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In Vitro Fertilization

ivf or tube reversal _nu fertility

Tube Reversal vs IVF Treatment : Which is the better Choice?

Attaining Motherhood and having children is one of the very important stages in life which a woman comes across. Though Pregnancy and Childbirth can get challenging at times, it is looked forward to as stage of immense significance, by every woman. While on one hand, birth control has become a topic for global discussion, on the other hand, there are many enthusiastic women, in their middle ages, who are looking at exploring options to extend their family, even after undergoing procedures towards achieving permanent birth control.

With life throwing up so many surprises at us at all times, circumstances change, relationships change and this might bring in a change in family building goals too. Recent studies indicate that in spite of having chosen the path to permanent sterilization, up to 14.3% of sterilized women request information about possible fertility options within a few years of having undergone the tubal sterilization procedure.

What are the possible options women can explore to achieve their dream of having children, following tubular sterilization?

Available Options

More widely suggested options for patients, in this case, is a surgical reversal of sterilization which is also referred as Tube Reversal or the process of In Vitro Fertilization or IVF, which is gaining global identity at a very rapid pace.

However, out of these two,

  1. which is the most preferred?
  2. Which process is cost-effective?
  3. Which is safer, easy and less risky based on female age? And most importantly,
  4. which process is more likely to yield the desired results?

To answer all these questions, which are on expected lines, let’s get straight into the options involved and study them independently.

Tube (block) Reversal

For simple understanding, Tube (block) Reversal is a short stay procedure, performed as an outpatient, to restore contact between tubal segments. This is a small procedure, performed using microsurgical techniques. Basically, this procedure is aimed at supporting women, who wish to become pregnant without more complex medical attention.

Process Involved during Tube Reversal,

  1. The blocked sections of the fallopian tubes are reconnected with the remainder of the Fallopian tubes, which subsequently facilitate the eggs to move up the tubes smoothly and interact with the sperm.
  2. Your doctor will take a closer look at your medical parameters before suggesting a Tube Reversal procedure. Age, body weight and fertility factors such as the (egg count, sperm quality) are taken into consideration.
  3. Furthermore, one must consider the post-operative recovery period and time off from work, usually relatively minimal but, could be possibly prolonged. Your doctors will also look into possible complexities for ectopic pregnancy as well.
  4. However, it is interesting to note that not every type of tubal sterilizations is reversible. If the earlier fallopian tube segments are either short or subjected to damage due to surgery or infection earlier, the Tube Reversal might not be the best option. Therefore, your doctor would clearly ascertain these factors to come to a conclusion.
  5. An in-depth study of the male partner’s semen sample is also conducted as a part of the pre-surgical tests required.
  6. The time taken to confirm that the Tube Reversal surgery was a success or not is usually 3 months after the surgery was performed.

In addition, it might take close to 2 years for the patient to become pregnant, after the success of the surgery.

Many patients tend to term this waiting period as pretty long as they continue to remain anxious about the results.

Misconceptions about IVF 

In Vitro Fertilization (IVF)

IVF or In-vitro fertilization continues to gain prominence as a very effective alternative to Tube Reversal. Since its inception in 1970, this technique has been refined and continues to make immense progress with very high success rates.

To put in in easy words, IVF is a procedure by which an egg is fertilized in the lab and then transferred to a woman’s uterus. This facilitates the process of pregnancy to occur by completely bypassing the Fallopian tubes. So, the events which ordinarily occur in the fallopian tubes thus occur in the laboratory, providing a sort of tubal bypass.

The process of IVF allows the choice of the strongest and healthiest embryos.

Compared to a Tube Reversal process, IVF can be thought about as an effective solution, even for problems like advanced age, tube damages beyond repair and male factor infertility. The post-procedure downtime in IVF is rather minimal. However, with the sensitivity involved with the procedure, it is always important to choose a best IVF clinic with care.

This question has been very effectively answered by best Fertility Hospital in Bengaluru, which has proven experience in offering high standard IVF services, to the fullest satisfaction of its patients. The experience and techniques employed by the IVF physicians at NU fertility is a combination of the very latest in technology and subject expertise.

Which then is the best choice: IVF or Tubal Reversal?

