InVitro Fertilization

In this day and age, IVF (In vitro fertilization) is almost a household word.  However, not so long ago it was a mysterious procedure for infertility that produced what were then known as “test-tube babies”.  IVF involves combining eggs and sperm outside the body in a laboratory. Once an embryo or embryos form, they are then implanted in the uterus.

IVF is a series of medical procedures that is used to help with fertility or prevent genetic abnormalities so as to assist with the conception of a child.  In an IVF procedure, mature eggs are collected from ovaries and fertilized with sperm in a lab.  Then the fertilized egg or eggs (as the case may be) are transferred to the uterus.  A full cycle of IVF takes about three weeks.  As each case is different, sometimes these steps are split into different parts and the process can take longer.

IVF is the most effective form of assisted reproductive technology.  What is to be understood is that an IVF procedure may involve eggs, sperm and embryos from a known or anonymous donor.  In some cases, a gestational carrier (a woman who has an embryo implanted in her uterus) might be used.

When it comes to infertility, the following problems are the base case for IVF:

  • Endometriosis
  • Low sperm counts
  • Problems with the uterus or fallopian tubes
  • Problems with ovulation
  • Antibody problems that harm sperm or eggs
  • The inability of sperm to penetrate or survive in the cervical mucus

Many factors come into play when it comes to deciding your chances of having a healthy baby using IVF.

Contrary to popular belief, IVF is never the first step in the treatment of infertility barring the case of complete tubal blockage.  Instead, it is reserved for cases in which other fertility medical treatments such as fertility drugs, surgery, artificial insemination failed to bring out the desired result.  If you think you are a potential candidate for IVF, carefully assess any treatment centre before embarking on the treatment program.

Why IVF is done?

IVF is the preferred treatment method for infertility and genetic problems.  If IVF is used to circumvent infertility, you and your partner might be able to try less-invasive treatment options before embarking on the treatment, which includes fertility-boosting drugs to enhance the production of eggs or intrauterine insemination (a procedure through which sperms is placed directly into your uterus near the time of ovulation).

For women over the age of 40, IVF sometimes is offered as primary treatment for infertility.  IVF is also an ideal procedure if you are suffering from some health disorders.  IVF may be an option of you or your partner under the following circumstances:

Fallopian tube damage or blockage:  It is difficult for an egg to be fertilized or for an embryo to travel to uterus if there is damage or blockage in the fallopian tube.

Ovulation disorders:Fewer eggs are available for fertilization if ovulation is infrequent or absent.

Endometriosis:Endometriosis is a condition in which uterine tissue implants and grows outside of the uterus, thereby affecting the function of the ovaries, uterus and fallopian tubes.

Uterine fibroids:  Fibroids refer to benign tumors in the wall of the uterus.  Uterine fibroids are a common finding in women in their 30s and 40s.  Fibroids can come in the way of implantation of the fertilized egg.

Previous tubal sterilization or removal:If you have had sterilization in which your fallopian tubes are cut or blocked to permanently prevent pregnancy (tubal ligation), IVF may be an alternative to reversal of tubal ligation.

Impairment in sperm production or function:  If the sperm concentration is below average or weak which may lead to poor sperm motility or abnormality in sperm size and shape, thereby making itdifficult for a sperm to fertilize an egg.  If semen abnormalities are found your partner may need to see a specialist to find out if it is a correctable problem or a sign of any underlying health concerns.

Unexplained infertility:Unexplained infertility refers to no identifiable cause of infertility has been found despite evaluation for common causes.

Genetic disorder:  If there is a genetic disorder in your family, you and your partner is at risk of passing on that disorder to your child.  If so, you may need pre-implantation genetic testing – a procedure that involves IVF.

Fertility preservation for cancer or other chronic health conditions:  God forbid, if you are going to start cancer treatment such as radiation or chemotherapy that could impair your fertility status, IVF for fertility preservation may be an option.  Women can have eggs harvested from their ovaries in order to be frozen in an unfertilized state for later use.  Apart from that the eggs can be fertilized and frozen as embryos for future use.

If a woman’s uterus is not functioning properly or pregnancy involves a serious health risk, IVF can be chosen to carry the pregnancy using another person (gestational carrier).  In this case, eggs are fertilized with the sperm, but the resulting embryos are placed in the gestational carrier’s uterus.

Ovulation induction :

If IVF is conducted using your own eggs, at the beginning of the cycle you will begin treatment with synthetic hormones to stimulate your ovaries to produce multiple eggs, rather than single eggs that normally develops each month.  The need for multiple eggs arises as some eggs may not fertilize and develop normally after fertilization.

