In Vitro Fertilization (IVF), alternatively known as IVF, entails a series of intricate procedures with the potential to result in pregnancy. It serves as a treatment for infertility, a medical condition that encompasses couples who have been unsuccessful in conceiving after a minimum of one year of actively trying. Moreover, IVF can be employed to prevent the transmission of genetic disorders to offspring.
The process of IVF involves the extraction of mature eggs from the ovaries, which are subsequently fertilized by sperm cells within a laboratory setting. Subsequently, one or more of these fertilized eggs, referred to as embryos, are carefully placed into the uterus via a specialized procedure. An entire cycle of IVF generally spans between 2 to 3 weeks, although the various steps can be divided into separate stages, making the overall process longer.
What is the IVF process?
In vitro fertilization (IVF) is a highly effective form of fertility treatment that involves the manipulation of eggs, embryos, and sperm. Collectively, these treatments are referred to as assisted reproductive technology.
IVF can be performed using a couple’s own eggs and sperm, or it may require eggs, fluids, or embryos obtained from either a known or unknown donor. In certain cases, a gestational carrier, who accepts an implanted embryo in the womb, may be involved.
The chances of achieving a healthy pregnancy through IVF depend on numerous factors, including the patient’s age and the underlying cause of fertility issues. Moreover, it is crucial to note that IVF entails time-consuming, expensive, and sometimes invasive procedures. Placing more than one embryo in the uterus can lead to a multiple pregnancy, where the patient carries more than one baby simultaneously.
To gain comprehensive knowledge about the functioning and associated risks of IVF, as well as to determine its suitability for individual cases, it is advisable to consult a qualified healthcare team.
Why it’s undertaken?
IVF is sometimes recommended as the primary solution for infertility in individuals aged 40 and above. It may also be pursued in cases of specific health conditions. These include:
1. Fallopian Tube Issues: Damage or blockage of both fallopian tubes can impede fertilization or the embryo’s journey to the uterus.
2. Ovulation Disorders: If ovulation is irregular or infrequent, the availability of eggs for fertilization is reduced.
3. Endometriosis: The abnormal growth of tissue resembling the uterine lining outside the uterus, commonly affecting the ovaries, uterus, and fallopian tubes.
4. Uterine Fibroids: Non-cancerous tumors in the uterus that can hinder the attachment of a fertilized egg to the uterine lining.
5. Past Surgery for Pregnancy Prevention: Tubal ligation, a surgical procedure to permanently prevent pregnancy, can be addressed through IVF for those seeking conception after the procedure.
6. Sperm-related Issues: Low sperm count or abnormalities in sperm movement, size, or shape may necessitate consultation with an infertility specialist.
7. Unexplained Infertility: When traditional tests fail to identify the cause of infertility.
8. Genetic Disorders: Risk of transmitting a genetic disorder to the child, prompting the use of preimplantation genetic testing during IVF.
9. Preserving Fertility due to Health Conditions: Cancer treatments like radiation or chemotherapy may compromise fertility, making IVF a viable option to harvest and freeze eggs for future use or to create and freeze embryos.
In situations where pregnancy poses health risks or individuals lack a functional uterus, IVF involving a gestational carrier may be chosen. This involves fertilizing eggs with sperm, and the resulting embryos are implanted in the uterus of the gestational carrier.
What are the risks?
Health problems are more likely to arise during IVF, which is a risky procedure. These risks range from the short term to more long-term:.
The cost of IVF can be exorbitant, posing challenges for the body, mind, and finances.Whether you are alone or with an infertility specialist, seeking help from counselors, family members, and friends can be crucial to managing the challenges.
Experiences in the egg-gathering process. Following the use of medication to encourage ovulation, sacs that contain eggs are formed in the uterus and then excreted.
This is referred to as egg retrieval.By using ultrasound images, a long, thin needle is guided through the vagina and into the sacs, which are called follicles. The needle has the potential to cause bleeding, infection, or harm to the bowel, bladder, and blood vessel.
During the procedure, anaesthesia may be given medicines that can help you sleep and prevent pain. Igor cell death caused by ovarian hyper-stimulation syndrome.
Inflammation and pain are common in this condition, which affects the ovaries. Getting fertile through fertility medication, such as human chorionic gonadotropin (HCG), can cause this.
