INTRODUCTION:

Assisted reproductive technology (ART) means any of a

variety of medical procedures conducted to aid reproduction
by manipulating 'outside of the body' oocytes (eggs), out of
which in vitro fertilization (IVF) is the most commonly used.
The term "in vitro" translates to "outside a living organism".
The first successful IVF birth is known as the birth of Louise
Brown, which took place in July 1978 and was a landmark
achievement orchestrated by Dr. Robert Edwards and Dr.
Patrick Steptoe in England. Dr. Edwards for the Nobel Prize
in Medicine in 2010.
IVF could be used in the management of a wide range of
causes of infertility, namely: blocked fallopian tubes, male
factor infertility, and unexplained infertility. These advances
in technology mean that genetic testing of embryos and the
ability to freeze embryos for future use are now
commonplace, generating much more flexibility around
treatment and increasing the chances of success.
DR. Robert Edwards DR. Patrick Steptoe
In vitro fertilization (IVF) is a common treatment for infertility and
certain genetic conditions. Before opting for IVF, couples may
explore less invasive alternatives, such as fertility medications to
stimulate egg production or intrauterine insemination (IUI), where
sperm is placed directly into the uterus around the time of ovulation.
IVF remains a key solution when other methods prove ineffective or
when specific medical conditions require more advanced intervention
to achieve pregnancy.
Fallopian tube damage or blockage:
Damaged or blocked fallopian tubes prevent eggs from traveling from
the ovaries to the uterus, hindering fertilization or embryo
implantation.
Ovulation disorders:
When ovulation is irregular or absent, fewer eggs are available for
fertilization. IVF can bypass this issue by stimulating egg production
and retrieving mature eggs directly for fertilization.
Endometriosis:
Endometriosis occurs when tissue similar to the uterine lining grows
outside the uterus, often affecting the ovaries, uterus, or fallopian
tubes. This can impact fertility, making IVF a recommended
treatment.
Uterine fibroids:
Noncancerous fibroids in the uterus can interfere with embryo
implantation, especially in people over 30. If fertility is affected, IVF
can help by bypassing these fibroids during embryo transfer.
Issues with sperm:
Low sperm count, poor motility, or abnormal size/shape of sperm can
hinder fertilization. IVF, combined with intracytoplasmic sperm
injection (ICSI), can overcome these sperm issues for successful
conception.
Unexplained infertility:
When no clear cause for infertility is found, IVF may be
recommended as a primary treatment to increase the chances of
conception when other methods haven't been successful.
Genetic disorder:
IVF with preimplantation genetic testing (PGT) can screen embryos
for specific genetic conditions before implantation, helping reduce the
risk of passing on inherited disorders to the child.
HOW IS IN VITRO FERTILIZATION PERFORMED?

EGG RETRIEVAL TECHNIQUE

Ovarian Stimulation:
First of all, to produce many eggs, ovarian stimulation is carried out, as more
than one egg is needed for a successful outcome. FSH and LH are hormones
that are usually administered. The hormone human chorionic gonadotropin
(HCG) as well as the use of other medications may be given to speed up the
eggs' maturation. Progesterone supplementation could also begin to thicken the
uterine lining to prepare for embryo implantation.
Egg Retrieval:
When the eggs are properly mature, egg recovery is carried out 34 to 36 hours
after the last hormone injection before ovulation occurs. Through the
transvaginal ultrasound aspiration process, a thin needle is led through the
vaginal wall and then into the ovaries where the follicles involve it to take out
the eggs. The procedure lasts around twenty minutes, and multiple eggs can be
gathered on the spot without delay. You might feel slight cramps, or pressure,
after treatment. The eggs recovered are then put in an appropriate liquid
medium in the laboratory so they can mature further and be ready for
fertilization.
Conception–About the Removal of Sperm:
In the event that your partner’s sperm is involved, a semen sample will be
collected on the day of the egg retrieval. Typically, this is the result of the male
masturbating, yet there are other methods, such as testicular aspiration, which
are used; that is, when ejaculation is not possible or if sperm count is low. There
is an alternative sperm from a donor to use as well. The most healthy sperm are
then separated from the semen in the laboratory and then only these are chosen
for fertilization.
INTRACYTOPLASMIC SPERM INJECTION
(ICSI)

