What is IVF?
In vitro in Latin is for “in glass” and refers to the laboratory Petri dish in which the egg and sperm are mixed. In vitro fertilization can overcome most causes of male and female infertility. IVF has a high rate of success because it allows for a controlled interaction of eggs and sperm. Medications increase the number of mature eggs a woman can produce at a single time. Each developed embryo can be evaluated to determine which ones are most likely to result in pregnancy. IVF offers a high chance of pregnancy in a short period of time.
In vitro fertilization (IVF) is an assisted reproductive technology that begins by collecting a woman’s eggs and a man’s sperm and combining them together outside the woman’s body in a laboratory dish for fertilization. After the eggs are fertilized and become embryos, the best embryo(s) are transferred to the woman’s uterus. If IVF treatment is successful, the embryo will implant in the uterus and result in a pregnancy. Any remaining embryos can be frozen and stored for future use.
How is IVF process done?
IVF is a complex technique involving five basic steps:
1) Superovulation, the process of stimulating a woman to grow multiple healthy eggs, as opposed to the single egg a woman normally ovulates.
2) Egg retrieval and sperm collection.
3) Insemination and fertilization of the eggs by the sperm.4) Embryo development
5) Embryo transfer into the woman’s uterus.
IVF-ICSI treatment starts from the 2nd or 3rd day of the periods. Hormone injections will be started from 2nd or 3rd day from the start of the periods. She needs to take injections daily for 8 to 9 days at around the same time. Internal scans will be done on 2nd day, 6th day, 8th day and 10th day of the periods to monitor the follicular growth. This will also help us to adjust the dose of the injections.
Husband needs to provide semen sample on the day of egg retrieval. (Usually any one day between 11th to 13thday, with abstinence period of 2-3 days). Oocyte (egg) retrieval procedure takes 20-30 minutes. It is done under general anaesthesia. She will not feel any pain during the procedure. Internal scan is done and under ultrasound guidance, all follicles were aspirated with egg retrieval needle and eggs will be obtained.
After the procedure, she will be drowsy for nearly 2 hours due to anaesthesia medicines and after 5 hours, she will be discharged. Oral medicines, vaginal gel and vaginal capsules will be prescribed at the time of discharge which should be taken regularly without fail. Embryologist will discuss the findings to you both before you get discharged and explain the details of the egg quality, sperm quality, number of mature eggs and IVF or ICSI procedure done. Embryologist will call you and will give information regarding the fertilisation and embryo quality status every alternate days from the next day after the procedure (day 1 after the IVF procedure, day 3 and day 5 of the embryos).
Embryo transfer will be done ideally on day 3 or day 5. Normally we do embryo transfer on day 5 (Blastocyst). Embryo transfer procedure takes around 10 minutes. It is similar to IUI procedure. She should not feel any pain during the procedure. Routinely women do not need anaesthesia for embryo transfer procedure. Full bladder will help in doing the procedure easily and will be less uncomfortable to the women.
After the procedure, she will be advised to take rest for 30 minutes. Oral Medicines, vaginal gel and vaginal capsules which are already been prescribed before need to be taken regularly on time. Pregnancy test need to be done 12 days after the embryo transfer date. On confirmation of pregnancy test, discuss with the doctor and these above medications need to be continued until 12 weeks of pregnancy
The most widely reported risk associated with IVF is a multiple birth pregnancy (twins or more). This can result in pregnancy and labour complications mainly premature delivery and resulting in prematurity of the babies and its long term complications.
Egg retrieval procedure risks: IVF carries the normal risks of surgery including reaction to anaesthesia, internal bleeding, infection, damage to tissue and organs.
Fertility medications can have a number of side effects including
1) Mild bruising and soreness at the injection site,
2) Nausea and, occasionally, vomiting,
3) Temporary allergic reactions, such as skin reddening and/or itching at the injection site
4) Breast tenderness and increased vaginal discharge
5) Headache, abdominal pain and bloating
6) Mood swings and fatigue
7) Ovarian hyperstimulation syndrome (OHSS)
Most symptoms of OHSS (nausea, bloating, ovarian discomfort) are mild. They usually go away without treatment within a few days after the egg collection. In severe cases, OHSS can cause large amounts of fluid to build up in the abdomen (belly) and lungs. This can cause much enlarged ovaries, dehydration, trouble in breathing, and severe abdominal pain. Very rarely (in less than 1% of women having egg retrieval for IVF), OHSS can lead to blood clots and kidney failure.
Fertility medications and cancer: Earlier reports from several decades ago suggested a link between ovarian cancer and the use of fertility medicines. Recent and well done studies no longer show clear associations between ovarian cancer and the use of fertility medications.
If I conceive with IVF, will my pregnancy be more complicated?
Having a multiple pregnancy (pregnancy with more than one baby) is more likely with IVF, particularly when more than one embryo is transferred. These pregnancies carry significant risks, including:
The risk of birth defects in the general population is 2%-3%, and is slightly higher among infertile patients. Most of this risk is due to delayed conception and the underlying cause of infertility.
Whether or not IVF alone is responsible for birth defects remains under debate and study. When intracytoplasmic sperm injection (ICSI) is done along with IVF, there may be an increased risk of birth defects. However, it is uncertain if these risks are due to the ICSI procedure itself or to problems with the sperm themselves.
Men with sperm defects are more likely to have chromosomal abnormalities, which can be transmitted to their children. However, these disorders are extremely rare. Rare genetic syndromes called imprinting disorders may be slightly increased with IVF.
The rate of miscarriage after IVF is similar to the rate following natural conception, with the risk going up with the mother’s age. The rate of miscarriage may be as low as 15% for women in their 20s to more than 50% for women in their 40s.There is a small risk (1%) of an ectopic (tubal) pregnancy with IVF. There is a 1% risk for a heterotopic pregnancy after IVF.
IVF Success Rate: A woman's age is a major factor in the success of IVF for any couple along with man’s age, sperm quality, woman’s weight and other factors. Woman who is under age 35 and undergoes IVF has 60% chances of pregnancy and 40% chance of having a child, while a woman over age 40 has 12% chance of having a child.
How many times can a woman do ivf treatment?
60% of couples have successful ivf treatment. Some couples are lucky after the first cycle, but a large percent are not. For this reason, you may need to keep on trying. The research suggests most couples will need approximately 6 embryo transfers before they achieve a pregnancy!
There are no limits to the number of IVF cycles you can have. This decision is entirely up to you and the fertility specialists. Most doctors recommend that you shouldn’t try more than three times without changing something.
It might be worth it to try the same IVF procedure again, assuming that your body and mind are ready. You can decide on the number of IVF cycles you have, but you need to be aware of the costs associated with IVF.
Arguably, the most important things you will need while undergoing IVF treatments are patience and a strong support system of friends and familybehind you as you work your way through this.