One of the best things about IVF is that the time taken for pregnancy is much shorter as it takes only two months for the process to be completed. The age of the woman in question is also important as the choice of whether to go for Tube Reversal of IVF depends largely on this factor. The number of children, a couple would desire also influences the decision. It is well understood that with advance in age, the chances of a woman to conceive is lesser and hence for those women who are above 35 years of age, IVF perhaps be a better choice.

Though women below the age of 35, who would want to attain parenthood again after having undergone Tube Ligation, might look into Tube Reversal, published reports for all age groups truly indicate that the success-per-cycle rates in IVF are better than those for tubal reversal.

Conclusion

Doctors connected with leading medical institutions suggest IVF over Tube Reversal, but that is surely not without a reason. Though there is not much of a difference with respect to cost in both the procedures, IVF enjoys less risk factors and more success rates, than Tube Reversal. Findings have suggested that the chances of ectopic pregnancy with Tube Reversals are as high as 20% while that with IVF is almost legible, as low as (3) %. (The pregnancy rates with IVF in tubal factor infertility are 65%; the highest among all causes of infertility while the pregnancy rates with tubal surgery vary between 20-60% depending on multiple factors.) Compared to a Tube Reversal procedure, IVF does not require a prolonged hospital stay.

Above all, it’s the quality of your medical service provider and the comfort level they offer from the basic stages of discussions that matters and NU Hospitals sees that you are comfortable, both before and after your treatment is completed to your fullest satisfaction.

ivf misconceptions

Misconceptions about IVF

IVF is one of the most fascinating discoveries of the 20th century. Nobel prize in medicine was awarded to Sir Robert G Edwards in 2010 for this amazing discovery. It has been about 40 years since the birth of the first child through IVF. Over 4 million people owe their existence to IVF. Despite this, many people are not convinced by this concept.

 Popular Misconceptions about IVF

  • IVF injections cause cancer.

All the injections which are given are eliminated from the body within one month. There have been numerous studies till date which have proven that the gonadotropin injections do not cause cancer. However, a small risk of borderline ovarian tumours is noted, which have an excellent prognosis with preservation of fertility. An oocyte donor can donate eggs for up to 6 cycles safely!

  • The medications take away all eggs and result in early menopause.

Normally a group of follicles containing eggs begins to grow at the beginning of a menstrual cycle. Only 1 egg matures enough and is released from the ovary. Remaining degenerate. In IVF, these injections rescue the degenerating eggs and stimulate them to reach maturity. As a result, the age of menopause is not affected.

  • Babies born through IVF are not normal physically and mentally.

2% of the babies conceived naturally are born with some malformation. Similarly, about 2-3% of babies born through IVF are with malformations. Most of the abnormal embryos do not implant in the uterus and grow.

  • IVF results in twins and higher-order pregnancies

We can limit the number of embryos transferred into the uterus and hence prevent multiple pregnancies. In other treatment options such as ovarian stimulation and Intrauterine insemination IUI, all the eggs that are released are capable of being fertilized. Hence, we have no control over the rate of multiple pregnancies.

  • After IVF treatment, complete bed rest is required.

Both the egg retrieval and embryo transfer are daycare procedures, requiring an admission of 3-4 hours. It is advisable to avoid the strenuous physical activity of any sort; however, there is no evidence that complete bed rest favours embryo implantation. Routine activities can very well be carried out without affecting pregnancy rates.

NU Fertility - IVF Treatment

Things To Know Before Opting For IVF

Once a couple decides to go ahead with IVF(In vitro fertilization), the next concern is the IVF success rate and to decide when to go for IVF treatment. As we all know IVF has its limitations and a variety of factors influence the outcome. Some of them are under our control and some of them are not.

What is the Sucess Rate of IVF?

The outcome of an IVF cycle depends on the quality of the embryo which in turn depends on the egg quality and the sperm quality. Egg quality is mainly dependent on the age of the woman. As age increases, particularly in the late thirties, the chances of having aneuploid/ abnormal eggs increases.

ICSI( intracytoplasmic sperm injection) can overcome most of the sperm-related problems but severely abnormal semen samples can give rise to poor quality embryos, thereby compromising the IVF success rates. Egg numbers are equally important. Studies show that IVF success increases as the number of eggs retrieved increases up to about 15 eggs. Thereafter there is no further increase in the success.