For a week, it is common to experience symptoms. Symptoms such as mild discomfort in the stomach, distended or flatulence, nausea, vomiting and diarrhoea are present. Your pregnancy may result in a delay of several weeks in the long run.
Rarely do individuals with ovarian hyper stimulation syndrome experience an enhanced condition that results in rapid weight gain and shortness of breath. I have a history of miscarriage. People who use IVF to have new embryos often experience miscarriage, which is comparable to the rate of naturally occurring conceptions.
The increase in rate is associated with the age of the pregnant woman.A pregnancy that is not sterile can lead to anaemia. In a fallopian tube, implantation of uterine tissue after fertilization occurs. The embryo cannot survive in a location other than the uterus, and there’s no way to continue the pregnancy.
IVF can cause an ectopic pregnancy in a small proportion of people. Multiple pregnancies are a common phenomenon. Having multiple offspring during IVF can increase the likelihood of complications.
When expecting multiple babies, the risk of pregnancy-related complications such as high blood pressure and diabetes, early labour and delivery time, low birth weight, and birth defects is greater than when having only one baby.
The occurrence of birth defects is noteworthy. No matter how the child is conceived, birth defects are most likely to occur at an older age than the mother’s age. There is a correlation between assisted reproductive technologies and the risk of premature births caused by heart defects, digestive issues, or other conditions.
It is necessary to conduct further research to ascertain if the elevated risk is linked to IVF or another method. Untimely delivery and reduced weight during pregnancy. Some studies indicate that IVF with minimal side effects increases the risk of an early delivery or low pregnancy weight.
The cancer type is a complex and pervasive condition that can lead to death. Early research indicated that certain drugs used to promote egg growth may have a correlation with the development of specialized ovarian tumours. Recent research does not confirm these findings. The likelihood of breast, endometrial, cervical, and ovarian cancer is not significantly elevated after IVF.
How to prepare?
Getting started with your search for a reliable fertility clinic will be essential. In India, individuals who reside in this country can access information about clinics from Indian Council of Medical Research or the National ART & Surrogacy Portal or even the Indian government website for Assisted Reproductive Technology online.
Several factors determine the level of success achieved by an approved fertility treatment center. Among them are the age of the patients being treated and their medical conditions, along with information about how the clinic provides treatment. During a consultation with s/he, ask for detailed details of the costs involved in each stage of treatment.
A number of screening tests may be required before you start IVF with your partner, where you use your own eggs and sperm. Included in the list are:
1. Test done on ovarian reserve. A blood test is conducted to determine the quantity of eggs present in the body. This activity is also referred to as egg supply. Blood tests and ultrasounds of the ovaries are frequently used in conjunction with blood testing to predict the response of fertility drugs to treatment.
2. Analysing sperm is one of the most important aspects of semen analysis. The substance that makes up sperm is called semen. The examination of it can establish the quantity of sperm, their shape, and the manner in which they circulate. This test could be included in a preliminary analysis of fertility. It could be attempted in the days leading up to the initiation of IVF treatment.
3. Vaccination for infectious diseases. Vaccinations such as HIV will be tested for both you and your spouse.
4. Execute embryo transfer. The actual embryo is not implanted in the uterus during this test. It can be utilized to determine the size of your uterus. This also aids in determining the optimal technique for inserting one or more genuine embryos.
5. Prior to IVF treatment, the inner lining of the uterus is examined. This could involve the use of a sonohysterography test. A thin plastic tube is used to pump fluid from the cervix into the developing uterus. The fluid aids in obtaining more detailed ultrasound images of the uterine’s lining. The uterine exam may involve a hysteroscopy test. Through the use of a thin, flexible light-emitting telescope that is attached to an in-utero window, one can observe the inside of the uterus by inserting it into the vagina and cervix.
Consider some important questions before the IVF cycle begins, such as:
1. When & how many embryos may be implanted in the uterus?
This depends on age and the number collected by researchers who collect eggs. With the decrease in the rate of fertilized egg attachment to the uterus’ lining, older individuals typically transfer more embryos, but they may choose to use donor eggs from young people, genetically tested embryonic stem cells, or alternative methods. Most health care professionals adhere to specific measures, such as avoiding triplets or more. In certain countries, there are laws that restrict the number of embryos that can be transferred. Make certain that you and your care team have an agreement on the number of embryos that will be placed in the uterus before the transfer is completed.
