IVF : history of IVF in Iran

IVF : history of IVF in Iran

The history of IVF in Iran has been shaped by the interaction between the pioneers of IVF and an interdisciplinary group of experts, together with the endorsement and strong support of the Shia jurists.

• 1992 – Birth of the first baby following retrograde ejaculation using intrauterine insemination (IUI) first started in 1989 in Aban Hospital by Dr. Jalil Pakravesh (personal communication).
• 1994 – Birth of the first baby resulting from intracytoplasmic sperm injection (ICSI) and the birth of the first baby through egg donation carried out in Yazd by Dr. Mohmmad-Hossein Amir Arjomand (personal communication).
• 1996/97–Use of ICSI + percutaneous epididymal sperm aspiration (PESA) resulting in the birth of a baby at Shariati Hospital, Tehran, carried out by Dr. Hojat-Allah Saeedi (personal communication).
• 1998–First case of transferring an embryo produced from testicular spermatozoon by microinjection carried out by Dr. Akhondi (the author).
• 2004–Birth of the first baby born following pre-implantation genetic diagnosis (PGD) Royan Institute, Tehran, carried out by Dr. Leila Karimian (personal communication).

Indeed, the use of IVF in a range of contexts such as PGD(more…) (as a preventive measure for diseases with a genetic basis or for sex selection); sperm, egg and embryo donation; surrogacy; fertility preservation; and animal conservation (freezing of egg, sperm and embryo), are commonplace in Iran.

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IVF : Infertility treatment in Iran

IVF : Infertility treatment in Iran

According to the World Health Organization (WHO), infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months of trying.

Infertility affects an estimated 20.4 % of couples globally.

The figure will drop to 12.4 percent after two years of trying, adding it shows that many infertile couples can have a baby if they keep trying.

The couples aged 35 years and above are not recommended to use the method because any delay in childbearing would aggravate their infertility problems(more…).

Iranian couples no longer need to travel abroad for consultation or treatment for infertility as advanced methods of treatment for couples who have problems to conceive, are available in the country.

There are 3 million infertile couples in the country.  Around 3-4% of young Iranian women suffer from recurrent miscarriages. Infertility rate is about 2.5% and secondary infertility is more prevalent than primary infertility. When a woman is not able to conceive at all, (due to infertility in either spouse), it is referred to as primary fertility. Secondary infertility is when a woman is unable to conceive again after the first successful pregnancy and childbirth. While causes of secondary infertility vary, the most important risk factors are advanced reproductive age, weight gain, abdominal surgeries, sperm quality and quantity, and smoking.

Microsurgical reconstruction for male infertility, new methods of male infertility treatment(more..) (medication, surgery, and Intracytoplasmic Sperm Injection (ICSI)(more…)), the role of complementary therapies and medicines to improve fertility, and new imaging techniques for assessment of infertility problems in both genders, are among the main important topics that will be discussed.

At present, there are 80 infertility centers across the country and 20 more will be launched by the end of the current year.

Additionally, 35 state-run universities of medical sciences have equipped with new laboratory equipment and devices for identification and treatment of infertility problems.

IVF is never the first step in the treatment of infertility. Instead, it’s reserved for cases in which other methods such as fertility drugs, surgery, and artificial insemination haven’t worked.

On average, an IVF cycle costs $2,300-$2,900 in the country, while the majority of women have per-cycle success rates of 20-35%, which means they may need multiple tries to get pregnant.

IVF may be an option if one of the spouses or both has been diagnosed with problems like endometriosis, low sperm count, problems with ovulation, antibody problems that harm sperms or eggs, and unexplained fertility problems.

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IVF: side effects

IVF: side effects

Typical side effects include:

• Passing a small amount of clear or bloody fluid shortly after the procedure — due to the swabbing of the cervix before the embryo transfer
• Breast tenderness due to high estrogen levels
• Mild bloating
• Mild cramping
• Constipation

If you develop moderate or severe pain after the embryo transfer, contact your doctor. He or she will evaluate you for complications such as infection, twisting of an ovary (ovarian torsion) and severe ovarian hyperstimulation syndrome.

About 12 days to two weeks after egg retrieval, your doctor will test a sample of your blood to detect whether you’re pregnant.

• If you’re pregnant, your doctor will refer you to an obstetrician or another pregnancy specialist for prenatal care.
• If you’re not pregnant, you’ll stop taking progesterone and likely get your period within a week. If you don’t get your period or you have unusual bleeding, contact your doctor. If you’re interested in attempting another cycle of in vitro fertilization (IVF), your doctor might suggest steps you can take to improve your chances of getting pregnant through IVF.