Keep Reading

In vitro fertilization (IVF)

In-Vitro Fertilization (IVF)

  •  What is In-Vitro Fertilization (IVF)?

IVF (In-vitro fertilization) or test tube baby as it is commonly called is a procedure in which the eggs and the sperms are fertilized outside the body and then transferred back to the womb after 2-5 days.

  • Who needs an In-Vitro Fertilization (IVF)?

IVF may be considered if,

  1. You have been diagnosed with unexplained infertility.
  2. Your fallopian tubes are blocked other techniques such as fertility drugs or intrauterine insemination (IUI) have not been successful.
  3. Other techniques such as fertility drugs or intrauterine insemination (IUI) have not been successful the male partner has fertility problems and an abnormal semen analysis.
  4. The male partner has fertility problems and an abnormal semen analysis.
  5. You are using your partner’s frozen sperm in your treatment and IUI is not suitable for you.
  6. You are using donated eggs or your own frozen eggs in your treatment.
  7. You are using embryo testing to avoid passing on a genetic condition to your child.
  8. If you have severe endometriosis.
  • What do I expect during my test tube baby treatment cycle?

Your IVF/ Test tube baby treatment cycle would be as follows, 

Step 1: Once you have decided to go ahead with IVF, you will undergo a daycare procedure called hysteroscopy to assess the suitability of the uterus to hold the baby. It is generally done one month before your IVF cycle and involves the introduction of a small camera into the womb through the vagina to visualize the inside of the uterus. You will be given anesthesia during the procedure and hence there will be no pain.

Step 2: Your husband has to freeze one semen sample as a backup.

Step 3: Typically your treatment would begin on the second or third day of periods. It involves a scan and hormone tests followed by daily injections for about 8-10 days, along with monitoring by scan and hormone tests in between. Once the eggs are sufficiently grown as per the scan and hormone tests, you will receive injection Hcg as an ovulation trigger.

Step 4: Egg retrieval is performed transvaginally 35 – 36 hours later, with light anesthesia, using transvaginal ultrasound guidance. You will be discharged the same evening unless there are problems associated with bleeding, undue pain or ovarian hyperstimulation.

Step 5: After retrieval, eggs are assessed for their maturity. Meanwhile, the husband has to give a fresh semen sample. Mature eggs are injected with the sperms on the same day and grown in the incubator for 3-5 days.

Step 6: The final step is the embryo transfer. 3-5 days after your egg retrieval, two or three embryos are selected and gently transferred into the womb using abdominal ultrasound guidance. The procedure is usually painless, no anesthesia is required and you will be discharged in about two to three hours.

Step 7: You will be given certain supportive medications starting from the day of egg retrieval until your pregnancy check. You will be called for a pregnancy check 16-17 days after your embryo transfer.

  • What precautions do I take during the In-Vitro Fertilization (IVF)/ Test tube baby treatment?
  1. Eat a healthy diet rich in fruits and vegetables
  2. Be stress-free and relax your mind
  3. Avoid intercourse during the treatment.
  4. Don’t do a strenuous job during the treatment as your ovaries are enlarged and they may twist sometimes causing acute pain.
  • How do I prepare myself for an egg retrieval procedure?
  1. You will get admitted to the hospital early in the morning, between 6 am – 7 am and you have to be empty stomach at least 6-8 hours before the procedure.
  2. You will be administered light anesthesia as intravenous medication.
  3. The procedure is done vaginally using the scan guidance and a small needle.
  4. The entire procedure takes about 20-30 minutes.
  5. Post-procedure you may have slight pain or bleeding which usually subsides with medication.
  6. You will be discharged about 6 hours later.
  • What do I expect during embryo transfer?

It is done 3-5 days following the egg retrieval, which will be decided by your clinician. No anesthesia is required as it is a painless procedure. Rarely during your initial assessment, if it is found that getting into the uterus is difficult or if you are very uncooperative, you may be given light anesthesia. Your bladder has to be full before the procedure as it is done under abdominal scan guidance. Do not wear perfume/ deodorant or powder on that day as they are harmful to the embryos. Two or Three embryos are gently transferred to the uterus using a small catheter. You will lie down for about 15 – 30 minutes after the procedure and later you can pass urine. No need to take bed rest until your pregnancy check. This does not increase your chances of becoming pregnant.

  • What is ICSI? How does it differ from In vitro fertilization (IVF)?

