In-Vitro Fertilization (IVF)
In-vitro Fertilization (IVF) is a highly popular treatment option for assisted reproduction. This procedure is usually recommended when previous treatments have been unsuccessful or there are medical factors which would make IVF more effective.
In IVF a woman’s eggs (or eggs from a donor) are retrieved from her ovaries and fertilized with sperm, either from a male partner or a sperm donor. This process is done in a laboratory. After the fertilization process, embryos are formed, which are then put back into the uterus of a woman who is intended to carry the baby in her womb and achieve pregnancy.
Who should undergo In-vitro Fertilization (IVF)?
Although IVF was primarily offered to patients with bilateral tubal blockages, however today it can help couples overcome various types of infertility. In numerous medical conditions, IVF is the first line of treatment for infertility and assisted reproduction. Below is the list of common indications for IVF treatment:
- Tubal blockages – damaged fallopian tubes
- Endometriosis (inflammatory condition of the pelvis) - Male factor infertility (sperm abnormalities, low sperm count) - Diminished ovarian function or age-related infertility - Anovulation or Poly Cystic Ovarian Syndrome (PCOS) - Unexplained infertility - Genetic diseases (cystic fibrosis, thalassemia)
IVF is also the first line of treatment for couples or partners looking for donated eggs/oocytes.
What is the IVF success rate?
IVF is a complex procedure and numerous factors determine its success. Factors like the age of the patient, type and duration of infertility, ovarian response, use of fresh or vitrified embryo transfer, or the use of self or donor eggs, are a few of the many indicators can determine IVF success. Based on your medical condition, your doctor will be able to give you a prognosis after proper evaluation. Discuss your concerns with your doctor and be informed that IVF is not a 100% successful path towards parenthood.
What is the IVF treatment process?
Before starting your cycle, the doctor will have you complete blood and ultrasound testing to determine the best treatment protocol for you. Tests to determine the ovarian reserves and hormone levels will also be included.
Your doctor will then evaluate your medical results and explain the IVF process to you to prepare you for the steps ahead. Your doctor will also discuss your cycle, prescribed medication plan, teach you how to inject the medication and assist in prescribing medication.
Once you are ready to start, you will be advised to take hormone injections for 10-14 days to help the follicles in your ovaries to grow. Once they have reached a certain size, you will take a final injection, to trigger the maturation of the eggs and ovulation.
If you want you can come to the clinic for the injections, but most patients administer their own medications at home. You can also bring your partner along and the clinic staff can train him/her too! Please note that these medications may cause some mild side effects like bloating or discomfort.
Ultrasound Examination/Cycle Monitoring
A vaginal ultrasound examination is conducted at regular intervals to assess the response of the injections on your ovaries. If the response is poor, then your doctor might advise you to cancel the IVF cycle. It is important that you take joint decisions with your medical doctor.
hCG injection / GnRH Injection
These injections trigger the final maturation of the eggs and make them ready for collection. The egg retrieval procedure is conducted 34-36 hours later.
Egg retrieval/Transvaginal Oocyte Retrieval
You will have the egg retrieval procedure around 36 hours after you have taken the final trigger shot. The doctor will insert a needle, guided by an ultrasound, through the vaginal wall into your ovaries to drain the fluid and eggs from each of your follicles. This procedure takes 15-30 minutes and the number of eggs collected will depend on your response to the injections. You can go home 2-3 hours after the procedure. Occasionally, you may have some vaginal spotting or abdominal discomfort, which will settle after 1-2 days.
Before the eggs can be fertilized with sperm, the sperm must first be isolated from the seminal fluid. Laboratory sperm preparation methods involve the removal of immotile (sperm that are not moving correctly) and dead sperm from the seminal fluid.
Embryo Development/Embryo Culture
The eggs will be fertilized in the lab with the sperm from your partner or a donor. To do this, the embryologist will select a single healthy sperm and inject it directly into the egg. The embryo will develop in the lab for 5-6 days. If you have chosen to perform Pre-Implantation Genetic Testing (PGS/PGD), it is at this point that a small sample of tissue from your developing embryo will be used to identify chromosomally normal embryos for transfer. If there are several well-developed embryos, it is possible to freeze them for a later transfer, if necessary.
This is performed 2-5 days after the egg collection. Your doctor will discuss with you the number of embryos that will be transferred. During your embryo transfer, a small catheter is passed through the cervix. The embryos are loaded into the catheter and then injected into the uterus. You will be prescribed medication to support the luteal phase. Occasionally, your doctor may suggest additional treatments such as Embryoglue® and insertion of a natural substance called hCG to enhance implantation.
About two weeks, after the embryo transfer, you will be given a pregnancy test. You can have the same in the clinic or at your home.
If it’s positive, a vaginal ultrasound scan will be performed 1 week later to confirm the pregnancy and view the gestational sac. You will also continue early pregnancy care with your doctor until you have been referred to an obstetrician, usually around week 12 of pregnancy.
If it’s negative, you will meet your doctor and decide on your next IVF cycle. Further treatment will also depend on whether you have frozen embryos or not.
What are the precautions to be taken after an IVF procedure?
- Avoid vigorous exercise, heavy lifting or any physical activity that involves jarring or jolting movements – cycling, jogging, tennis, etc. You can, however, follow other routine activities.
- Please follow the medical regime prescribed by your doctor. Following the same will improve your chances of pregnancy.
- Avoid smoking, passive smoking, alcohol and exposure to x-rays.
- Do not self-medicate and consult with your doctor before taking any medication.
- Intra Cytoplasmic Sperm Injection (ICSI)
- Preimplantation Genetic Testing (PGT)
- Tests to Assess Fertility in Women
- Tests to Assess Fertility in Men
- Natural Fertility Therapy
- Intrauterine Insemination (IUI)
- In-Vitro Fertilization (IVF)
- Intracytoplasmic Sperm Injection (ICSI)
- Cycle Monitoring
- Counseling for Infertility