IN VITRO FERTILISATION (IVF) / TEST TUBE BABY

IN VITRO FERTILISATION (IVF) / TEST TUBE BABY

In Vitro Fertilisation is commonly referred to as IVF but originally termed “test tube” babies by the Press. IVF is the scientific approach to getting pregnant. It is the process by which eggs are removed from your ovaries and mixed with sperm in a laboratory culture dish. Fertilisation takes place in this dish, "in vitro" , which means "in glass". IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman’s ovaries and letting sperm fertilise them in a fluid medium. The fertilised egg (zygote) is then transferred to the patient’s uterus with the intent to establish a successful pregnancy. Since it is very crucial for everybody have their own biological children, this method has become one of the most famous methods to couples that have been trying to have their own child but failed to do so in the neutral way. One attempt at pregnancy through IVF is termed a cycle, and can be divided into five general phases namely preparation, stimulation, harvesting, fertilisation and embryo transfer. The first two methods were for cases where the husband's sperm lacked in quality or quantity. IVF is a technique used mostly for women whose fallopian tubes are blocked and cannot be remedied by surgical procedures. Also for those who fail to conceive despite having normal fallopian tubes and when all possible causes of infertility have been excluded. 

  IVF procedures  need a very serious supervision as the process is very fragile and could lead to miscarriage. The process started by removing one or more ova from the mother through a small syringe and placed in a test-tube. Then the sperm of the husband is used to fertilize the ovum. After fertilization, the ovum is allowed to develop in the test-tube till the eight-cell stage. Then it is implanted into the mother's womb. IVF is employed in the case of impediment preventing access of sperm to ovum. This is manifested in various ways such as diseases or fallopian obstruction. The would-be mother is given hormone therapy causing a number of ova to mature at the same time. During ovulation, ova are aspirated from the ovary via laparoscopy or under ultrasound screening. In the latter case the aspirating needle may approach the ovary through the abdominal wall, the bladder wall or the vaginal wall, depending on the position of ovary to avoid iatrogenic  complications. The ova are exposed to husband’s sperm in-vitro with chances that at least one ovum would fuse with the sperm. If fortunate, the fertilized ovum is maintained in specific medium for division. At the four or eight cell stage, seen under the microscope, this early embryo is aspirated and pumped into the uterus of the woman through the natural route. An approximate of three embryos can be embedded with hope that at least one is successful in adhering to the lining of the uterus. Pregnancy mirroring natural pregnancy ensues.  

What concerns us most, as Muslims, is what options are Islamically permissible for us. Are the IVF procedures permissible, what is not permissible, why are certain things not permissible, are just some of the questions we would like to address. Bear in mind that we need to make sure what is permitted and what prohibited or in other words what is halal  and haram . It is said that IVF is permissible in Islam  as long as the semen and ovum are from a husband and wife who are legally married and the fertilisation takes place during their marriage, not after divorce or the death of the husband. A divorced woman is not allowed to receive the fertilised ovum (embryo) from her ex-husband. Similarly, a widow is not allowed to take it after the death of the husband. On the other hand, surrogacy ; giving the embryo to another woman to carry on the pregnancy in the womb is not also permissible in Islam. It is also prohibited for a muslim woman to act as a surrogate mother. Even so, IVF may also be used in cases where the husband's semen contains so few sperms that it becomes difficult for them to fertilize an ovum in the fallopian tube. By IVF, sperm of such a person is used to fertilize the ovum in a test-tube. As far as the shari'ah is concerned, in vitro fertilization is allowed as long as it be being done between a married couple.  

There are several factors in the whole fertilization process , such as the opening of a woman’s cervix, cervical mucus that helps the sperm reach the egg. Not to mention healthy non deformed sperm that can survive and fertilize the egg. Although seemingly an easy process there are many factors that can decrease the chances of fertilization from occurring. These can include blocked fallopian tubes, which can be caused by pelvic inflammatory disease (PID) , endometriosis, scar tissue from miscarriages or surgical proceedings. There is also the factor of PCOS, which affects the woman's ability to normally produce and release an egg each month. These being only female factors of infertility, it is false to assume that infertility is only a woman's problem. Male factors also make up for about 40% of infertility problems, which include blocked ducts, low amount of sperm, and deformed sperm. Normally when couples have unprotected sex for a year, a pregnancy will occur. If a woman does not become pregnant within a year (6 months for women over 35)the couple should have a fertility work-up to find out what is going on. Most couples that seek a fertility work-up by a Reproductive Endocronologist (differing from a regular GYN), should know within a month, or shortly thereafter, why pregnancy has not been successful. Such a work-up includes, but is not limited to: medical history, blood tests, pap smear, vaginal examination, HSG, a semen analysis, cervical cultures and Laparoscopy. Having infertility problems , in most cases, does not mean the end of conceiving. There are many options open to couples that will help them to conceive children and one of it is IVF. 

