IVF: TURNING hope into happiness
“In-vitro” stands for outside the body. IVF treatment involves the joining of a woman's egg and a man's sperm in a laboratory dish. The treatment can be performed using the persons own eggs and sperm, or using either donated sperm or donated eggs, or both. Fertilization means the sperm has attached to and entered the egg.
When is IVF recommended
IVF is recommended for the following fertility problems:
If someone has a blocked or damaged fallopian tubes or any other problem.
If the partner has a problem with his sperms. Major problems are better treated using ICSI.
If a female has been trying to conceive for at least two years and a cause hasn't been found to explain why you she has not become pregnant.
If a women has fertility disorders like endometriosis and polycystic ovary syndrome (PCOS).
For couples who are using embryo testing to avoid passing on a genetic condition to their child.
For female who have undergone tubal ligation — a type of sterilization in which the fallopian tubes are cut or blocked to permanently prevent pregnancy.
If a female is about to start cancer treatment — such as radiation or chemotherapy — that could harm her fertility.
IVF techniques vary according to the individual circumstances. IVF techniques are also employed in gestational surrogacy, in which the fertilized egg is implanted into a surrogate's uterus, and the resulting child is genetically unrelated to the surrogate.
In theory, IVF can be done by collecting the contents from a woman's fallopian tubes or uterus after natural ovulation, mixing it with sperm, and reinserting the fertilized ova into the uterus but without additional techniques, the chances of pregnancy would be extremely small. The additional techniques that are routinely used in IVF include ovarian hyper-stimulation to generate multiple eggs or ultrasound-guided transvaginal oocyte retrieval directly from the ovaries after which the ova and sperm are prepared.
Before the treatment starts the couple might have to undergo blood tests to screen for HIV, hepatitis B, hepatitis C and human T cell lymphotropic virus (HTLV) I and II.
For women treatment involves the following stages:
Suppressing the natural menstrual cycle
Women are put on medications (generally in the form of a daily injection) for about two weeks, which help in suppressing their natural menstrual cycle.
Boosting the egg supply
Fertility medications containing the Fertility Hormone FSH (follicle stimulating hormone) are prescribed to stimulate egg production. FSH makes the ovaries produce more eggs than normal. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval.
Vaginal ultrasound scans will help in monitoring the ovaries. A hormone injection in injected between 34 and 38 hours before the eggs are due to be collected. This will help the eggs to mature. This is likely to be human chorionic gonadotrophin
Retrieving the eggs
A minor surgery, called follicular aspiration, is done to remove the eggs from the woman’s body. The surgical procedure uses ultrasound imaging to guide a hollow needle through the pelvic cavity to remove the eggs.
Surgery is done as an outpatient procedure in the doctor’s office most of the time. Woman will be given pain medicines so she does not feel pain during the procedure.
A very thin needle is inserted through the vagina and into an ovary. The needle - which is connected to a suction device - sucks the eggs out. This process is repeated for each ovary.
After the process the patient might experience some cramps, feel a little sore and bruised and/or experience a small amount of bleeding from the vagina.
After the eggs have been collected, she will be given medication in the form of pessaries, injection or gel to help prepare the lining of the womb for embryo transfer.
Insemination & fertilization
Sperms are placed together with the best quality eggs. The mixing of the sperm and egg is called insemination.
Eggs and sperm are then stored in an environmentally controlled chamber. After a few hours the sperm eventually enters (fertilizes) an egg.
If the doctor thinks the chance of fertilization is low, the sperm may be directly injected into the egg. This is called intracytoplasmic sperm injection (ICSI).
Many fertility programs routinely do ICSI on some of the eggs, even if things appear normal.
The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.
The fertilized egg divides and becomes an embryo. At this stage a pre-implantation genetic diagnosis (PGD) can be done ,which can screen an embryo for genetic disorders
Woman is given progesterone or HCG (chorionic gonadotrophin) to help the lining of the womb receive the embryo
Embryos are placed into the woman's womb 3 ~ 5 days after egg retrieval and fertilization.
