IN VITRO FERTILIZATION (IVF) : A NEW BEGINNING TO PARENTHOOD

WHAT IS IN VITRO FERTILIZATION?

In vitro fertilization (IVF) is a complex series of procedures used to help with fertility or prevent genetic problems and assist with the conception of a child.

In vitro fertilization is the most effective form of assisted reproductive technology. The procedure can be done using your own eggs and your partner’s sperm. Or IVF may involve eggs, sperm or embryos from a known or anonymous donor. In some cases, a gestational carrier — a woman who has an embryo implanted in her uterus — might be used.

Your doctor can help you understand how IVF works, the potential risks and whether this method of treating infertility is right for you.

 

WHY IN VITRO FERTILIZATION IS DONE?

IVF is performed to treat infertility, after trying less invasive treatment options, including fertility drugs for the formation of egg or IUI (Intrauterine Insemination – when sperm are placed directly in the uterus near the time of ovulation

IVF may also be done in cases where there is:

• Fallopian tube damage or blockage: Blocked or damaged Fallopian tubes make it difficult for an egg to be fertilized or for an embryo to travel to the uterus.
• Ovulation disorders: In cases where ovulation is infrequent or absent and as a result, fewer eggs are available for fertilisation.
• Premature ovarian failure: The loss of normal ovarian function before age 40. This means that the ovaries don’t produce normal amounts of the hormone oestrogen, or that no eggs are released regularly.
• Endometriosis: Endometriosis occurs when the uterine tissue implants and grows outside of the uterus, often affecting the function of the ovaries, uterus and Fallopian tubes.
• Uterine fibroid: Common in women in their 30s and 40s, fibroids are benign tumors in the wall of the uterus that can interfere with implantation of the fertilized egg.
• Previous tubal sterilization or removal: In cases where a patient’s fallopian tubes are cut or blocked to permanently prevent pregnancy, IVF may be a good option.
• Impaired sperm production or function: Poor mobility – low sperm concentration, weak movement of sperm or poor morphology – abnormalities in sperm size and shape often make it difficult for sperm to fertilize an egg. (also read about VASECTOMY – A BETTER CHOICE)
• Unexplained infertility: When no cause of infertility has been found despite evaluation.
• A genetic disorder: If the patient or her partner are at risk of passing on a genetic disorder to the child, pre-implantation genetic diagnosis, a procedure that involves IVF, may be used. After the eggs are harvested and fertilized, they can be screened for some genetic problems. Only embryos without the identified problems are transferred to the uterus.
• Fertility preservation for cancer or other health conditions: If a patient is about to begin cancer treatment that could harm fertility, IVF is an option for fertility preservation. Eggs can be harvested from the patient’s ovaries and frozen for later use. Eggs can also be fertilized and frozen as embryos for use later.
• Lack of a functional uterus and high-risk pregnancies: Patients who do not have a functional uterus or those for whom pregnancy poses high health risks may choose IVF. In this case another person or a surrogate appointed by the couple is used to carry the baby to term. In this case, the patient’s eggs are fertilized with sperm and the resulting embryos are placed in the surrogate’s uterus.

 

HOW TO PREPARE FOR IN VITRO FERTILIZATION?

Before beginning a cycle of IVF the patient and her partner will need to go through several tests:

• Ovarian reserve testing: This helps determine the quantity and quality of the patient’s eggs. The concentration of follicle-stimulating hormone (FSH), estradiol (estrogens) and anti-mullerian hormone in the patient’s blood is tested during the first few days of her menstrual cycle.
• Semen analysis.If not done as part of the initial fertility evaluation, a semen analysis is necessary before the start of an IVF treatment cycle.
• Infectious disease screening. Both partners will be screened for infectious diseases including HIV, HBsAag and HCV.
• Mock embryo transfer. A mock embryo transfer is often carried out to determine the depth of the uterine cavity to ascertain the technique most likely to successfully place the embryos into your uterus.
• Uterine cavity exam. The IVF specialist will examine the uterine cavity before beginning IVF. This often involves a diagnostic hysteroscopy where a thin, flexible, lighted telescope is inserted through the vagina and cervix into the uterus.

 

WHAT TO EXPECT AT EACH STEP?

IVF involves several steps: ovulation induction, egg retrieval, sperm retrieval, fertilization and embryo transfer. One cycle of IVF takes about two weeks and sometimes, more than one cycle may be required.

STEP 1: Controlled Ovarian Hyper stimulation

The patient will be treated with synthetic hormones to stimulate the ovaries to produce multiple eggs rather than the single egg that normally develops each month. Multiple eggs are needed as some eggs don’t fertilize or develop normally after fertilization.

The patient may be given medications:

• For ovarian stimulation
• For egg maturation
• To prevent premature ovulation
• To prepare the lining of the uterus

It usually takes one to two weeks of ovarian stimulation before eggs are ready for retrieval

 

STEP 2: OPU (Ooctye/Egg pick-up) and Sperm retrieval

Egg pick-up or OPU is usually done 34 to 36 hours after the final injection and before ovulation. The OPU procedure is a day-care procedure done under anaesthesia, and is usually completed within 10 to 20 minutes. It is a simple surgical procedure performed under the guidance of ultrasound.

What to expect:

• The patient will be instructed not to eat from the night before the procedure. The patient has to be on an empty stomach on the day of the procedure as well.
• Guided by ultrasound monitors, the doctor inserts a needle through the vagina and into the ovaries
• The doctor then draws back the needle to remove the eggs from the follicles. Not all follicles contain eggs.
• Mature eggs are placed in a nutritive liquid and incubated. Eggs that appear healthy and mature will be mixed with sperm to attempt to create embryos. Not all eggs may be successfully fertilized.

Some patients might experience cramp-like pains on the day of process which subside by the next day

STEP 3: Fertilization and Incubation

• Once the eggs have been retrieved, an embryologist prepares the eggs and the sperm from the partner.
• The eggs and sperm are mixed in the laboratory to promote fertilization.
• The fertilized eggs called embryos are then incubated for several days.

Intracytoplasmic Sperm Injection or ICSI.

In ICSI, a single healthy sperm is injected directly into each mature egg. ICSI is used when semen quality or number is low or when fertilization attempts have failed during prior IVF cycles failed.

 

RESULTS

About 12 days to two weeks after egg retrieval, your doctor will test a sample of your blood to detect whether you’re pregnant.

• If you’re pregnant,your doctor will refer you to an obstetrician or other pregnancy specialist for prenatal care.
• If you’re not pregnant,you’ll stop taking progesterone and likely get your period within a week. If you don’t get your period or you have unusual bleeding, contact your doctor.

The average IVF success rate is around 40% in young women.