The world’s first successful “test tube baby”  is Louise Joy Brown. She was born at Oldham General Hospital, Oldham on July 25, 1978 at 11.47 p.m. She weighed 5 pounds, 12 ounces (2.608 kg) at birth. She had blue eyes and blond hair and seemed healthy. Still, the medical community and the world were preparing to watch her to see if there were any abnormalities that couldn't be seen at birth. Her parents, Lesley and John Brown, had been trying to conceive for nine years. Lesley was diagnosed with bilateral fallopian tube obstruction. Having gone from doctor to doctor for help to no avail, in 1976, she was referred to Dr. Patrick Steptoe. He recommended that she try a new experimental procedure that would bypass the fallopian tubes blockage completely. Lesley underwent a laparoscopy whereby a single mature egg was aspirated from one of her ovaries. John’s sperm was added to the egg in the laboratory under the direction of Dr. Robert Edwards. A few days later a developing embryo was placed into Lesley’s uterus. On 10 November 1977, Lesley Brown underwent IVF, developed by Dr. Patrick Steptoe himself and Dr. Robert Edwards. Robert Edwards was then awarded the 2010 Nobel Prize in Medicine for the success of IVF and test tube baby. Although the media referred to Louise Brown as a “test tube baby”, her conception actually took place in a petri dish. Her younger sister, Natalie Brown, was also conceived through IVF four years later, and became the world’s fortieth IVF baby. Later, Lesley had her first child she given birth to herself-naturally-in May 1999, to a daughter named Casey. Lesley Brown's pregnancy gave hope to hundreds of thousands of couples not able to conceive. Yet, as many cheered this new medical breakthrough, others were worried about future implications. 

There are some advantages from the IVF  treatment. One of them is that we can have children that would be biological ours. There is nothing more important than a woman to be a mother. With this new technology, we can expand the population of human and muslims in the world. When do so, we would also gain the advantage of following the sunnah of our beloved prophet, Nabi Muhammad S.A.W.  Even in the Qur'an, Allah comforts those who face fertility difficulties: "To God belongs the dominion of heavens and earth. He creates what He wills. He bestows female (offspring) upon whom He wills, and bestows male (offspring) upon whom He wills. Or He bestows both males and females, and He leaves childless whom He wills. For He is All-Knowledgeable All-Powerful." (Surah Ash-Shura 42:49-50). “And Allah has made for you Azwaaj (mates or wives) of your own kind, and has made for you, from your wives, sons and grandsons, and has bestowed on you good provision. Do they then believe in false deities and deny the Favour of Allah (by not worshipping Allah Alone)” (Surah An-Nahl 16:27). And Allah says “Your wives are a tilth for you, so go to your tilth,  when or how you will, and send (good deeds, or ask Allah to bestow upon you pious offspring) for your ownselves beforehand. And fear Allah, and know that you are to meet Him (in the Hereafter), and give good tidings to the believers (O Muhammad صلى الله عليه وسلم)” (Surah Al-Baqarah 2:223).  

One drawback of IVF is that it is not guaranteed . Odds of success change greatly based on varying elements together with the age of woman. Adult females who are around the age of 35 most probably might not have the identical chances of achievements as women who are under the age of 35. Success rates of IVF are the percentage of all IVF procedures which may result in a favourable outcome. The outcomes may represent the number of confirmed pregnancies depends on the type of calculation used based on the pregnancy rates or number of live births and the live birth rate. IVF success rates are substantially better today than they were few years ago due to the advancement in the reproductive technology. The truth is that the IVF success rate varies according to many factors. It basically depends on you, and in most cases, the cause of the infertility. Factors like age, quality of semen, uterus, and a few others. Both sexes can contribute to infertility, so it is not always the woman's fault. Although in most cases it is the woman. Research has shown that the IVF success rate is much higher for women younger than 30 compared to women who are over 30 years of age. The success rates decrease with increasing age, but don't come to the conclusion that age is the only factor. Many women get pregnant with IVF but can't carry the baby and give birth. So it is important to take into account the actual live birth rate as well as the pregnancy rate. According to studies, the IVF success rate in women who are 35 and younger is only about 30 percent. When you look at such rates, you may think that IVF may not be too helpful. 