You may be given different medications, such as:

  • Medications for ovarian stimulation
  • Medications for oocyte maturation
  • Medications to prevent premature ovulation
  • Medications to prepare the lining of your uterus

What can I expect from IVF?

IVF treatment begins with the first step of injecting hormones so you produce multiple eggs each month instead of only one, upon which you will be tested to determine if you are ready for egg retrieval.

Before the retrieval process, you will be given shots of a medication that ripens the developing eggs and start the process of ovulation.  Here time is a critical factor as the eggs must be retrieved just before they emerge from the follicles in the ovaries.  In the unlikely event, if the eggs are taken out too early or too late, normal development is impaired.  Your doctor may opt for a blood test or ultrasound to make sure that the eggs are at the right stage of development before retrieving them.  The IVF clinic may provide you all the necessary instructions to be adhered to the night before and the day of the procedure.  Generally pain medication is given or mildly sedated or in some cases this is done under full anesthesia.

The procedure starts with the doctor locating follicles in the ovary with ultrasound and removing the egg with a hollow needle.  Usually, the procedure will not take more than 30 minutes. Upon retrieval of your eggs, they will be mixed in the laboratory with the sperm of your partner, which he will have donated on the same day.  You and your partner can go home after donating egg and sperm respectively.  The fertilized eggs are kept in the clinic under observation to ensure there is optimum growth.  Depending on the clinic you have chosen, you can even wait up to five days until the embryo reaches a more advanced blastocyst stage.

Once the embryos are matured, you will be asked to return to the IVF facility for the doctors to transfer one or more embryos into your uterus.  This procedure is easier and quicker than the retrieval of egg.  A flexible tube called catheter will be inserted via your vagina and cervix into your uterus, where the embryos will be deposited.  In order to maximize the chances of pregnancy, most IVF experts recommend transferring up to three embryos at a time.  However, it should be understood that transferring more embryos increases the chances of multiple pregnancy.  Upon completion of this procedure, you may be required to stay in bed for several hours and is likely to be discharged four to six hours later.  You may be requested to come to the hospital about two weeks after the embryo transfer for a pregnancy test to be conducted.  However, if your partner’s sperm count is extremely low, doctors may combine IVF with a procedure called intracytoplasmic sperm injection.  In this procedure, a sperm is taken from a semen (in some cases directly from the testicle) and inserted directly into the egg.  Once an embryo is produced, it is deposited in the uterus through the usual IVF procedure.

IVF – FAQs

  1. How many times IVF treatment can be attempted?

There is no limit for it.  In some cases, several attempts are made until a pregnancy is achieved.  There are couples who achieved success after eight or ten attempts.

  1. Is age a factor in IVF treatment?

Yes, age is a deciding factor in IVF treatment.  There are greater chances of achieving pregnancy for women younger than 35.  Women between the age of 35 and 38 are also accepted for treatment.  However, women between 38 and 40 are generally met with fewer chances of success.  There is a ray of hope for women between 40 and 42. Women above 42 have no chances of successful IVF under general conditions.

  1. Is there a connection between number of embryos and pregnancy?

Yes, there is.  The chances of getting pregnancy increases with the number of embryos being transferred.  With single embryo transfer it is 28% and with double embryo it is 48%.

  1. Is bleeding normal in the early stages of pregnancy?

Irrespective of the type of pregnancy, bleeding is always abnormal.  If there is bleeding the patient should always consult her physician.  However, with IVF bleeding is more common and may not lead to miscarriage.

  1. What are the chances of pregnancy with frozen embryos?

Sometimes, some high-quality embryos are left after IVF cycles.  These embryos can be frozen to give the couple the option of using them in the future.  Embryo freezing may be a good option for patients.  It has been found out that when thawed 70% to 80% of these embryos are still viable and each transfer has a success rate of 50 to 80%.

  1. Is there a diet to be followed before treatment?

Though there is no clear-cut diet to be followed before treatment, some research have shown that a significant number of successful treatments were those of patients who stuck to a diet based on vegetables prior to their cycles.

  1. Do patients need to lose weight before treatment?

Overweight ladies may have to undergo extended treatment periods and there is an increased possibility of miscarriage.

  1. Can patients have sexual intercourses after embryo transfer?

Sexual intercourses after embryo transfer have no bearing on the progress of pregnancy.  However, treatment may involve bleeding which may make sexual intercourses uncomfortable.

  1. Does weight lifting affect the prospects of pregnancy?

Contrary to popular opinion, lifting heavy objects, travelling and being active right after the embryo transfer does not impair prospects of pregnancy.  But make sure medications are taken on time.

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