2. What would you like to do with any surplus embryos?
These embryos can be frozen and stored for extended periods of time. Although not all embryos will survive the freezing and thawing process, the majority usually do.
Storing surplus embryos can contribute to reducing the cost and invasiveness of future cycles of In Vitro Fertilization (IVF). Alternatively, there is a possibility of donating unused frozen embryos to another couple or a research facility. Another option could be the responsible disposal of unused embryos. Prioritize feeling comfortable with the decisions regarding surplus embryos before their creation.
3. To address the possibility of a multiple pregnancy, it is important to consider how you would manage it. With in vitro fertilization (IVF), there is a chance of having multiple embryos placed in your uterus, which can lead to a multiple pregnancy. However, this carries certain health risks for both you and your babies. In certain situations, a medical procedure known as fetal reduction may be considered to reduce the number of babies being carried, thereby minimizing the associated health risks. Nonetheless, opting for fetal reduction is a significant decision that involves ethical, emotional, and mental considerations.
4. Consider the Potential Risks Associated with Donor Eggs, Sperm, Embryos, or a Gestational Carrier
Prior to proceeding with the utilization of donor eggs, sperm, embryos, or engaging a gestational carrier, it is imperative to thoroughly evaluate and understand the associated risks. Seeking guidance from a skilled counsellor specialized in donor-related matters can provide valuable insights into areas of concern, including the legal rights of the donor. Additionally, in the case of embryo development within the uterus, it may be necessary to seek the assistance of a legal professional in order to initiate the appropriate legal procedures that will establish your status as the rightful parents.
IVF Cost:
The average cost of IVF treatment in India can fluctuate based on various factors such as geographical location, the reputation of the clinic, the components included in the complete IVF package, the expertise of the specialist, the success rate, the specific type of IVF procedure required, and the necessary medications. On an average scale, the cost of a single IVF cycle in India can range from ₹1,00,000 to ₹3,00,000 or potentially higher, depending on the aforementioned factors. After seeking advice from IVF specialists, couples can select from numerous reasonably priced options for their IVF treatment.
What To Expect?
Once the preparations are finalized, an individual In Vitro Fertilization (IVF) cycle typically spans from 2 to 3 weeks. It is important to note that multiple cycles may be necessary to achieve the desired outcome. The various steps encompassed within a cycle can be succinctly described as follows:
Treatment for Inducing Mature Eggs in IVF
In the process of initiating an In Vitro Fertilization (IVF) cycle, the utilization of artificially synthesized hormones is employed to stimulate the ovaries, encouraging the production of a larger number of eggs compared to the usual monthly ovulation cycle. This approach, deemed necessary due to the potential occurrence of unsuccessful fertilization or improper development when combining eggs with spermatozoa, provides an enhanced chance for successful conception in IVF treatments.
Certain medications can be used to achieve specific purposes in the context of fertility treatment:
Ovarian Stimulation: Some medicines can be administered via injections to stimulate the ovaries. These medications contain hormones such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), or a combination of both. Their purpose is to enhance the development of multiple eggs simultaneously.
Maturation of Eggs: To facilitate the ripening and eventual release of eggs from the follicles in the ovaries, a hormone known as human chorionic gonadotropin (HCG) is commonly used. In addition to HCG, other medicines can also assist in promoting the maturation of eggs.
Ovulation Control: Medications can be employed to prevent premature release of developing eggs by delaying ovulation. These medications are designed to regulate the timing of egg release, ensuring that it aligns optimally with the treatment plan.
Uterine Lining Preparation: To enhance the chances of successful embryo implantation, hormone supplements like progesterone may be prescribed. These supplements can be initiated on the day of the egg collection procedure or around the time when an embryo is transferred into the uterus. By improving the receptivity of the uterine lining, these supplements increase the likelihood of successful attachment of a fertilized egg.
Please note that the aforementioned medications serve specific functions within the realm of fertility treatment and should only be administered under the guidance and supervision of qualified healthcare professionals.
The administration of medications and the timing of their usage are solely determined by your doctor. In most cases, it typically takes around 1 to 2 weeks of ovarian stimulation before your eggs are prepared for collection through the egg retrieval procedure. To determine the optimal time for egg retrieval, additional measures may be required.
Ultrasound is a diagnostic procedure that examines the ovaries to monitor the growth and development of follicles. Follicles are fluid-filled sacs present in the ovaries where eggs mature.