On the other hand, IVF is very costly and need serious commitment . It involves some great money talk as it is very expensive. To start trying this treatment, we need to be very sure about our decision and women should take extra precautions. The cost of IVF is a major factor for many people when choosing infertility treatments. Many insurance plans do not cover the full costs of infertility treatments. IVF is often not successful on the first cycle of treatment. It is hard to know in advance how many cycles it will take to achieve a successful pregnancy. This statistic is influenced by factors such as age and medical history.  This can cause financial uncertainty as to the final total cost of treatments. Some couples have a limited budget and can only undertake a fixed number of treatments. IVF is a very demanding process. You will be required to go to multiple doctor visits each week, keep your physical activity to a minimal, and may be put on bedrest for up to three days after the transfer.  The timing and the environment of the procedures have to be perfect. Even a slight increase or decrease in your temperature can spoil the chances of becoming pregnant. The commitment when undertaking IVF is significant. It is a process that can be both physically and emotionally demanding. IVF is a very invasive treatment and requires extensive tests, blood tests, hormone injections and appointments. This aspect of IVF can be very challenging and is referred to as an 'emotional rollercoaster'. The physical demands combined with the emotional uncertainty can often add to the existing strains that infertility bring to a relationship. 

As this IVF treatment involved inserting needles into women’s body, we should be aware of the risks and side effects  that might occur during the treatment and yet after the treatment as well. An IVF cycle involves three needles a day for the last 10 days or so, and one needle a day for a week or so before that. Towards the end of the cycle, you have to go in for a 7:30 am check every second day, so the doctor can see if your eggs are mature. A baby conceived through IVF doesn’t have a better chance of implanting and staying healthy in the womb and miscarriage rates are surprisingly high (not just for in vitro fertilization babies, but for all babies in general). Multiple births are the major complication with IVF, and they occur because of the transfer of multiple embryos. The risks of multiple births include risk of losing the baby, complications at birth, prematurity, and neonatal morbidity, possibly long-term. Some countries have tried to avoid these problems by placing strict limitations on how many embryos may be implanted; however, even in those cases they are not necessarily being followed. Another risk is the spontaneous splitting of embryos in the womb although it is rare. This condition produces identical twins. Another more recent study indicates that babies born singly as a result of IVF tend to be at risk for lower birth weight although no reason has been suggested for that phenomenon. The stage in IVF where the ovaries are being stimulated by fertility medication has been shown to result sometimes in a condition called ovarian hyperstimulation syndrome (OHS) . The cases range from mild to severe and may extend into early pregnancy. Some symptoms are abdominal bloating, nausea, diarrhea, and weight gain. Urination may be affected and in severe cases may cease. Symptoms usually go away in a week or two although they may be more severe and hang around longer if pregnancy occurs. Several fatal cases have occurred; however, the rate is quite low. Birth defects are often mentioned in connection with IVF and much controversy has arisen around this issue although most studies don’t show a significant increase.  

In a nutshell, I believe that IVF is a very smart and brilliant treatment to overcome infertility. Apart from the expensive cost and long hours commitment to the hospital, it is a good resort to try to have our own kids. As long as the semen and ovum are from a husband and wife who are legally married and the fertilisation takes place between a legally married couple, then it is permitted in Islam. Scholars agree that there is nothing in Islamic law which forbids many types of fertility treatment, as long as the treatments do not go outside the bounds of the marriage relationship . Assisted reproductive technologies which blur marital and parental ties are forbidden: such as donor eggs or sperm from outside the marriage relationship, surrogate motherhood, and in-vitro fertilization after a spouse's death or divorce of the married couple. It is imperative, in the end, to remember that while we have been commanded by Allah Most High to take all the permitted means, we have also been commanded to believe that means themselves do not have an effect; only Allah does. Verily, Allah knows best.