1. Three months: At three months, the fetus is distinctly shaped. The fingers and toes are well outlined, and the eyelids are fully formed.
2. Four months: By four months, the fetus is lengthened in size, but it is not changed otherwise in appearance.
3. Five months: By five months, the first fetal movements are observed generally. Fine hair begins to grow on scalp and forehead. A delicate network of arterial circulation is observed when the fetus is injected with an opaque material.
4. Six months: Rapid growth of fetus occurs during this period. The body will be covered by fine hair and a protective oily secretion.
5. Seven months: The fetal skeleton is virtually complete and the digestive and nervous systems are well advanced.
6. At Eighth and Nineth months, the fetus develops rapidly and movement of the baby can be felt.

Images of Human Fetus:

How this procedure is done?
This procedure is done in a surgical theater using aseptic precautions and safety methods under local anesthesia. After injecting a local anesthetic a needle is passed under the guidance of an ultrasound into the amniotic sac. The selection of the place is carefully monitored to avoid any injury to the fetus. It is delicate procedure should be done by an expert. A small quantity of amniotic fluid about 20 ml is withdrawn using a syringe and sent to the genetic laboratory for culture. In the lab the cells are separated and cultured in a special culture medium. After culturing, the cells are stained and the chromosomes are studied for abnormalities.

Indications for the test:

• Down’s Syndrome: A chromosomal disorder wherein an extra chromosome is inherited (T21) making 47 chromosomes instead of 46. Due to this the physical characters are altered and development delayed.
• To study any other chromosomal abnormalities.
• To study neural tube defects.
• Any infections.
• Rh in compatibility.
• In women more than 35 years age.
• Birth of any abnormal children previously.
• Doubts in ultrasound or blood test indicating to do this test.
  A latest emerging study revealed that amniotic cells can also be used as stem cells .However due to risk for the fetus the use of the amniotic cells is limited.

Possible Complications:

• Infection
• Pre term delivery
• Miscarriages
• Fetal injury

Women who have a poor chance of success: The following women will have a poor chance for pregnancy.
Aged women whose ovaries are failing and producing poor quality of oocytes
Severe male factor infertility
Infections of uterus

What are the basic procedures followed in this?

• Investigations of the male and the female
• Down regulation
• Super ovulation
• Egg collection or oocytes retrieval
• Culture of the oocytes
• Embryo transfer
• Pregnancy tests

Down Regulation: It is necessary to suppress the natural hormones temporarily to have a greater control over the treatment cycle. An agonist usually Gonodotropin releasing hormone GnRh is used to down regulate the hormones on 21st or 22nd day of the previous cycle. After 14 days the blood is checked for the E2 and LH levels. If they are very low stimulation will be done otherwise the cycle will be cancelled.

Super Ovulation: In the normal cycles of women only one egg is released. But for a good success of the IVF cycles more eggs are required. To accomplish this Follicular stimulating hormones FSH injections are given daily and the development of the eggs are carefully monitored by means of transvaginal ultrasound imaging and blood tests. When the follicles reach an optimum size HCG injection is given to trigger the final phase of egg maturation. Egg retrieval is done 36 hours after this injection.

Oocyte Retrieval or Egg Collection: Egg retrieval is done by means of trans vaginal ultrasound aspiration. Egg collection is done as a minor surgical procedure in a theater using mild general anesthesia under light sedation. The eggs are collected into sterile test tubes from all the follicles and sent into the lab for checking the quality and further processing.

Culture of the Oocytes: After the egg collection the embryologist will check for the quality of the oocytes and whether they are mature or not. Using the husband’s semen the oocytes are fertilized in a culture medium in an incubator maintained at 370 C under co2 atmosphere. After 24 hours of culture the eggs are evaluated under a stereo microscope for signs of fertilization. If all goes well 3-5 days after the egg retrieval healthy appearing embryos are selected for transfer into the uterus. The excess embryos if any are frozen for further use with the couples request and agreement for storage in liquid nitrogen.

Embryo Transfer: The embryos are transferred as a simple procedure in a theater using an embryo transfer catheter. The embryos are released into the abdominal cavity where they get implanted to the endometrial wall. Once they get implanted they grow like in the normal pregnancy. Normal activity can be resumed a day after the transfer. However the physical activities should be restricted to a minimum.

Pregnancy Test: On 15 day after the transfer of embryos the patient will have to attend the clinic for a pregnancy test. Urine or serum is checked for the presence of HCG.A tentative diagnosis is made and the patient will be asked to come back after another 14 days for a ultra sound scan. Presence of a gestational sac and pulsation confirms the pregnancy. Ultra sound examination also helps to detect multiple pregnancies.

