In Vitro Fertilization(IVF) is an assisted reproductive technique (ART) also referred to as ‘testtube baby’ in common language. IVF is a process where eggs are developed inside a female’s body by use of certain hormone injections followed by extraction of eggs outside the body. The extracted eggs are then made to fertilise with husband’s sperms through conventional IVF or through Intra Cytoplasmic Sperm Injection (ICSI). The embryos thus formed are cultured carefully in an IVF lab and incubated. After two or three days, the embryos formed are assessed. The best embryo(s) are transferred inside women’s uterus(womb).
Who should undergo IVF?
IVF can be used for couples with infertility in the following cases:
- Blocked orfunctionally damaged fallopian tubes or women with previous ectopic pregnancies resulting in removal of tubes.
- Women with advanced age (Age >37 years or with low AMH)
- Male factor infertility including decreased sperm count or sperm motility, abnormal morphology.
- Individuals with a genetic disorders
- Unexplained infertility, when other treatments like Intra Uterine Insemination (IUI) have already failed.
Multiple combined factors
There are five basic steps in the IVF and embryo transfer process:
Step 1: Controlled ovarian stimulation: certain injections are prescribed to stimulate egg production. Fertility doctors try to produce multiple eggs so that even if a few eggs are not fertilised, still there are adequate embryos that multiple embryo transfer attempts can be made. A transvaginal ultrasound(TVS) is done on second or third day of periods and after confirming that ovaries are silent, dose of injections is decided according to expected number of eggs that can be obtained. Follicular monitoring is done after four days to check for the response. The dose of injections is modified accordingly and the monitoring is done every 2/3 days.
Step 2: Oocyte retrieval/ Oocyte pick up (OPU): Eggs are retrieved under short general anaesthesia (GA) through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the vagina to remove the eggs. This procedure does not involve any cuts or stiches. It takes around 15-20 minutes in experienced hands.
Step 3: Collection of semen sample: The male is asked to produce a sample of sperm through masturbation in a private room. These sperms are then processed by washing in specific culture media and rotating in a centrifuge. The best sperms thus obtained can then be used for inseminating the eggs.
Step 4: Insemination: The sperm and eggs are mixed together in a culture dish and placed carefully in an incubator. Next day these eggs are checked for fertilisation. In some casesintracytoplasmic sperm injection (ICSI) is done where each oocyte is injected with one sperm under microscope. Once fertilisation happens, the eggs are labelled as embryos. These embryos are further cultured till third day.
Step 5: Embryo transfer: The embryos are transferred into the woman’s uterus three to five days following egg retrieval. The embryos are carefully placed inside woman’s uterus under ultrasound guidance. This procedure does not require anaesthesia in most of the cases.
Step 6: Luteal Phase Support: The woman is then given a set of medicines (oral, vaginal or injectables) to support the pregnancy by supporting the lining of uterus or endometrium. She has to take medicines for two weeks.
Step 7: Beta HCG blood testing: To know whether pregnancy has happened or not.
Step by Step guide to ‘In Vitro Fertilization’
Success rates of in vitro fertilization (IVF)?
The success rate of IVF depends on a number of factors including maternal age, the cause of infertility, quality of eggs and sperms and lifestyle factors. It is also important to understand that pregnancy rates are not the same as live birth rates. Once the blood test is positive, it is labelled as chemical pregnancy. Once the pregnancy is detected on an ultrasound scan, it is labelled as clinical pregnancy. Once a lady gives birth to a healthy baby, it is labelled as a live birth. So, whenever we talk about success rates, we should understand that it is the live birth rate that is actually important.
In most of the advanced countries like USA and parts of Europe, the live birth rate for each IVF cycle started is approximately:
- 40-45%for women under age 35
- 32-36%for women ages 35 to 37
- 22-28%for women ages 38 to 40
- 15-18%for women ages over 40
In Indiaalso, IVF technology has advanced a lot and good IVF centres have reached similar success rates. But the irony in India is that there is no database and each centre is quoting their own success rates which are falsely high just for the purpose of trapping or attracting more and more patients. Some centres even give a ‘money back guarantee’. This practice has to be discouraged. Also, to know about the real success rates, one must go by genuine articles and sites, and not by individual blogs or advertisements. Vasundhara hospital and fertility research centre is one of the most advanced fertility and IVF centre in Jaipur and offers counselling about individualised success rates to the couple depending on a lot of factors like age, medical reports and previous history of treatment.
Use of donor eggs or sperms
It is important to note that the use of donor eggs or sperms is restricted for special cases where the wife is not able to produce her own eggs due to advanced age or poor ovarian reserve or where the husband has very poor quality or nil sperms and can not be retrieved or used for the purpose of IVF. The embryo thus formed is thus not genetically related to one of the parents but the embryo harbours inside the uterus of the lady and hence biological connection is established. As a policy, our hospital discourages the practice of using donor gametes (eggs or sperms) for not so clear reasons. Encouraging self eggs or sperms should be the aim of every IVF done. Also, it is important to know that success rates might be better with the use of donor gametes.
How many IVF cycles can be done for a couple?
There is no fixed number of IVF cycle that should not be exceeded. But as the procedure is both financially and physically draining, we should make our best efforts to optimise each and every cycle.
Blastocyst transfer
It involves culturing of embryos in lab for 5 days and then transferring inside the uterus. Although it is considered that blastocysts are better in terms of implantation potential but the drawback is that only 50-60 % embryos proceed to blastocyst and thus there is a wastage in number of embryos. Thus there is not much gain in cumulative pregnancy rates. Also, most of the IVF centres charge extra amount for blastocyst culture.
How many embryos should be created or transferred?
The number of embryos transferred typically depends on the number of embryos available, previous obstetric history and maternal age. As more number of embryois being transferred, pregnancy rates improve till three embryos and after that stabilises. However, a greater number of embryos transferred also increases the chances of having a multiples pregnancy. So, make sure that you discuss about the number of embryos to be transferred with your doctor. In any case, it should not be more than three. It is better to freeze any extra embryos and take another chance of transfer than to waste all embryos in one chance.
How do I choose an infertility clinic?
There are a number of factors to decide the best IVF centre. Make sure you go as a couple and speak to the doctor till the time all your queries regarding cost and procedure are solved. Don’t fall in the false trap of incredibly high success rates.
Click to more info :- IVF Hospital in Jaipur
