In Vitro Fertilisation - IVF

In Vitro Fertilization is assisted reproductive technology in which the egg and sperm are combined in a ab with an aim to create a fertilized egg. The fertilized egg is incubated, and it grows into an embryo. Three to Five days after fertilization, a selected embryo is transferred to the woman’s uterus with a hope that it would implant itself in the lining and develop into a fetus that will become a healthy infant.

The eggs are recovered from the follicles, and in the laboratory, the eggs come in contact with the sperm inside special dishes with culture medium to facilitate fertilization. The fertilized eggs, or zygotes, are placed inside an incubator and are cultured under special conditions for two to six days so that the embryos can achieve their first stages of development. Instead of reaching the uterus naturally through the fallopian tube, the embryos are transferred to the uterus using a thin catheter into which the embryos have been previously loaded by the embryologist. The embryos then implant in the endometrium by themselves just like in natural conception and if implantation occurs, then pregnancy will follow.

The initial IVF cycle includes the following steps:

• The cycle starts when the intended egg donor or mother receives hormone therapy to stimulate the production of multiple eggs. The eggs are retrieved from the ovary and sperm is provided by the intended father or a donor. The sperm and eggs are combined in the lab for fertilization and embryos are created and are incubated to grow. The most viable embryo is chosen for implantation, and after
• 3-5 days of fertilization, the selected embryo is shifted to the uterus of the intended gestational carrier or mother and the remaining embryos are frozen for use in the future.

Subsequent IVF cycles that involve the transfer of a frozen embryo are performed.

You may choose IVF for a number of reasons, including if you or your partner has:

• Low sperm count
• Problems with ovulation
• Problems with the fallopian tubes
• If either of the couples has been sterilized
• Endometriosis
• Want to avoid passing on inherited genetic disorders to your children.

Thanks to the potential health risks associated with multiple births, most fertility experts accept the fact that only one embryo should be transferred at a given time. The remaining embryos can be frozen and can be used in the future.

Due to improved Vitrification technology, success rates are equal for fresh and frozen embryos in women under the age of 35.

The cycles that use frozen embryos are usually less expensive and less invasive than cycles using fresh embryos.

IVF children are as healthy and normal as children conceived naturally. The introduction of IVF does not present a significant increase in chromosome-related abnormalities.

• Multiple births.
• Premature delivery and low birth weight.
• Ovarian hyperstimulation syndrome.
• Miscarriage.
• Egg-retrieval procedure complications.
• Ectopic pregnancy.
• Stress.

A single IVF cycle in India can cost anywhere in between INR 65,000 and INR 3,00,000.

IVF may be done in the following cases:

• Damage to the fallopian tube (a pair of tubes that carry the female eggs from the ovaries, where the eggs are produced, to the uterus or womb of a woman)
• Fallopian tube blockage
• Ovulation (release of matured eggs from the ovary, that occurs once in every menstrual cycle of a woman) disorders
• Endometriosis (a condition in which tissue similar to the uterus lining implants and grows outside the uterus)
• Uterine fibroids (non-cancerous growths in the uterus)
• History of tubal sterilization or removal (the fallopian tubes are cut or blocked permanently for preventing pregnancy)
• Poor sperm motility
• Impaired production of sperms
• Abnormalities in the sperm shape and size
• Infertility without a known cause
• Genetic disorder
• Preservation of embryos by IVF before treatment for cancer

The following diagnostic tests may be performed before an IVF procedure:

1. Blood tests: These tests help the doctor to check for underlying medical conditions that may be present.
2. Ovarian reserve testing: This test helps in checking the quality and quantity of the female eggs. It helps in predicting how well the female ovaries would be able to respond to fertility medication.
3. Vaginal ultrasound: High-frequency sound waves are used in this test to obtain clear images of the female reproductive system. It helps the doctor in monitoring the development of the follicles, which are fluid-filled ovarian sacs where the eggs mature.
4. Sonohysterography: This test involves the examination of the inside of the uterine lining before starting with IVF by injecting a fluid through the cervix (the lower, narrow end of the uterus) into the uterus and then taking an ultrasound.
5. Hysteroscopy: The doctor inserts a flexible, thin, lighted telescope, known as a hysteroscope, through the vagina and cervix into the uterus.
6. Semen analysis: The semen (the thick fluid that oozes out from a man’s penis in ejaculation during sexual activity) analysis of the male partner is performed before starting with the IVF treatment cycle. It helps in checking male fertility.
7. Infectious disease screening: The male and female partners are both screened for infectious diseases, such as HIV before IVF treatment.

