In Vitro Fertilization (IVF) for Infertility Treatment

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IVF has come a long way from the days when it was first heralded as a medical miracle. The first IVF baby was born in 1978. Since then, according to the European Society of Human Reproduction and Embryology, a total of 5 million such births have bought joy to parents across the globe. Unfortunately, this has also created a scenario where many couples turn to this procedure without understanding its implications. Small, unsupervised clinics prey on this lack of knowledge, and non-specialist doctors sell themselves as “fertility experts”. An IVF procedure without proper adherence to the rules creates grave risks for the mother and the child. So let’s attempt to demystify this medical marvel and understand its basic concepts.

What is In Vitro fertilisation?

Typically, in vitro fertilisation is a biological process that has been made to occur in a laboratory vessel, test tube or other in a controlled experimental setting.  In simple terms, in vitro fertilization is a fertility treatment where sperm and eggs are combined in a laboratory to form embryos, and placed in the uterus through the cervix to enable conception of an IVF baby. Nowadays, IVF treatment is considered to be the most commonly used fertility treatment, accounting for more than 99 percent of assisted reproductive technology procedures.

IVF treatment procedure step by step

This revolutionary procedure is basically used to treat fertility or genetic problems and help in the conception of a child. You might also go for less invasive treatment options before attempting IVF. These include taking medications to increase production of eggs, or intrauterine insemination (a procedure in which sperm are placed directly in your uterus near the time of ovulation).

But if you are one of those couples who has failed to conceive after all other treatments and want to try IVF treatment, then you should be aware of the procedures you would be required to follow during the course of the treatment. First, you should know that the procedure is done using your own eggs and your partner’s sperm. It may also involve eggs, sperm or embryos from an anonymous donor. There are cases where a gestational carrier – a woman who has an embryo implanted in her uterus – might also be used.

Before you proceed for IVF treatment, both partners will have to undergo the following screening tests:

Evaluation of ovarian reserve: In order to determine the quantity and quality of your eggs, you have to take certain tests determining the concentration of follicle-stimulating hormone, oestrogen and anti-mullerian hormone in your blood during the first few days of menstrual cycle. The tests may be combined with an ultrasound of ovaries to predict the ovaries’ response to the fertility medication.

Semen analysis: Your partner might be asked to take a semen analysis test before starting the treatment. This test analyzes the health and viability of sperm, including the number, shape, and movement (or motility). Both of you might also have to take screening tests for infectious diseases, including HIV.

Uterine cavity exam: This test helps the doctor to examine your uterine cavity or the space inside of the uterus. A healthy uterine cavity is essential to conceive and maintain a pregnancy.

There are also some important points to consider as a couple, and discuss them with the doctor before taking the plunge to go through the IVF treatment cycle. Some of these things are:

Embryos for transfer: Normally, the number of embryos that will be transferred during the treatment depends on the age and number of eggs retrieved. Since the rate of implantation is lower for older women (above 35 years of age), more embryos are usually transferred to increase the likelihood of conception. This happens except in cases where donor eggs are being used.

However, legislation in a few countries limits the number of embryos that can be transferred in one IVF cycle. This is because some studies indicate that implanting multiple embryos at one time can lead to complications for both mothers and babies, and increase the likelihood of multiple gestations. So you should discuss it with your doctor in depth and decide on the number of embryos to be transferred before the transfer procedure actually happens.

Multiple pregnancies: You should also know that if more than one embryo is transferred to your uterus, the IVF treatment can lead to a multiple pregnancy. To avoid such a situation, in some cases, people opt for foetal reduction. This can help a woman minimise the chances of complications and give birth to a healthy baby. However, this could be a major decision with ethical, emotional and psychological consequences.

Extra embryos: What do you do with the extra embryos during the treatment? You can choose to discard the unused embryos, but you should also know that they can be frozen and stored for future use. However, there is no assurance that all embryos will endure the freezing and thawing process. It is recommended to discuss this with the doctor and follow expert advice.

Other issues: You also need to consider the chance of complications arising out of donor eggs, sperm or embryos from a gestational carrier. For this, you should consult a trained counsellor with expertise in donor issues who can thoroughly explain the legal rights of the donor. You also may need an attorney to file court papers to help you become legal parents of an implanted embryo.

How does the in vitro fertilisation process work?

There are a number of stages that the couple has to pass through before being able to conceive. Let’s look at the procedure step-by-step to understand the complexities of the process.

Ovulation induction

This is the first phase of your treatment. If you’re using your own eggs, then initially you will be treated with synthetic hormones to stimulate the ovaries for producing multiple eggs instead of a single egg that normally develops each month. It is important that multiple eggs are produced as some eggs might not fertilize or develop after fertilization.

For this the doctor could prescribe medication at different stages of the treatment:

  • Ovarian stimulation. For stimulation of the ovaries you are generally advised to take injections containing a follicle-stimulating hormone, a luteinizing hormone or a combination of both. This will help in producing more than one egg at a time.
  • Oocyte maturation. After the eggs are formed and follicles are ready for egg retrieval (this typically happens between eight to 14 days) you are prescribed medications to help the eggs mature.
  • Premature ovulation. You might even be asked to take medications that could prevent the body from releasing the developing eggs too soon.
  • Lining of your uterus. Another set of medications may be prescribed on the day of egg retrieval or at the time of embryo transfer. You are given progesterone supplements to prepare the lining of uterus, and make it receptive for implantation.

Your body might take one to two weeks for ovarian stimulation before the eggs are retrieved. But during the course of medications, you will have to be checked every two to three days for blood hormone levels and get an ultrasound for measurements of ovaries. This helps to track the growth of the follicles – the fluid-filled sacs where eggs mature, and to determine if the eggs are ready for collection.

