Tuesday, 26 July 2016

First "Test Tube" Baby born 25 July 1979

Seems a little strange to think of 1979 as historical but this was definitely a historic event.

This was the day the first child conceived using in-vitro fertilisation (IVF) was born. Louise was born via planned caeserian in a hospital in England.

Contrary to the popular press fondness for alliteration,  the technique developed by Dr Patrick Steptoe (obstetrician and gynaecologist) and Robert Edwards (physiologist) actually takes place in a petri dish. 

Robert Edwards was awarded the Nobel Prize for Medicine in 2010. Unfortunately the Nobel Prize is not awarded posthumously and as Dr Steptoe had died in 1988, he did not share in the Nobel Prize.

For the many couples who were not able to conceive naturally this assisted reproductive technology has been a major step forward. There have been an estimated five million babies born using this technique during the 35 year period. 

Certainly also the introduction of IVF has also raised much controversy in certain sections of the community.   

The Process
In-vitro fertilisation is not just a few quick manipulations in a petri dish but is instead a complex procedure consisting of  a number of steps requiring meticulous timing.

1. The eggs need to harvested from the ovaries. This entails generally injections of  Follicle Stimulating Hormone (FSH) , which encourages the development of several follicles (sacs on the ovaries that contain eggs), this part usually takes a couple of weeks then the eggs are harvested.

2. The semen needs to be collected and the next step is indeed where a test tube is used as the most common way of preparing the semen is using a density gradient in the test tube which harvests the most motile sperm. 

3. For normally motile sperm they are placed in a petri dish with the egg and left overnight. For sperm which are less motile a single sperm are assisted into the egg by injection and also left overnight.

4. The eggs are checked to see if fertilisation has occurred and if it has then the now embryo grows for around six days.

5. The embryo(s) are transferred via a small plastic tube placed through the cervix into the uterine cavity.


Infertility
There are many causes of infertility both for the female and the male:
  • Fallopian tube damage or blockage
  • Ovulation disorders
  • Endometriosis
  • Ovarian failure 
  • Sperm: 
    • Below-average sperm concentration, 
    • Weak movement of sperm  or 
    • Abnormalities in sperm size and shape making it difficult for sperm to fertilize an egg
Chlamydia is now the commonest cause of Pelvic Inflammatory Disease (often shortened to PID) which left untreated can cause infertility due to damage to the Fallopian tubes.  Unfortunately Chlamydial infections in women are usually asymptomatic. Sadly,  it is believed that around 25% of cases of infertility could be caused by previous infection with chlamydia. What is even more concerning, is that it is also estimated that 10% of women infected with chlamydia are at risk of infertility.  The increasing incidence of the bacterial infection  is of particular concern particularly among younger women. In 2014, a total of 1,441,789 chlamydial infections were reported to Centre for Disease Control. With treatment the condition can be cured.


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