In – Vitro Fertilisation ( IVF ) involves a procedure where a sperm and mature eggs are fertilized in a lab or ‘in vitro” and then the embryo is implanted in the uterus of the female. It is the most effective method of assisted reproductive technology and has rapidly gained popularity in India.
This procedure is usually done for treating infertility or gestational surrogacy.
Infertility is diagnosed when a heterosexual couple is unable to achieve clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Infertility can be caused by both male factors and female factors.
It is estimated that about 5% of heterosexual couples have an unresolved problem with infertility. Nearly 7 – 8 million seek help through some form of assisted reproductive technology every year.
There are 2 major indications for IVF:
The common causes of male infertility are defects in either sperm quality, or quantity, or both. The common causes for female infertility are menstrual cycle irregularities, blockage in fallopian tubes, defects in the uterus. This can be caused by a variety of factors like age, genetics, autoimmune diseases, Sexually Transmitted Diseases, environmental factors, previous medical procedures. The cause is unidentifiable in about 10-20 % of couples.
Surrogacy is an arrangement whereby a woman agrees to bear a child for another person / persons, who will become the child’s parent(s) after birth.
People may seek a surrogacy arrangement when pregnancy is medically impossible for the couple, when pregnancy complications are dangerous for the intended mother, or when a single man or male couple wish to have a child. The legality of surrogacy varied widely between different countries. In 2015, the Indian Government banned commercial surrogacy.
Although IVF is primarily a safe procedure done under controlled, sterile environments, the following risks may ensue:
premature delivery or low birth weight
ovarian hyperstimulation syndrome
In Vitro Fertlization is a process in which the egg from the female and sperm from the male are fertilized outside the body in a laboratory. When the cause is male infertility due to i) the sperm having difficulty entering the egg or ii) the sperm count is low , a procedure called Intracytoplasmic Sperm Injection ( ICSI ) is used. In ICSI, the sperm is directly injected into the egg. This produces an embryo. If the partner’s sperm is unusable or results in a failed attempt, a donor’s sperm may be used. Donor eggs or donor embryos may also be used as necessary. A few embryos are injected into the uterus of the female for implantation and subsequent pregnancy.
Several cycles of IVF may be attempted in order to achieve successful pregnancy.
This process requires a series of steps as follows:
Your doctor will start by taking various blood tests to determine your hormone levels. Other screening tests may also be taken and include the following:
Ovarian reserve testing : This determines whether the quality and quantity of your eggs are sufficient to perform the procedure. This might involve testing hormone levels in your blood including FSH, estrogen and anti-Mullerian hormone. An Ultrasound of the ovaries may also be done.
Semen analysis : To determine the quality and quantity of the sperm.
Infectious disease screening: To detect the presence of undiagnosed infectious diseases that may interfere with the procedure or pregnancy, like HIV. Both partners may need to be tested.
Uterine screening: To assess if the inner lining and structure of the uterus is suitable for the procedure. It might involve investigations such as i) Sonohysterography ii) Ultrasound of the uterus iii) Hysteroscopy.
Practice embryo transfer: To determine the correct technique to be used for a successful implantation, depending on the depth and structure of the uterine cavity.
Ovulation Induction and Egg Retrieval
If you decide to use your own eggs, they need to be induced and retrieved for fertilizing with the sperm.
Induction is necessary for stimulating multiple eggs as only one egg matures per cycle naturally. It is a 2-3 week process involving multiple hormone injections including Follicle Stimulating Hormone ( FSH ), Leutenizing Hormone ( LH ), HCG, Progesterone as necessary. Ultrasound tests and blood tests to measure hormone levels may be done to monitor the maturation of the eggs the body’s response to the hormone injections.
Egg retrieval is done about 1-2 days after the final injection at the hospital. The procedure is done at the hospital under general anaesthesia to ensure it is pain-free. This procedure involves retrieving the eggs to be used for fertilization. This may be done under advanced ultrasound technology and requires expert skills of a fertility expert in order to retrieve enough eggs, usually around 8-15. The recovery period for this procedure is quick, usually around 30 minutes.
You may experience cramping after the procedure. The retrieved eggs will be placed in a culture medium and fertilization with the sperm will be attempted.
If you are using your partner’s sperm, it will be retrieved from him by masturbation at the hospital on the morning of egg retrieval. Other methods such as testicular aspiration ( using a needle to retrieve sperm directly from the testicles like egg retrieval ) can be used if necessary. Donor sperm can also be used.
Fertilization then takes place in a laboratory where scientists place both in a dish for the sperm to find the egg as they would in the body. Once it has been fertilized and an embryo has formed, the next step is placing it in an incubator for the embryo to develop. Intracytoplasmic Sperm Injection may be done if there is an indication for it.
Before embryo transfer to the uterus, genetic testing of the embryo may be done by examining a single cell from the embryo. This can be used to rule out genetic diseases in the embryo.
Embryo transfer is done 3-5 days after egg retrieval.
The embryos are placed inside the inner lining of the uterus for implantation and a subsequent pregnancy. This is done by placing the embryo(s) in a syringe on a flexible tube called catheter and passing it inside the uterus through the vaginal canal. You may be sedated during the procedure to avoid the mild discomfort that may be caused.
After The Procedure
You may resume normal activities after the procedure. Consider avoiding rigorous activities.
Typical side effects include:
Please contact your doctor immediately if you experience moderate or severe pain or any other concerning symptoms after the procedure.
About 10-12 days after the procedure, your doctor may perform a blood test to determine if you are pregnant.
According to estimates, the chances of a successful pregnancy for women < 35 years of age is about 40-50 % for each attempt, and the chances decrease with increasing age.
What are the factors affecting the chances of a successful pregnancy with IVF?
There are various factors that can alter the chances for a successful pregnancy, and it varies with each couple.
Age – Women < 35 years of age have the highest chance of a successful pregnancy
Embryo Status – Transfer of a more developed embryo ( more than 2 or 3 days ) is associated with a higher rate of success than a less developed embryo.
Reproductive History – Women who have previously given birth are more likely to be able to get pregnant using IVF than women who have never given birth.
Cause Of Infertility – Conditions such as endometriosis, pelvic inflammatory disease, previous uterine surgeries are associated with a decreased likelihood of successful pregnancy.
Lifestyle factors – Smoking, Obesity, Alcohol, Excessive Caffeine and Recreational Drug use has been associated with a decreased ovarian reserve and as a consequence have a lesser likelihood of successful pregnancy.
Most women undergoing IVF will be able to work full time.
It is suggested to avoid travel during the month of the IVF cycle and 2 weeks after Embryo Transfer.
We recommend sexual abstinence for 2-5 days prior to the semen retreival. Other than that, sexual intercourse is not contraindicated during the course of IVF.
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