The following are the pre-procedure steps taken before IVF:

• The doctor may perform a mock or practice embryo transfer to determine a woman’s uterine cavity depth and the technique that is most likely to be successful for the placement of the embryos in the uterus.
• It is important to consider how many embryos are going to be transferred. This usually depends on the age of the female patient and the number of eggs that are retrieved. The doctor follows specific guidelines to try and prevent multiple births.
• The future IVF cycles can be made less expensive and less invasive by freezing and storing the extra embryos for future use.
• Discuss the possible complications of IVF with your doctor and be prepared for some discomfort, mentally and physically, before opting for the procedure.
• The cost factor for IVF should be discussed with the doctor before opting for the IVF procedure.

The IVF procedure is done in the following steps:
1. Inducing ovulation by fertility medications:

• Fertility medicines are hormones that stimulate the ovaries to produce several eggs.
• Most medications are given in the form of injections that need to be administered by the patient herself, as instructed by the doctor.
• Blood tests and ultrasound exams may be required for monitoring the progress.
• This step may take about one or two weeks time.

2. Eggs retrieval through a minor surgical procedure:

• An ultrasound is used in this step to guide a hollow needle to the ovary.
• Gentle suction is applied to help in the retrieval of the eggs.
• The completion of this step takes less than 30 minutes.

3. Sperm sample collection:

• Just before egg retrieval from the female, a sperm sample is usually collected from the male partner.
• The sperm sample is normally collected by masturbation.
• Sometimes, sperm is collected through a surgical procedure in certain cases.
• In certain cases, donor sperm is obtained.

4. Fertilization of the eggs
This procedure is done in a laboratory after preparing the eggs and sperm.

5. Embryo transfer:

• The doctor inserts a thin, flexible tube, known as a catheter, through the vagina into the uterus of the female.
• The embryo is transferred into the uterus.
• This step is performed 2 to 6 days after eggs retrieval.
• It is recommended to take a pregnancy test 12 to 14 days after egg retrieval.

The post-procedure steps after IVF include:

• Once the procedure of embryo transfer is complete, the patient can resume her daily activities, although her ovaries may still be enlarged.
• It is advisable to avoid strenuous activities which may lead to discomfort.
• It is normal to pass a small amount of clear or bloody fluid after the procedure. This occurs due to the swabbing of the cervix before embryo transfer.
• It is normal to have some mild cramping and bloating after the procedure.
• It is also normal to have some constipation after the procedure.
• There may be some breast tenderness following the procedure.
• If the patient has pain after the procedure of embryo transfer, she should immediately contact the doctor. The doctor checks for signs of infection.

The results of IVF treatment are as follows:

• The doctor checks for pregnancy using a simple blood test.
• If the woman is pregnant, she is referred to a gynecologist for prenatal care.
• If the woman is not pregnant, she can stop taking progesterone medications and she will mostly get her period within a week. If the periods do not arrive or there is unusual bleeding, she should immediately visit her doctor.
• If the woman is not pregnant and she wants to try another cycle of IVF, the doctor will suggest certain steps to increase the likelihood of getting pregnant through IVF.

The following factors in a woman increase the chances of a successful IVF, and giving birth to a healthy baby:

• Young age (less than 40 years of age)
• Transfer of the more developed embryos 
• Women having a history of childbirth
• Women who do not smoke, consume alcohol, take illicit drugs, have excessive caffeine intake, or take certain medications
• Women having a normal supply of eggs
• Not having conditions like endometriosis

During the egg retrieval procedure the patient may feel slight discomfort. However, the procedure is usually done under a light sedative to keep the patient in a drowsy and relaxed state. The doctor may also give pain medication. 
A sedative may also be given during the embryo transfer procedure. However, this is not a painful procedure.

A reproductive endocrinologist usually performs the IVF procedure.

The complications associated with an IVF treatment procedure are:

• Headaches 
• Hot flashes 
• Mood swings
• Bloating
• Ovarian hyperstimulation syndrome (pain and swelling in the ovaries due to some fertility drugs like human chorionic gonadotropin or HCG used for inducing ovulation)
• Nausea
• Vomiting
• Quick weight gain
• Shortness of breath
• Stomach pain and bloating
• Bleeding
• Infection
• Bowel damage
• Bladder damage
• Stress
• Multiple births
• Miscarriage
• Premature delivery
• Low birth weight