ICSI Clinic in BangaloreICSI – Intracytoplasmic Sperm Injection, is an IVF procedure in which a single sperm is injected directly into an egg whereas in IVF, about 50,000 to 1,00,000 sperms are inseminated around the eggs and one of them penetrates the egg on its own. ICSI increases the fertilization rates especially in male factor infertility and cases of previous fertilization failure.

  • What is the success rate of test-tube baby?

The success rate varies with multiple factors especially the age of the women, egg and the sperm quality and the underlying cause of infertility. Overall the success varies between 40-50 %. Success decreases as the age of the woman increases.

  • What is the frozen embryo transfer?

Surplus embryos after your transfer can be frozen and kept in liquid nitrogen at -180 degree Celsius, for later use.

  • What are the complications?

Two most important complications of In-Vitro Fertilization (IVF) are

  1. Multiple pregnancies (20-25%).
  2. Ovarian hyperstimulation syndrome which occurs due to excessive response and can be prevented b appropriate modifications in the medications.
  3. Rarely ovaries may twist causing acute pain and may require a laparoscopy.
  • When can I know if I have become pregnant?

You will be tested for beta HCG – a blood test to confirm pregnancy 14 to 16 days after your embryo transfer.

  • Is my pregnancy going to be riskier after IVF? IVF Centre in Bangalore

There is no evidence to show that IVF babies have an increased rate of abnormalities. The pregnancy outcome will be like a normal conception but your doctor may have a low threshold for intervention when the problem arises.

References

  • Fertility: assessment and treatment for people with fertility problems.NICE clinical guideline;– Issued: February 2013.
  • van Loendersloot LL, van Wely M, Limpens J, Bossuyt PM, Repping S, van der Veen F (2010). “Predictive factors In-Vitro Fertilization (IVF): a systematic review and meta-analysis”. Human Reproduction Update 16 (6): 577–589.
Does the collection of eggs increase the chance of pregnancy?

Does the collection of eggs increase the chance of pregnancy from IVF?

The process of IVF(In-Vitro-Fertilization) involves the ovarian stimulation with hormones with the intention of retrieving more eggs. The whole idea is to have enough eggs to produce an optimum number of good embryos to transfer and to freeze a few in case the fresh transfer fails. The question here is how many do we actually need? What is the optimum number of eggs needed to achieve a live birth, which in turn is the ultimate aim of IVF?

Does the collection of eggs increase the chance of pregnancy?

The higher number of eggs retrieved is associated with a probability of more chromosomally normal (euploid) embryos which can implant and give rise to a living birth. Chromosomally abnormal embryos (“aneuploid”) are unlikely to develop as pregnancies, and, if they do, frequently result in miscarriage. The frequency of chromosomally abnormal embryos increases with age and thus the pregnancy rates decrease with age. To produce one and two euploid embryos respectively, five and 14 oocytes would be required at age 34, while 10 and 24 oocytes would be required at age 38. Thus it makes sense to retrieve more eggs.

But this comes at a cost .. To retrieve more eggs often we have to use a higher dose of hormones increasing the cost as well as the side effects. It also leads to a potentially serious complication of ovarian hyperstimulation where they collect fluid in the abdomen, lungs and also susceptible to hypotension, increased clotting tendency and at times renal shutdown. The excessive ovarian response can also cause the enlarged ovaries to twist on its pedicle, cutting off its blood supply – what we call as ovarian torsion. This is an acutely painful condition which requires immediate medical and surgical attention. Another reason for concern is the compromised egg quality for unknown reasons when there is an excessive ovarian response. The raised estradiol hormone in case of excessive ovarian response advances the implantation window, thereby causing an asynchrony between the embryo and the endometrium (uterine lining), ultimately decreasing the implantation rates.

Frozen Embryo Transfer

So our aim in IVF cycle is to retrieve anywhere between 8 to 15 oocytes, so as to consider a fresh embryo transfer and also to expect a reasonably good pregnancy rate. Studies have proven that pregnancy rates steadily increase till 15 oocytes and thereby it decreases. When there is hyperresponse we may have to defer embryo transfer and freeze all embryos to avoid potential complications of ovarian hyperstimulation. They can be transferred at a later date after preparing the endometrium – Frozen Embryo transfer.