The procedure is done in the doctor's clinic while the patient is awake. The doctor inserts a thin tube (catheter) containing the embryos into the woman's vagina, through the cervix, and up into the womb. If an embryo sticks to (implants) in the lining of the womb and grows, it results in pregnancy.
If the procedure is successful, implantation typically occurs around six to ten days following egg retrieval.
This procedure is usually painless & no sedation is required, though some may experience mild cramping.
If a female is under the age of 40, one or two embryos may be transferred. If she is 40 or over, a maximum of three embryos may be used. The number of embryos transferred is restricted because of the risks associated with multiple birth
For men the treatment involves:
The sperm will be washed and prepared so the active, normal sperm are separated from the poorer-quality sperm.
If stored sperms are used, it will be removed from frozen storage, thawed and prepared in the same way.
After the procedure
After embryo transfer, woman may be advised to rest for the remainder of the day
Complete bed rest is not necessary, unless there is an increased risk of OHSS. Most women return to normal activities the next day.
Women who undergo IVF would require to =take daily shots or pills of the hormone progesterone for 8 - 10 weeks after the embryo transfer as too little progesterone during the early weeks of pregnancy may lead to miscarriage.
About 12 -14 days after the embryo transfer, a pregnancy test is done.
On an average it takes 3 IVF cycles to conceive.
If a patient experience any of the following symptoms, then the doctor should be called immediately:
A fever over 100.5 F (38 C)
Heavy bleeding from the vagina or blood in the urine
Side effects & associated risk with ivf
Feeling down or irritable
Ovarian hyper stimulation syndrome
Eight to ten pound weight gain within three to five days after the procedure
Decreased urinary frequency
Egg retrieval carries risks of bleeding, infection, and damage to the bowel or bladder.
Psychological stress and depression if IVF fails.
Multiple pregnancies: women who undergo IVF have high chances to deliver , about 63% single babies, 32% twins, and 5% triplets or more
IVF pregnancies can become ectopic
Who may not benefit from ivf
They are few conditions where IVF can’t be applied to couples who want a child. The conditions that IVF can’t be successful:
Female is on menopause.
Ovarian functions are lost.
Female’s uterus is removed by hysterectomy.
Apart from the above factors, female’s hormonal balance is important as well. If there is a hormonal imbalance, possibility of conceiving with IVF is a very low.
Success rate of IVF
There are a host of factors that determine the outcome of the IVF procedure and thus determine its success rate. Factors affecting IVF success rate are:
Woman’s age - This gives a clear picture of her ovarian reserve.
Status of the uterus – whether it is absolutely normal, the quality of the semen must also be cultured.
Success or failure rate of the fertilization and cleavage in the vitro procedure.
Total number, maturity level and the quality of eggs that are retrieved also play a vital role.
Total number of embryos that have been transferred and cryo-preserved.
Whether the luteal phase post transfer is adequate or not
Actually cause of infertility also plays a major factor in determining the success rate of IVF.
Interesting facts about IVF
Acupuncture can increase IVF success rate
Using younger eggs give a youthful fertility advantages
Eggs harvested does not equal to eggs fertilized
There are high chances of having identical twins from a multiple embryo transfer
Healthy sleep habits make for better IVF cycles
More than 4 million babies have been born worldwide as a result of using the in vitro fertilization technique
It has been estimated that IVF technique has reduced the Fallopian tubes surgeries by half
IVF OR IUI?
It is difficult for a couple to decide as to which fertility option to go for intrauterine insemination (IUI) or in vitro fertilization (IVF). There are a variety of factors that can impact the chances of having a successful fertility, including the infertility diagnosis & age. Deciding on which treatment protocol is right, the couple needs to have a conversation with the doctor.
IUI - Intrauterine Fertilization
IVF - In Vitro Fertilization
It is a procedure in which processed and concentrated motile sperm are inserted directly into a woman’s uterus
In this the fertilization is done by manually combining an egg and sperm in a laboratory dish, and then transferring the embryo to the uterus.