“All you need to know about
In Vitro Fertlization – IVF”
— Get Well in India
IVF or In Vitro fertilization literally means “fertilization in glass” or “test tube baby”. It is a method to help a woman conceive by a process of fertilization.
It is executed by removing eggs from the ovaries of the female and then manually combining the egg with the sperms sample from the male partner in the laboratory. The fertilized egg or embryo is then implanted in the woman’s womb to make her conceive.
IVF has many stages to complete the process and it takes several months. It sometimes works in the first try, but sometimes many tries are needed. IVF increases your possibilities of being pregnant. However, it should be kept in mind that everyone’s body is different and IVF may not work out for everyone.
IVF can prove out to be the best treatment, if the fallopian tubes are damaged or the sperm is poor. It can prove out be very effective treatment for most other types of infertility too. The rate at which embryos successfully implant depends mostly on two factors: the quality of the embryo and the receptiveness of the uterus.
Dr. Firuja Parikh
Director of Assisted Reproduction and Genetics at Jaslok Hospital, Mumbai
Dr. Manish Banker
Causes of Infertility
There are many causes of infertility among women. Some of them are listed below:
- Advancing age
- Drinking and smoking
- Ovulation disorders
- Fallopian tube injury
- Uterine abnormalities
- Polycystic ovarian syndrome
- Salpingitis (Pelvic inflammatory disease)
Before the actual treatment starts, females are put on birth control pills. These pills are recommended because they reduce the risk of ovarian hyperstimulation syndrome and also improve the rates of success of IVF. There are many stages of IVF, step-by-step details are mentioned below;
- Stimulation of ovaries: This is also called superovulation. This process can last upto 12 days.
In a regular cycle, one egg is produced in the ovaries. In this process, medicines which are called fertility drugs are given to encourage the follicles in your ovaries to produce more eggs.
The most common hormones in the medications used to stimulate the follicles are:
- follicle-stimulating hormone (FSH)
- luteinizing hormone (LH)
Blood tests and ultrasounds are done on a regular basis to measure your hormone levels and to examine your egg formations.
Towards the end of the stimulation phase, you will be monitored more frequently because you will be given a ‘trigger injection’.
The aim of the trigger injection is to get the eggs ready for ovulation.The natural process where eggs are released and you have your period. Your doctor will tell you exactly when to do the trigger injection and will schedule the egg retrieval before you ovulate.
- Egg retrieval: After ovarian stimulation, a procedure called ‘follicular aspiration’ or ‘egg pick up’, is performed to remove the eggs from the woman’s body.
The is performed under sedation guided by ultrasound. A thin needle is inserted into the ovary and sacs (follicles) containing the eggs. The needle is connected to a suction device, which pulls the eggs one at a time and removes the fluid.
Your fertility specialist should have a fair idea from your ultrasounds how many eggs there are before retrieval. The average number of eggs collected is 8-15.
Recovery takes about 30 minutes and you’ll be able to walk out on your own. It’s a good idea to have a support person with you as you won’t be able to drive after the procedure.
- Insemination: In this process, the mixing of the sperm and egg takes place and hence it is called insemination. Sometimes, the sperm may be directly injected into the egg. This is called intracytoplasmic sperm injection (ICSI).
Each mature egg receives a single healthy sperm. After 16-18 hours, the eggs are examined to see if the fertilization process has been successful. A fertilised egg is called an embryo. The embryo is then cultured in an incubator for 3 to 5 days.
- Embryo transfer: Embryos are placed into the uterus 3 to 5 days after fertilization through a catheter.
You’ll need to drink water before the transfer so you have a full bladder. Ultrasound is done to get the embryo in the perfect spot, and it helps to see the lining of the uterus.
The embryo transfer is a very simple process, like a pap smear. It takes about 5 minutes, you’ll be awake, there’s no anaesthetic, and you can get up straight away. You can continue with your day, the embryo can’t fall out if you stand up or go to the toilet.
The transfer is done via a a thin tube (catheter), which goes up the vagina and into the womb, successfully transferring the embryo. When the embryo sticks to the lining of the womb healthy embryo growth begins.
- After embryo transfer: Two weeks after your embryo transfer, you’ll have a blood test to measure your levels of the hormone HCG (human chorionic gonadotropin). HCG in your bloodstream usually means a positive pregnancy test. Pregnancy test kits may potentially give a false result. So, it’s best to go for a blood test.
The time between the embryo transfer and the blood test is often called the ‘two week wait’. After conception, the baby grows in the womb of the mother just like a normal pregnancy.
IVF is considered to be most successful ART (Assisted reproductive technology). So far, no medical problems have been directly linked to the procedure.
- No link to cancer: There no connection between ovulation-inducing fertility drugs and cancer. It’s completely safe.
- Improved techniques: IVF procedures have refined and improved over years.
Before and After Embryo transfer:
Here are some guidelines to help you prepare for the procedure to give yourself the best possibility of success.
Before embryo transfer:
- Blastocyst transfer: You can talk to your healthcare specialist about blastocyst transfer. A blastocyst is the final stage of the embryo’s development before it hatches out of its shell and implants in the uterine wall.
Transferring blastocysts instead of early-stage embryos allows more time to monitor the embryo’s quality. By doing so most viable embryos are chosen for transfer, thus, improving the chances of implantation success. Blastocyst transfer also significantly reduces the possibility of potentially dangerous high-order multiple births, such as triplets.
- Embryo screening: You can consider embryo screening after talking to your healthcare specialist. Testing of embryos prior to transfer is a good way to make sure that the most viable embryos or blastocysts are chosen, which can improve your chances of implantation. It helps find out that the embryos have the right number of chromosomes with the help of a technique called ‘Preimplantation genetic screening (PGS)’.
- EmbryoScope: If you want more insights into the health and development of your embryos as they are cultured in the lab, you may want to look into the use of new time-lapse photography technology. A special incubator called the EmbryoScope takes photos of the embryos every five minutes and puts them together into time lapse films. This means that the embryologist can watch how the cells divide and develop. You can talk to your doctor about the same.
- Assisted hatching: You can talk to your doctor about a technique called Assisted hatching. It makes it easier for an IVF embryo to implant.
- Estrogen and progesterone supplementation: You can talk to your doctor about the same. Carefully managed hormone supplementation both before and after transfer can help healthy implantation and early development.
After embryo transfer:
- Relax: Don’t stress and completely relax. Get plenty of sleep and listen to your body. Stress will complicate and won’t sooth you.
- Avoid vigorous exercise and sexual intercourse:Your ovaries are likely to be enlarged and tender at this point and need to be well cared for.
- Take a good diet: Eat nutritionally balanced food with lots of protein, fiber, and vegetables. Avoid foods like high-mercury fish and soft cheeses, and check with your doctor about any vitamins or supplements . Avoid alcohol, nicotine, and caffeine.
- Avoid extremes of temperature: Hot tubs, saunas, hot yoga, or any activity that raises your internal temperature is something to avoid at this point.
- Be happy and be around family: This is the time when your loved ones can take care of you and make you feel loved. Do not stress at all.
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