BLASTOCYST CULTURE
Conception:
Two techniques are employed for fertilization of the oocytes in the laboratory:
Conventional insemination: Healthy sperm and mature eggs are joined
together and kept in a controlled environment in the lab, where natural
fertilization occurs.
Intracytoplasmic sperm injection (ICSI): One sperm is directly put into each
mature egg which is the most common method used when there are the quality
or quantity of sperm issues or when the previous IVF cycles have been failed to
fertilize with the sperm.
Embryo Transfer (Optional Procedures):
After the fertilization, the development of the embryos is monitored. Several
optional procedures might be proposed before embryo transfer:
Assisted hatching:
The development of the embryo involves it that “hatch” out of its protective
covering and thus the surrogate womb is implanted. Assisted hatching consists
of cutting a small aperture in the embryonic wall to induce gestation of the
embryo to the endometrial surface of the uterus, especially for old women or the
embryos which have been cryopreserved, as the membrane may become brittle
with freezing.
Preimplantation genetic testing (PGT):
This procedure refers to the step of embryos being screened in order to detect
the most common congenital disabilities or chromosomal problems before they
are inserted into the uterus. A small number of cells are taken from the embryo
is checked this way for the genetic disorders and it in effect prevents the disease
from being passed on by the parents. Even though this method can diminish the
risk, it cannot rid of it completely, and prenatal tests might be relevant towards
the end of the gestation period.
Once the healthiest embryos are identified, they are transferred into the uterus in
the hopes of successful implantation and pregnancy.
SUCCESSFUL IVF METHODS USED IN INDIA
Some of the most commonly used and successful IVF techniques in India
include:
1. Conventional IVF (In Vitro Fertilization) - This involves ovarian
stimulation, egg retrieval, fertilization in the lab, and embryo transfer. It’s
widely used and has a success rate that ranges between 40-50%,
depending on age and health conditions.
2. ICSI (Intracytoplasmic Sperm Injection) - This method is especially
useful for male infertility cases. It involves injecting a single sperm
directly into an egg to increase fertilization chances. ICSI has a success
rate of around 45-50%.
3. PGT-A/PGS (Preimplantation Genetic Testing for Aneuploidy) - This
is used to screen embryos for chromosomal abnormalities before
implantation. It improves success rates by selecting healthy embryos,
especially beneficial for older women or couples with a history of genetic
conditions.
4. Frozen Embryo Transfer (FET) - Here, embryos are frozen for future
use, which allows the body to recover from ovarian stimulation before
implantation. FET can offer comparable or even higher success rates than
fresh transfers in certain cases.
5. Blastocyst Transfer - This involves growing embryos in the lab for five
days until they reach the blastocyst stage. It’s considered more effective
for implantation as only the healthiest embryos are selected, improving
the chances of successful pregnancy.
6. Assisted Hatching - Used for patients with previous IVF failures or older
women, this technique helps the embryo "hatch" and implant more easily,
slightly improving success rates.
Each center may have varying success rates, often between 35-50% per cycle.
Centers such as Nova IVF, Cloudnine, Indira IVF, and others in major cities are
well-known for their success rates and specialized techniques.
The trend with one of the highest success rates in IVF is Preimplantation
Genetic Testing (PGT) combined with Frozen Embryo Transfer (FET). This
approach often offers higher success rates for specific groups, particularly
women over 35, patients with recurrent pregnancy loss, and those with a history
of genetic issues.
THE LATEST TREND: PGT + FET AND ITS
BENEFITS

Why PGT + FET Has High Success Rates:

1. Embryo Screening with PGT: By testing embryos for chromosomal
abnormalities before implantation, PGT ensures only genetically healthy
embryos are used, which reduces the risk of miscarriage and increases the
chances of implantation. This can raise the success rate to 60-70% in
some cases.
2. Frozen Embryo Transfer (FET): FET allows for embryos to be
implanted in a more natural, stable uterine environment. By freezing
embryos, the body can recover fully from ovarian stimulation, leading to
higher implantation and pregnancy rates.
Success Rates and Target Groups:
 Younger Patients: Typically see success rates of 60-70% per cycle with PGT +
FET.
 Older Patients (over 35): Experience significantly better outcomes with this
approach, as it helps to screen for chromosomal abnormalities that become
more common with age.
 Patients with Previous IVF Failures: Often benefit from higher implantation
rates with PGT + FET, as the process increases the likelihood of using a viable
embryo.
This combination is widely adopted and offers the most success for couples
seeking optimal outcomes in IVF treatments
The combination of Preimplantation Genetic Testing (PGT) and Frozen
Embryo Transfer (FET) is currently one of the most promising approaches in
IVF due to its ability to enhance success rates through careful embryo selection
and an optimal implantation process. Here’s a closer look at how each of these
techniques works and why their combination is effective:
1. Preimplantation Genetic Testing (PGT)
 Purpose: PGT involves testing embryos for genetic or
chromosomal abnormalities before implantation. This is
especially important because genetic issues in embryos are a
common cause of IVF failure and miscarriage.
 Process:
1. After fertilization, embryos are grown in the lab to the
blastocyst stage (around five days post-fertilization).
2. A few cells are biopsied from each embryo, which are then
sent for genetic testing while the embryos are frozen.
3. The testing identifies embryos with the correct number of
chromosomes (euploid) and screens out those with genetic
abnormalities (aneuploid).
 Benefits: Selecting only healthy, chromosomally balanced
embryos increases the chances of a successful implantation,
healthy pregnancy, and live birth. This testing is especially
beneficial for patients:
o With recurrent pregnancy loss
o Over age 35, where chromosomal abnormalities in
embryos become more common
o With a family history of genetic disorders
PREIMPLANTATION GENETIC TESTING
(PGT)
2. Frozen Embryo Transfer (FET)
 Purpose: FET allows embryos to be transferred at a time when
the woman’s body is in the most receptive and natural state,
which generally increases implantation success.
 Process:
1. Embryos that have undergone PGT are frozen using
vitrification, a quick-freezing method that preserves the
embryos effectively.
 2. The woman can then prepare for transfer at a later date,
either through natural ovulation or a controlled hormonal
protocol.
3. At the optimal time in the cycle, the embryo is thawed and
transferred into the uterus.
 Benefits: FET allows the woman’s body to return to normal
after ovarian stimulation, which is part of the standard IVF
cycle, leading to a more stable uterine lining for implantation.
Additionally, freezing also enables PGT to be done without
rushing, and embryos can be stored for future use if needed.
FROZEN EMBRYO TRANSFER (FET)
Combined Success Rates of PGT + FET
 Higher Pregnancy Rates: Clinics report up to a 60-70% success rate per
transfer cycle with PGT + FET, significantly higher than standard IVF
without these techniques.
 Reduced Risk of Miscarriage: Since only healthy embryos are selected,
PGT significantly reduces miscarriage rates, especially valuable for older
women.
 Improved Outcomes for High-Risk Groups: This method is particularly
advantageous for patients with failed IVF attempts, unexplained
infertility, or genetic issues in family history.
Considerations and Limitations
While PGT + FET is highly effective, it is also more costly, as genetic testing
adds to the total cost of IVF. Moreover, the freezing and thawing processes can
sometimes affect embryo quality, although advanced vitrification methods have
minimized this risk.
Overall, PGT + FET represents a significant advancement in IVF, giving
patients a better chance of a healthy pregnancy and reducing emotional and
financial strains associated with repeated cycles. This technique is a preferred
choice in leading IVF centres in India and globally, especially for patients who
want to maximize their chances of success in fewer cycles.
IVF SUCCESS: PGT + FET IN INDIA