Blood tests are conducted to assess your response to ovarian stimulation medications. These tests primarily focus on monitoring the rise in estrogen levels during follicle development. However, progesterone levels usually remain low until after ovulation.
There are instances in which IVF cycles may require cancellation prior to the collection of eggs. This can occur due to several reasons including:
Insufficient development of follicles.
Premature ovulation.
Excessive development of follicles, which elevates the risk of ovarian hyperstimulation syndrome.
Occurrence of other medical complications.
In the event that your cycle is discontinued, your healthcare team may suggest modifying the medications or adjusting their dosages. This approach holds the potential for an improved response in subsequent IVF cycles. Alternatively, you might be advised to consider utilizing an egg donor.
Egg Retrieval
The process of collecting eggs from either one or both ovaries is referred to as egg retrieval. This procedure is typically conducted in a medical practitioner’s office or a clinic setting. It occurs precisely 34 to 36 hours following the administration of the last dose of fertility medication and prior to the onset of ovulation.
Prior to the egg retrieval procedure, you will receive medication to induce relaxation and eliminate any potential discomfort. An ultrasound device will be utilized to locate the follicles within the female reproductive organ. These follicles are small sacs within the ovaries that house the eggs. Subsequently, a slender needle will be inserted through the ultrasound guide, navigating through the reproductive organ to reach the follicles and retrieve the eggs. This technique is known as transvaginal ultrasound aspiration.
In the event that accessing the ovaries through this approach is not feasible, an alternate method may involve performing an ultrasound of the abdominal area. This ultrasound will serve as a guide, assisting in directing the needle through the abdomen and into the ovaries.
The retrieval of eggs from the follicles is accomplished using a needle attached to a suction device. This procedure typically takes around 20 minutes and allows for the extraction of multiple eggs.
Following the completion of the procedure, it is normal to experience cramping as well as sensations of fullness or pressure.
The mature eggs obtained are then immersed in a nourishing liquid, enabling their further development. Subsequently, these healthy and mature eggs are combined with sperm in an effort to generate embryos. However, it is important to note that not all eggs can be successfully fertilized.
Sperm Retrieval for Assisted Reproduction
To obtain spermatozoa for assisted reproduction, the process of collecting a seminal sample is usually conducted in your physician’s office or a clinic on the same day as egg retrieval. Alternatively, you can choose to have the sperm collected in advance and preserved by freezing.
Typically, conventional methods are employed to collect the sample. However, alternative techniques may be utilized in cases where an individual is unable to produce sperm through normal means or if there is an absence of spermatozoa in the seminal fluid. One such approach is known as Testicular Sperm Aspiration (TESA), wherein spermatozoa are directly collected from the male reproductive glands using a needle or surgical intervention.
Additionally, donated sperm can also be utilized for the procedure. Subsequently, in the laboratory, the spermatozoa are separated from the surrounding fluid.
Fertilization
There exist two widely adopted approaches for attempting fertilization of eggs with spermatozoa:
Conventional insemination: In this method, a controlled environment known as an incubator is utilized to mix and preserve healthy spermatozoa along with mature eggs.
Intracytoplasmic Sperm Injection (ICSI): This technique involves the direct injection of a single healthy spermatozoa into each mature egg. ICSI is typically employed when there are concerns regarding the quality or quantity of spermatozoa. It may also be employed if previous attempts at fertilization during in-vitro fertilization (IVF) cycles were unsuccessful.
In certain instances, it may be advised to undergo alternative procedures prior to implanting embryos into the uterus. One such procedure is known as assisted hatching. Typically occurring around 5 to 6 days post-fertilization, this process involves the “hatching” of an embryo from its surrounding membrane layer to facilitate attachment to the uterine lining.
Assisted hatching may be recommended for women of advanced maternal age seeking pregnancy or those who have previously undergone unsuccessful IVF attempts. This technique involves creating a small opening in the embryo’s membrane just before its placement in the uterus.
By doing so, the embryo is assisted in its hatching process and subsequent attachment to the uterine lining. Assisted hatching is particularly beneficial for eggs or embryos that have undergone freezing, as this preservation method can cause the membrane to become hardened.
