In Vitro Fertilisation (IVF)

IVF is considered the most effective form of assisted reproductive technology. The procedure is conducted using the patient’s eggs and her partner’s sperm. In some cases, the IVF procedure may involve using sperm or embryos from a donor. IVF is also used when a couple needs to use a surrogate – a woman who has an embryo implanted in her uterus and carries the baby to term.

One cycle of IVF takes about two weeks and the procedure involves several steps:

  1. The first step involves stimulating ovulation to produce mature eggs. During this stage the growth of the follicles are monitored through serial ultrasounds.
  2. The second stage is called Egg pick-up or Oocyte pick-up, where multiple mature eggs are retrieved from a woman’s stimulated ovary.
  3. Fertilisation is the next stage where the woman’s eggs are fertilised with her husband’s sperm in a dish in a lab under sterile conditions.
  4. In the fourth stage, the embryos are implanted in the uterus three or five days after fertilisation.

When is IVF recommended?

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.)

Often, IVF is used as a primary treatment for infertility in women over 40.

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.
  • 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 fertilised, 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 fertilised with sperm and the resulting embryos are placed in the surrogate’s uterus.

Tests before the IVF procedure

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. Test results often used together with an ultrasound of her ovaries help predict how the ovaries will respond to fertility medication.
  • 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.

Embryo transfer and cryopreservation:

At Motherhood Hospitals’ IVF Center, two embryos are usually transferred into the patient’s uterus and any extra embryos can be frozen for future use. Not all embryos will survive the freezing and thawing process, although most will.

Embryo transfer is a painless procedure It is done without anesthesia. In some rare conditions, anesthesia might be required if sp, the doctor will inform you, prior to the procedure.

Cryopreservation or freezing can make future cycles of IVF less expensive and less invasive.

What to expect at each step?

IVF involves several steps: ovulation induction, egg retrieval, sperm retrieval, fertilisation 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 fertilise or develop normally after fertilisation.

The patient may be given medications:

  • For ovarian stimulation. The patient might get an inject-able medication containing a follicle-stimulating hormone (FSH), a luteinising hormone (LH) or a combination of both. These medications help stimulate multiple egg to development.
  • For egg maturation. When the follicles are ready for egg retrieval, usually after 9 to 14 days, then Human Chorionic Gonadotropin (HCG) or other medications may be administered to help the eggs mature
  • To prevent premature ovulation. A certain injection is started on the sixth day of ovarian stimulation, this may vary depending on the growth of the follicles. This prevents the premature rupture of the developing eggs.
  • To prepare the lining of the uterus.On the day of egg retrieval or at the time of embryo transfer, progesterone supplements may be prescribed to make the lining of the uterus more receptive to implantation.

It usually takes one to two weeks of ovarian stimulation before eggs are ready for retrieval. To determine when the eggs are ready for collection, the following checks are performed:

Vaginal ultrasound: this helps monitor the development of follicles where eggs mature.

  • Blood tests: In response to ovarian stimulation medications, oestrogen levels typically increase as follicles develop and progesterone levels remain low until after ovulation.

Sometimes IVF cycles may be cancelled before egg retrieval because of:

  • Inadequate number of follicles developing
  • A risk of ovarian hyper stimulation syndrome – when too many follicles develop
  • Premature ovulation
  • Other medical issues

If the IVF cycle is cancelled, the IVF specialist might recommend changing medications or doses to promote a better response in future IVF cycles. In some cases, the patient might be asked to consider an egg donor.

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.
  • The surgery is conducted using general anaesthesia
  • Guided by ultrasound monitors, the doctor inserts a needle through the vagina and into the ovaries
  • If the patient’s ovaries aren’t accessible through trans-vaginal ultrasound (which is very rare), an abdominal surgery or laparoscopy (a procedure in which a slender viewing instrument -laparoscopy – is inserted through a tiny incision near the navel) may be used to guide the needle.
  • 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 fertilised.
  • Following the procedure, patients recuperate in a recovery room, have some food and return home the same day.

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

Sperm retrieval

A sperm sample is sought from the patient’s partner on the morning of egg retrieval. Donor sperm also can be used. The sperm are then separated from the semen fluid in the lab.

STEP 3: Fertilisation 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 fertilisation.
  • The fertilised eggs called embryos are then incubated for several days.

Fertilization is attempted using two methods:

    1. Insemination.In this case, healthy sperm and mature eggs are mixed and incubated overnight.
    2. Intracytoplasmic sperm injection (ICSI).

In cases of severe male infertility, the embryologist can inject a single sperm directly into the egg by a process called

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 fertilisation attempts have failed during prior IVF cycles failed.

How ICSI is performed:

Fertility medications are usually prescribed to stimulate ovaries to produce multiple mature eggs. With a transvaginal ultrasound-guided needle, the eggs are removed from the patients’ ovaries and placed in a petri dish for fertilisation. If her partner’s semen does not contain enough motile sperm, sperm can be extracted from a testicle with a needle. If a sperm sample reveals too few sperm, a biopsy can be taken from testicular tissue in hopes that there will be sperm attached.

Next, a single sperm is injected directly into each individual egg.

The next day the eggs are checked to see if fertilisation was successful. The fertilized eggs will remain in the petri dish for a few days as they continue to divide and become early embryos. Using a thin catheter, the doctor then places the embryos into the uterus.

The full IVF cycle takes about 15 to 20 days to complete – from the first day of treatment until embryo transfer.

STEP 4: Embryo transfer

Embryo transfer is usually done two to five days after egg retrieval.

The patient can have a light breakfast before the procedure.

  • The procedure is usually painless although experience mild cramping might be experienced.
  • The IVF specialist inserts a catheter (a long, thin, flexible tube), into the vagina through the cervix and into the uterus.
  • A syringe containing one or more embryos suspended in a small amount of fluid is attached to the end of the catheter.
  • Using the syringe, the IVF specialist places the embryo or embryos into the uterus.

If successful, an embryo will implant in the lining of your uterus 6 to 10 days after egg retrieval.

After the procedure.

Post the procedure, you will be moved to a recovery room to rest and have a meal. You can return home after 2 hours. Once home you can go about normal activities but be sure not to lift or carry anything that’s heavy. You will also be asked to try avoiding vigorous activity, as it may cause discomfort.

Results

About 15 days after embryo transfer, the IVF specialist will advise a blood test to detect pregnancy. Success of IVF ranges from 38% to 40% at our center.

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I am Dr. Swapna and my husband name is Venkat its been 10years of married life we have no kids and we visited Dr. sunil sir for IVF Treatment and sir explained us treatment procedures

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I was both happy and worried when I got pregnant. The test came positive and added a hundred doubts. One thing I decided was to find a good hospital and stick to it throughout the pregnancy.

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