You should know that the IVF cycle at this stage may be cancelled for reasons such as an insufficient number of follicles developing, premature ovulation, or too many follicles creating a risk of ovarian hyperstimulation syndrome. If your cycle doesn’t progress for some reason, then the doctor might recommend changing medications or doses to support a better response in future cycles.

Egg extraction

After the follicles are ready, you are given a trigger shot – an injection that will help the eggs to mature fully and prepare them for fertilization. The eggs are ready for retrieval from 36 hours after the shot is given.

Transvaginal ultrasound aspiration

Before you undergo transvaginal ultrasound aspiration (the usual procedure of retrieving eggs), you will be first sedated through medication. Normally in this procedure an ultrasound probe is inserted into your vagina to identify follicles, which is then followed by a thin needle into an ultrasound guide to go through the vagina and into the follicles for retrieving the eggs.

The matured eggs collected are then kept in a nutritive liquid and incubated. Eggs that appear healthy and mature will be infused with sperm to create embryos.

Sperm retrieval

Now it’s your partner turn, where he will be asked to provide a semen sample the same morning when egg retrieval is expected to be carried out. In rare cases, and methods such as testicular aspiration, the needle or surgical procedure is done to extract sperm directly from the testicle. The sperms are then separated from the semen fluid in the laboratory.

Fertilisation

Now your eggs will go through the most important phase – fertilisation. It can be carried out through two popular methods. The first is insemination, in which healthy sperm and mature eggs are mixed and incubated overnight. The other is intracytoplasmic sperm injection (ICSI) where a single healthy sperm is injected directly into each mature egg. ICSI is often used in cases when semen quality or number is an issue or if the fertilisation attempts during previous IVF cycles have not yielded fruitful results.

Embryo or blastocyst transfer

The next critical stage is at the three-day mark when some fertilised eggs will transform into multi-celled embryos. Within two more days, they further metamorphose into blastocysts. At this stage, they develop a fluid-filled cavity with tissues which will ultimately separate into the placenta and baby.

After you have passed through the above stages, you reach the stage where the embryo can be finally transferred into your womb. It is usually done after two to six days from egg retrieval. Here again, you will be given a mild sedative. However, the procedure is generally painless for the patient. The doctor will insert a long, thin, flexible tube called a catheter into your vagina, through the cervix and into your uterus. A syringe containing one or more embryos suspended in a fluid is attached to the end of the catheter. If successful, an embryo will implant in the lining of your uterus in around six to 10 days after egg retrieval.

Why is fertility treatment good for you?

If you have been trying to conceive for a couple of years now, and your efforts have gone in vain, then it’s time you consider IVF treatment. Even those who have not been able to conceive because of problems such as ovulation or egg quality, blocked fallopian tubes, endometriosis, uterine fibroids, unexplained infertility and more can take the treatment. It is one of the best medical procedures available today, which can help you get pregnant and carry your own baby to full term. In fact, it is offered as the primary treatment to treat infertility in women who have crossed over 40 years of age. If your partner has problems with low sperm count, or if you are using donor eggs to become pregnant, then this is one of the best treatments at hand.

What is IVF treatment for pregnancy?

IVF has become one of the popular treatments for couples with fertility issues or genetic problems. Both partners can take the treatment depending on the problems diagnosed and go on to become a parent.

How does IVF help in treating a woman?

It is important to determine the cause of fertility problems in a woman before the treatment can begin. In some cases, the reason or cause could be completely unknown. Find out some of the causes of infertility problems in women and their treatment:

Ovulation issues: If you have problems with ovulation and have been detected with polycystic ovary syndrome then some medications would be prescribed to stimulate your ovaries to release eggs or for treating PCOS.

Unexplained infertility: If any treatment has failed to determine the cause of infertility so far then you may be treated with medications such as Clomiphene, hormone injections, etc.

Blocked/damaged fallopian tubes or Fibroids: In the case of a blocked or damaged fallopian tubes, treatment may include tubal surgery. If mild to moderate endometriosis has been detected as the primary reason for infertility, then the treatment would include laparoscopic surgery to remove the endometrial tissue growth. Endometriosis is the result of the implantation and growth of the uterine tissue outside the uterus. This affects the function of the uterus, ovaries, and fallopian tubes.  You could also have uterine fibroids, which are benign tumours in the wall of the uterus, and could be interfering with implantation of the fertilised egg.

How does IVF help in treating a man?

In men, below-average sperm count, weak movement of sperm, or abnormalities in sperm size and shape can pose a challenge for the sperm to fertilise an egg. If such problems are found, you could be recommended to try insemination first wherein your sperms will be collected, and then concentrated to raise the number of healthy sperm required for insemination.

How long does it take to get pregnant through IVF?

It takes about four to six weeks to complete one cycle of IVF.  Typically 12 days to two weeks after the procedure of egg retrieval is done, you will be asked to take blood tests for determining pregnancy.

What is the success rate of IVF?

For any couple who has decided to take the IVF-route to starting a family, the primary question is ‘how successful is IVF’. It is difficult to get a conclusive answer to this question as the success rate of the IVF treatment varies depending on various reasons including infertility and age. Younger women usually have healthier eggs and higher success rates. According to the recent study, the birth rates resulting from a single cycle of IVF using women’s own eggs are about 30% to 40% for women aged 34 and younger. The rates decrease steadily once you cross 35 years of age. Besides embryo status, reproductive history, lifestyle factors such as smoking, and obesity are also factors contributing to the success of IVF.

Advantages or disadvantages of in vitro fertilisation

There are always concerns whenever you have to undergo a medical procedure. So, anxiety before taking the IVF treatment is also natural. Hence it is important to understand the pros and cons before you proceed.

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