Preimplantation genetic testing involves the developmental process of embryos within an incubator until they reach a suitable stage for a small sample extraction. This sample is then subjected to testing, aimed at identifying specific genetic diseases or ensuring the presence of the correct number of DNA’s threadlike structures, known as chromosomes. Normally, each cell contains 46 chromosomes. Embryos lacking affected genes or abnormal chromosomes can subsequently be transferred to the uterus.
The implementation of preimplantation genetic testing has the potential to reduce the probability of parents transmitting genetic disorders to their offspring. Nevertheless, it is important to note that although this testing method minimizes the risk, it does not eliminate it entirely. Consequently, prenatal testing may still be recommended during pregnancy.
The embryo transfer procedure, which involves the placement of one or more embryos into the womb, is typically carried out in a medical setting such as your doctor’s office or a clinic. This procedure is usually scheduled 2 to 6 days after the eggs have been collected.
To help you relax during the procedure, you may be administered a mild sedative. While the process itself is generally painless, you may experience mild cramping as a possible side effect.
During the procedure, a long, thin, and flexible tube known as a catheter is carefully inserted through the cervix and into the womb. Attached to the end of the catheter is a syringe containing one or more embryos suspended in a small amount of fluid.
Using the syringe, the embryos are gently placed into the womb. If successful, one of the embryos will attach itself to the lining of your womb approximately 6 to 10 days after the retrieval of the eggs.
Post-Procedure Guidelines:
Following the completion of the embryo transfer, it is permissible to resume your regular daily activities. Nonetheless, it is possible that your ovaries may still be enlarged, therefore engaging in vigorous physical activities may result in discomfort. To determine the appropriate duration of avoidance, kindly consult your care team.
Common Side Effects:
The typical side effects experienced after the procedure may include:
Passing a small quantity of clear or bloody fluid shortly following the procedure. This occurrence is attributable to the cervical swab that is performed prior to the embryo transfer.
Tenderness stemming from elevated estrogen levels.
Mild bloating.
Mild cramping.
Possibly, constipation might be experienced.
Should you experience moderate or severe pain, or if heavy bleeding occurs after the embryo transfer, it is essential to promptly contact your care team. Such symptoms may necessitate further evaluation for potential complications, such as inflammation or ovarian hyperstimulation syndrome.
Results
Following egg retrieval, a blood test is conducted at least 12 days later to determine pregnancy status. In the event of a positive pregnancy result, you will likely be recommended to see an obstetrician or other pregnancy specialist for prenatal care.
Contrarily, if the test results confirm that you are not pregnant, the usage of progesterone will be discontinued and you can expect to have your period within a week. If your period does not occur or you experience unusual bleeding, it is advisable to contact your healthcare team.Should you wish to pursue another cycle of in vitro fertilization (IVF), the care team may suggest measures to enhance the likelihood of achieving pregnancy in subsequent attempts.
The chances of delivering a healthy baby through IVF are influenced by various factors such as:
Maternal age: The probability of conceiving and delivering a healthy baby using one’s own eggs during IVF increases with a younger maternal age. Individuals aged 40 and above are frequently advised to consider incorporating donor eggs in their IVF treatment to enhance the chances of success.
Embryo status: Opting for the transfer of more developed embryos is associated with higher pregnancy rates as compared to less-developed ones. However, not all embryos successfully progress through the development phase. It is advisable to consult your medical team regarding your specific circumstances.
Reproductive history: Individuals who have previously given birth are more likely to achieve pregnancy through IVF compared to those who have never experienced childbirth. People who have undergone multiple unsuccessful IVF attempts generally witness lower success rates.
Causes of Infertility: One factor that contributes to infertility is the quantity of eggs a person has. Those with a sufficient supply of eggs are more likely to achieve pregnancy through IVF (In Vitro Fertilization). Conversely, individuals with severe endometriosis face reduced chances of successful IVF compared to those experiencing unexplained infertility.
Influence of Lifestyle: Certain lifestyle choices can significantly impact IVF outcomes. Smoking, for instance, diminishes the probability of IVF success as it may result in fewer eggs retrieved and a higher risk of miscarriage. Additionally, obesity can lower the chances of conceiving and delivering a healthy baby. The consumption of alcohol, engagement in recreational activities, excessive caffeine intake, and the use of specific medications can also be detrimental in such cases.
It is essential to discuss these factors with your medical team to comprehend their relevance to your unique situation and how they might influence your chances of achieving a successful pregnancy.
Sperm Retrieval for Assisted Reproduction