-360X.2021.01161