- 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,
- You have been diagnosed with unexplained infertility.
- Your fallopian tubes are blocked other techniques such as fertility drugs or intrauterine insemination (IUI) have not been successful.
- 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.
- The male partner has fertility problems and an abnormal semen analysis.
- You are using your partner’s frozen sperm in your treatment and IUI is not suitable for you.
- You are using donated eggs or your own frozen eggs in your treatment.
- You are using embryo testing to avoid passing on a genetic condition to your child.
- 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?
- Eat a healthy diet rich in fruits and vegetables
- Be stress-free and relax your mind
- Avoid intercourse during the treatment.
- 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?
- 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.
- You will be administered light anesthesia as intravenous medication.
- The procedure is done vaginally using the scan guidance and a small needle.
- The entire procedure takes about 20-30 minutes.
- Post-procedure you may have slight pain or bleeding which usually subsides with medication.
- 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 – 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
- Multiple pregnancies (20-25%).
- Ovarian hyperstimulation syndrome which occurs due to excessive response and can be prevented b appropriate modifications in the medications.
- 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.
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.
- 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.
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.