In Vitro Fertilization (IVF)

Introduction

In vitro fertilization (IVF) is a type of Assisted Reproductive Technology (ART), which is used to treat infertility. In IVF, mature eggs are retrieved from the ovaries, and these eggs are fertilized by sperms in a lab to form embryos. The embryos are then implanted in the uterus. This process roughly takes about two weeks. IVF is the most successful form of ART. It can be done with your and your partner’s eggs and sperms, or by using eggs and sperms from a known or anonymous donor. Sometimes, the embryos are implanted in a surrogate (gestational carrier).The chances of having a healthy baby using IVF depend on your age and the cause of infertility. It is an invasive, expensive, and time-consuming process, with no guarantee of a successful outcome. Sometimes, it might also result in a multiple pregnancy. Talk to your doctor about the possible risks and different methods of treating your infertility. You can try less invasive methods like fertility drugs and intrauterine insemination before opting IVF.

What Are Its Uses?

IVF is the treatment of choice for infertility in women above 40 years of age. It can also be done in the following health conditions:

• Blocked or Damaged Fallopian Tubes – If your fallopian tubes are blocked or damaged, then it is difficult for the egg to fertilize or for a fertilized egg to move to the uterus.

• Ovulatory Disorder – If you do not ovulate or ovulate less frequently, then only a few eggs will be available to form an embryo.

• Endometriosis – Endometriosis causes extrauterine growth, which affects the function of the uterus, ovaries, and fallopian tubes.

• Premature Ovarian Failure – It is the loss of the normal function of the ovaries before the female reaches 40 years of age. It affects the production of estrogen and ovulation.

• Fibroids – Fibroids are benign tumors. Fibroid in the uterus can interfere with the implantation of the embryo.

• Tubal Ligation or Removal – If you have had your fallopian tube removed or blocked to prevent pregnancy previously, but want to conceive now, IVF might be useful.

• Sperm Problems – Sperm abnormalities like low count, reduced mobility, or abnormal shape and size, makes it difficult for the sperm to fertilize the egg.

• Fertility Preservation – People who are about to get treatment that might affect their fertility, can have their eggs or sperm harvested and frozen for later use.

• Unexplained infertility.

What Are the Tests to Do Before Starting IVF?

Before beginning the process, you and your partner need to undergo various screening processes. These tests include ovarian reserve test, semen analysis, screening for infectious diseases, mock embryo transfer, and examination of the uterine cavity.

What Are the Things to Consider Before Beginning IVF?

• The Number of Embryos to Be Transferred – The number of embryos is usually based on the age and number of eggs collected. As the implantation rate is lower in older patients, more embryos are transferred. So, discuss this with your doctor properly before you start the treatment, as there are changes of a multiple pregnancy.

• Storage of Extra Embryos – Extra embryos can be frozen for many years and can be used in future cycles of IVF. This will make the next cycle of IVF less invasive and less expensive.

• The Possibility of a Multiple Pregnancy – There are chances that IVF will result in a multiple pregnancy. You should be financially and mentally prepared to manage twins, triplets or higher multiple pregnancy.

What Are the Steps Involved in IVF?

There are basically five steps involved in IVF, which are Stimulation, Egg retrieval, Fertilization, Embryo culture, Embryo transfer.

1. Stimulation: It is also called superovulation. If you have decided to use your own eggs for the process, then you will be given synthetic hormones to stimulate your ovaries to produce multiple ova (eggs). You will be prescribed various medicines for:

• Ovarian Stimulation – Injectable medication containing follicle-stimulating hormone (FSH), luteinizing hormone (LH), or a combination of both.

• Oocyte Maturation – You will be given human chorionic gonadotropin (HCG) to help mature the developing eggs.

• Prevent Premature Ovulation – You will be prescribed few medicines to prevent your ovaries from releasing the matured egg too soon.

• Prepare the Lining of Your Uterus – The day when the eggs are collected, the doctor might give progesterone supplements to make the uterus lining more receptive to implantation. During this period, the doctor will perform regular blood tests and ultrasounds to monitor the process of egg maturation and will decide when to retrieve the egg accordingly.

2. Egg Retrieval: It is also called follicular aspiration. It is a surgical procedure that is done under anesthesia, where the doctor with the help of ultrasound, will guide a needle through your vagina into the ovary. This needle will suction eggs and fluid from each egg-containing follicle. Multiple eggs are collected within 20 minutes. The mature eggs are then placed in a culture medium and incubated.

3. Fertilization: It is the process of fertilizing the collected eggs with sperms to form embryos. It can be done using two methods:

• Insemination: After receiving the semen sample, the mature eggs and healthy sperm are mixed in a petri dish and incubated overnight.

• Intracytoplasmic sperm injection (ICSI): If insemination fails, then a single healthy sperm is injected into each mature ovum to form an embryo.

4. Embryo Culture:The fertilized eggs are monitored to ensure development. The embryos might be tested for genetic conditions at this stage.

5. Embryo Transfer:The embryos are transferred back into your uterus after two to six days of egg collection. It usually is a painless procedure and done under mild sedation. The doctor will place the embryo using a catheter.If the process is successful, the embryo or embryos will get implanted in your uterus. This entire process takes about 6 to 10 days.

Risks:

The risks associated with IVF are as follows:

• Multiple Pregnancy – Multiple pregnancy is considered a high-risk pregnancy, as it carries a higher risk of preterm labor and underweight baby.

• Miscarriage – The rate of miscarriage in women who conceive through IVF is 15 to 25 % and one needs to follow all the precautions to prevent IVF failure. But it increases with maternal age.

• Ectopic Pregnancy – When the embryo gets attached outside the uterus, it is called an ectopic pregnancy. The rate of ectopic pregnancy in IVF treated women is 2 to 5 %.

• Ovarian Hyperstimulation Syndrome (OHSS) – Due to the fertility drugs like HCG, the ovaries can become swollen and painful. The symptoms are abdominal pain and bloating, nausea, diarrhea, etc.

• Bleeding – During egg retrieval, the needle can cause bleeding, infection, and damage the bowel and bladder.

• Stress – IVF can be physically, financially, and mentally draining.

Side Effects After the Procedure:

After the process, you might have the following side effects:

• Vigorous activities can cause discomfort as the ovaries will be enlarged.

• You can pass a small amount of clear or bloody fluid.

• Your breasts might be tender due to high estrogen levels.

• Bloating.

• Abdominal cramps.

• Constipation.

Success Rates Of IVF:

The success rate of IVF treatment can be either calculated by the number of women who got pregnant, called the pregnancy rate, or the number of women who gave birth to a live baby, called live birth rate.

The pregnancy rate in the United States is:

• Women under 35 years – 47.6 %

• Women 35 to 37 years – 38.9 %

• Women 38 to 40 years – 30.1 %

• Women 41 to 42 years – 20.5 %

• Women above 42 years – 8.6 %

And the live birth rate is:

• Women under 35 years – 40.7 %

• Women 35 to 37 years – 31.3 %

• Women 38 to 40 years – 22.2 %

• Women 41 to 42 years – 11.8 %

• Women above 42 years – 3.9 %

Deciding when and how to undergo IVF treatment again after a failed attempt can be a tough and stressful situation. Talk to your doctor about the various options and the best way for you to conceive.