Number stay I am Dr. Donna Villa organic collages practicing in Barcelona Bombay. And I thought we will speak today about the positioning of IVF in the treatment of infertility. Infertility is defined as the inability to conceive after almost a year of unprotected intercourse. So, there are many factors which can cause infertility and IVF is positioned today for certain important indications. 40 years back when the first IVF baby was gone, that indication was restricted for tubal infertility. What do we mean by that?

Every month egg is released from the ovary, it travels through the fallopian tube to go into the uterus and it means the sperm there to result in an embryo and a pregnancy. But if the tubes are blocked or destroyed are somehow not working, then there's no way the egg can meet the sperm. So IVF was first defined, developed so that the egg could be retrieved from the ovary before it ruptures mixed with the sperm in a petri dish. And then that resulting embryo was transferred back into the uterus so that we bypass the tube completely. So that was the process of test tube baby 40 years back, this was developed and in India, the first test tube baby was achieved by Dr. Indira Hindu Jaya at the km hospital where we were working at that time, and I remember during those days, to retrieve this particular egg, we used to use the procedure of laparoscopy which was a little cumbersome, you know to do a process up, retrieve all the eggs and then process it, mix it with the sperm.

So that was that was those times things evolved since then. And we don't use laparoscopy anymore to retrieve the egg IVF has become more patient friendly, and we use the ultrasound today to retrieve the eggs. So this development has made IVF so much more easier and accessible for all patients. Under the development which has also happened is when we take out the egg, we today possibly can take one sperm and inject it into that egg to fertilize it. This is known as interest cytoplasmic sperm injection, or Ixy. So the process of Ixy has revolutionized the IVF treatment and made it more accessible to couples where the sperm count is very, very low.

So sometimes and male infertility is difficult to treat. You know sometimes when there's no other way that we can get the sperm count up. Initially, we had no answers or no hope for this video. Who had a very low sperm count. But today IVF has opened a new VISTA for them. So anybody with a sperm count of less than 1 million, we recommend straightaway to go for IVF because we are not going to get results with any other treatment between one and 10 million.

If with other treatment modalities. conception hasn't occurred for about two years or so that again be restored to IVF. So indications have changed since the first indication of tubal block. Even for tubal block today, we first try to open up the tube by doing a history scopic. cannibalization if possible, but many times it is not possible. So the indication of tubal block does remain as one of the indications of IVF.

A second indication which has come up is a very low sperm count. Third common cause of infertility is an ovulation or chronic and ovulation. That is the egg is not being formed and not rupturing properly at the time, in many, many women and 60 to 70% of these women are women were suffering from Polycystic Ovarian disease. These women require drugs to stimulate the ovaries to form the egg. And once it ruptures, then it can meet the sperm naturally and then it can result in a pregnancy. So IVF is not the first line of treatment offered to them.

Definitely not. But a lot of factors come into play if if repeated cycles of ovulation induction have failed or repeated cycles with even what we what we call as integrated insemination of semen have failed. Then this is another major group which comes up for treatment with IVF. The fourth indication which is very common for IVF is endometriosis. endometriosis is a disease of the pelvis, where the pelvic anatomy is distorted. Typically, these women have a lot of pain during periods because there are lesions growing in the pelvis.

Sometimes these women present with her sensed in the ovary known as chocolate cyst, it is just filled with altered blood. Now this condition is difficult to treat and generally request surgery. These patients also have a distorted pelvic anatomy. So, sometimes the tubes even if the paitent do not work properly and many of them would require treatment for infertility IVF comes to the rescue because generally we find treatment with treatment of endometriosis with IVF giving us better results. The tricky part is that suppose that woman has a chocolate cyst do we operate first or we offer IVF first. So, because when we operate on a ovary and remove the chocolate says some amount of ovarian tissue normal wear and tissue is removed and so the the resulting ovary may have less As ovarian reserve after surgery today the recommendations say that if you have an ovarian or chocolate cyst which is measured in less than four centimeters, then men should first try IVF to achieve a pregnancy and not do a surgery first.

So that is about endometriosis, a very distressing condition which does many of the patients have infertility associated with it, but talking about a burden reserved. The other few group of patients which is really helped with IVF is patients with a very low ovarian reserve or sometimes women who have achieved premature menopause means that their eggs are over at a very early age. We have seen women with premature menopause as early as 2627 but in generally we have some women coming in the early 30s and there is ovarian reserve is very very low. Even after stimulating the ovaries we do not get follicles or we do not get eggs out Then these are the woman which we can help with IVF. And how do we do that? We recruited donor for these women, a donor is stimulated, the donors eggs are taken out.

They undergo IVF with this husband's sperm and the embryo is transported back into the woman with premature menopause. So she does care here on baby. So it's a huge difference which other IVF has made to this group of women who have gone into early menopause or menopause and the desire a child and this is done by donor eggs. The another chunk of patience 10 to 20% of infertile patients will have what is known as unexplained infertility means we just can't figure out what is wrong, why they haven't conceived. Apparently they're ovulating. sperm count is good things are going well.

But these patients do not achieve a pregnancy. And we don't know for what reason for these patients in general IVF is offered after adequate length of treatment by other modalities, simpler modalities, techniques, which do not involve so much of cost and the results which are better. But if nothing achieves a pregnancy as a last resort, we do offer them IVF treatment because sometimes it helps, because the success rate with an IVF is almost 40% as compared to modalities like a UI, which has got only a 10 to 15% success rate. So unexplained infertility is one of the indications for an IVF. But yes, we have to weigh the balance what is known as effectiveness against the cost and adverse effects of different treatments for this group of patients. There are rare indications but very useful ones for like fertility preservation in women who was under undergoing treatment for cancer, you can either remove the eggs and store them or form embryos and store them.

If a woman is undergoing treatment for malignancies. another indication is when the uterus is not functioning well or uterus is absent in some conservative cases and then we have the effect of surrogacy, but again the IVF can come to head. So these are the broad indications and it is where IVF has really spilled over to give us a good success rate for infertility treatment. So when we are faced with patients dealing with fertility problems, they can be divided into two groups. One group is patients who would definitely require treatment and they cannot do without therapy like patients with two blocks or is a sperm er, chronic and ovulation. And the second group is patients with reduced fertility chances but still have Enough.

John's considered Charles to conceive spontaneously with time. So one has to evaluate all the factors and then offer a particular line of treatment. It's not only an ovulation, which we talk about if it's an ovulation combine with a patient's age which is higher or a low ovarian reserve, then we put them on the IVF cycle earlier. But if it's a young patient who still has a lot of time with her, we would still refrain from going right to IVF and offer them simpler methods, which which can give them results. So everything is a balance between the cost of the treatment, the side effects of the treatment, the convenience of the patient, as against the success rate per cycle, what we achieve. So this is what makes us decide which couple would go for IVF and which would get a simpler treatment option and better result with that, of course, when one is talking about fertility or infertility as a as a problem, nothing has as much as a lot of luck on your side, and a lot of prayers, and sometimes things just work out very simply.

Sometimes we have to work at it. But then today, with so many treatment modalities, we have a lot of help, technically given to patients facing this problem of infertility. Thank you.