The chances of giving birth to a healthy baby after using IVF depend on various factors, including:

• Maternal age. The younger you are, the more likely you are to get pregnant and give birth to a healthy baby using your own eggs during IVF. Women age 41 and older are often counseled to consider using donor eggs during IVF to increase the chances of success.
• Embryo status. Transfer of embryos that are more developed is associated with higher pregnancy rates compared with less developed embryos (day two or three). However, not all embryos survive the development process. Talk with your doctor or another care provider about your specific situation.
• Reproductive history. Women who’ve previously given birth are more likely to be able to get pregnant using IVF than are women who’ve never given birth. Success rates are lower for women who’ve previously used IVF multiple times but didn’t get pregnant.
• Cause of infertility. Having a normal supply of eggs increases your chances of being able to get pregnant using IVF. Women who have severe endometriosis are less likely to be able to get pregnant using IVF than are women who have unexplained infertility(more…).
• Lifestyle factors. Women who smoke typically have fewer eggs retrieved during IVF and may miscarry more often. Smoking can lower a woman’s chance of success using IVF by 50 percent. Obesity can decrease your chances of getting pregnant and having a baby. Use of alcohol, recreational drugs, excessive caffeine, and certain medications also can be harmful.

Talk with our doctors about any factors that apply to you and how they may affect your chances of a successful pregnancy.

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IVF: Ovulation induction

IVF: Ovulation induction

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If you’re using your own eggs during IVF, at the start of a cycle you’ll begin treatment with synthetic hormones to stimulate your ovaries to produce multiple eggs — rather than the single egg that normally develops each month. Multiple eggs are needed because some eggs won’t fertilize or develop normally after fertilization.

You may need several different medications, such as:

• Medications for ovarian stimulation. To stimulate your ovaries, you might receive an injectable medication containing a follicle-stimulating hormone (FSH), a luteinizing hormone (LH) or a combination of both. These medications stimulate more than one egg to develop at a time.
• Medications for oocyte maturation. When the follicles are ready for egg retrieval — generally after eight to 14 days — you will take human chorionic gonadotropin (HCG) or other medications to help the eggs mature.
• Medications to prevent premature ovulation. These medications prevent your body from releasing the developing eggs too soon.
• Medications to prepare the lining of your uterus. On the day of egg retrieval or at the time of embryo transfer, your doctor might recommend that you begin taking progesterone supplements to make the lining of your uterus more receptive to implantation.

Your doctor will work with you to determine which medications to use and when to use them.

Typically, you’ll need one to two weeks of ovarian stimulation before your eggs are ready for retrieval. To determine when the eggs are ready for collection, your doctor will likely perform:

• A vaginal ultrasound, an imaging exam of your ovaries to monitor the development of follicles — fluid-filled ovarian sacs where eggs mature
• Blood tests, to measure your response to ovarian stimulation medications — estrogen levels typically increase as follicles develop and progesterone levels remain low until after ovulation

Sometimes IVF cycles need to be canceled before egg retrieval for one of these reasons:

• Inadequate number of follicles developing
• Premature ovulation
• Too many follicles developing, creating a risk of ovarian hyperstimulation syndrome
• Other medical issues

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IVF FAQs

·         IVF

FAQs

1.   How many embryos will be transferred? The number of embryos transferred is typically based on the age and number of eggs retrieved. Since the rate of implantation is lower for older women, more embryos are usually transferred — except for women using donor eggs. Most doctors follow specific guidelines to prevent a higher order multiple pregnancies — triplets or more — and in some countries, legislation limits the number of embryos that can be transferred at once. Make sure you and your doctor agree on the number of embryos that will be transferred before the transfer procedure.

2.   What will you do with any extra embryos? Extra embryos can be frozen and stored for future use for several years. Not all embryos will survive the freezing and thawing process, although most will. Cryopreservation can make future cycles of IVF less expensive and less invasive. However, the live birth rate from frozen embryos is slightly lower than the live birth rate from fresh embryos. Or, you might be able to donate unused frozen embryos to another couple or a research facility. You might also choose to discard unused embryos.

3.   How will you handle a multiple pregnancy? If more than one embryo is transferred to your uterus, IVF can result in a multiple pregnancy — which poses health risks for you and your babies. In some cases, a fetal reduction can be used to help a woman deliver fewer babies with lower health risks. Pursuing fetal reduction, however, is a major decision with ethical, emotional and psychological consequences.

4.   Have you considered the potential complications associated with using donor eggs, sperm or embryos or a gestational carrier? A trained counselor with expertise in donor issues can help you understand the concerns, such as the legal rights of the donor. You also may need an attorney to file court papers to help you become legal parents of an implanted embryo.

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