The success rate of the Preimplantation Genetic Testing (PGT) combined

with Frozen Embryo Transfer (FET) procedure in India varies depending on
factors like the patient’s age, the fertility clinic, and underlying health
conditions. On average, the success rates reported in India for PGT + FET can
be quite promising:
1. For Women Under 35: Success rates for PGT + FET in this age group
can reach approximately 60-70% per transfer cycle.
2. For Women Aged 35-40: Success rates are generally around 50-60% per
transfer cycle.
3. For Women Over 40: Success rates may decrease but can still range
between 40-50% per transfer cycle, depending on individual health and
embryo quality.
Factors Influencing Success Rates in India:
 Clinic Expertise and Technology: Reputable clinics with advanced
technology, such as Cloudnine, Nova IVF, and Indira IVF, tend to have
higher success rates for PGT + FET procedures.
 Laboratory Standards: The quality of embryo freezing techniques
(vitrification) and genetic testing accuracy are crucial for success.
 Embryo Quality and Uterine Environment: Embryo quality, the health
of the uterine lining, and adequate luteal phase support impact the
likelihood of successful implantation.
In India, the combination of PGT and FET is regarded as one of the most
effective IVF approaches, especially for couples with a history of failed IVF
attempts, recurrent miscarriages, or genetic disorders. This approach minimizes
the risk of miscarriage and increases the likelihood of a healthy pregnancy
CONCLUSION
In vitro fertilization (IVF) with the combined use of Preimplantation Genetic
Testing (PGT) and Frozen Embryo Transfer (FET) has emerged as one of the
most effective approaches in assisted reproductive technology, particularly for
couples facing infertility challenges, recurrent pregnancy losses, or genetic
concerns. This project has explored the comprehensive steps involved in IVF,
with a focus on the benefits and success rates associated with the PGT + FET
procedure.
The PGT process enhances IVF outcomes by allowing for the selection of
chromosomally normal embryos, significantly reducing the risk of miscarriage
and improving the chances of a healthy pregnancy. Coupled with FET, which
allows the embryo transfer to occur when the woman’s body is most receptive,
this method has consistently demonstrated higher success rates, reaching up to
60-70% per cycle in certain cases, particularly among younger women. By
identifying and utilizing only genetically viable embryos, this technique
increases the likelihood of successful implantation and full-term pregnancy,
offering renewed hope for patients with complex fertility needs.
In India, leading fertility centers have adopted PGT + FET, setting a new
standard for successful IVF treatments. Despite the higher cost associated with
genetic testing and advanced freezing methods, the PGT + FET approach
represents a significant advancement in reproductive medicine, reducing the
emotional and financial burdens associated with multiple IVF cycles. This
combination of techniques not only optimizes pregnancy outcomes but also
empowers couples with greater control and confidence in their journey toward
parenthood.
In conclusion, PGT + FET has become a preferred choice in modern IVF
treatment, offering a promising solution for individuals and couples striving to
build families. As reproductive technologies continue to evolve, these methods
hold great potential for transforming the future of fertility care, both in India
and worldwide.
BIBLIOGRAPHY:

1. Cloudnine Fertility –
[Link]
2. Nova IVF Fertility – [Link]
3. Indira IVF – [Link]
4. Indian Society for Assisted Reproduction (ISAR) –
[Link]
5. European Society of Human Reproduction and
Embryology (ESHRE) – [Link]