Early diagnosis of pregnancy is very important to monitor. There are several methods to diagnose pregnancy. Urine test is simple for diagnosing of pregnancy. Test cards are available, which are very simple to use. Housewives can conveniently use the cards at home to know their pregnancy result. HCG is detected by these cards and the result is seen within few minutes. Serum HCG can also be checked if there is any doubt. Serum HCG or urine HCG can be checked soon after the periods are missed or after 14 days of embryo transfer in case of IVF or ICSI cycles. After about 14 days of testing the urine or serum ultra sound scan can be done to detect the gestational sac and the pulsation which confirms the pregnancy. Ultra sound examination also is useful to detect multiple pregnancies.

As soon as the pregnancy is confirmed a gynecologist should be consulted for a thorough examination and to take necessary instructions and care to be taken. The gynecologist monitors the pregnancy till delivery of the baby. If the pregnancy is due to an IVF or ICSI utmost care should be taken since the pregnancy is valued very high. The following aspects should be taken care during the monitoring of pregnancy.

• History: A complete history of the pregnant women should be collected regarding the sicknesses before pregnancy and treatments taken for taking necessary care.
• Urine test: To detect glucose and albumen for any symptoms of diabetes or kidney problem.
• Blood tests: To find out hemoglobin levels, blood group, blood glucose and any antibodies against diseases like hepatitis, HIV to take necessary preventive measures.
• Blood pressure: For monitoring of blood pressure throughout the pregnancy period to be cautious against pre-eclampsia.
• Measurement of weight: To monitor the growth rate of the fetus.
• Ultra sound scan to monitor the growth of the baby and to study the genetic abnormalities of the baby.(Usually done between 11-20 weeks).

The above tests are very useful to take preventive measures in case of any negative results.

Nutritional requirements during pregnancy: The pregnant women require more nutrition to cope up with the growing fetus. Nutritious food should be given to prevent anemia, calcium deficiency. Green vegetables and fruits should be included in the diet. Fish, eggs, and dairy products also should be included in the diet to get enough calcium, iron, protein and folate. Grains and beans provide vegetable protein.

Exercise during pregnancy: Exercise prepares the pregnant women to gain necessary stamina to face the labor. If the pregnancy is not complicated exercise is a useful option to keep the body healthy and active. Mild walking, low level aerobics, or indoor cycling is good options to take up. However it is advisable to take the guidance of your doctor before taking up any exercise who will decide the type of exercise suitable to you.

Substances which should be avoided during pregnancy: Coffee, tea, smoking, alcohol, should be avoided since they adversely affect the developing baby. Medications if necessary should be taken as per the advice of the doctor only since many drugs affect the baby and cause adverse reactions.

• Dieting has to be stopped immediately by the women who have that habit. For a normal woman, daily requirement of energy is 2100 calories. But when pregnant, an additional 300 calories of energy is required and it has to be supplied through diet.
• Four cups of milk have to be compulsorily taken daily and she has to eat more than two fruits. Vegetables in all colours should be taken. Preferably the food containing calcium, vitamin D, iron, folic acid have to be taken in double amount. Though they are obtained from tablets, it is better to get them through natural diet.
• It is good to reduce the salt intake as much as possible. More water has to be taken. Pregnant women have to carry out their normal daily activities unless insisted by the doctor to take bed rest. Due to this the problems like back pain, constipation, insomnia can be prevented. The possibility of normal delivery can be increased many folds and also recovered fastly after delivery.
• Due to pregnancy, the skin gets expanded and stretch marks are formed. To prevent the stretch marks, massage the stomach gently daily with Olive Oil for some time from the first month itself. After the delivery also it can be continued for 1 or 2 months if only it is a normal delivery. Coconut water has to be taken frequently as it is good to their skin. Ghee has to be taken daily in food so that it acts as a natural moisturiser.
• Hair dyeing has to be stopped atleast in the important phase i.e. in the first 3 months. It is also advisable to stop usage of anti-dandruff lotions, anti-pimple creams and also to be away from make-up.

The team of researchers observed that ART demonstrated a 33% of success rate where as dietary improvement was effective by 32%. These dietary regulations are abstaining from alcohol, decreasing the intake of caffeine, including more fruits and vegetables in the diet. All these dietary regulations play a significant role in improving the fertility.

The recent studies shows that intelligence is influenced by exercising by pregnant mothers. A light exercise walking or stretching or running helps in achieving this. Exercise boosts blood supply to brain and helps in the growth of neurons. Exercise also coupled with breast feeding helps to boost up intelligence.

Therefore pregnant mothers if they want their children to become intelligent may do exercise under the guidance of competent guides.