In Vitro Fertilization is a method of assisted reproductive technology for couples unable to conceive naturally or who have tried other fertility methods and failed.
For couples trying to conceive, a delay in pregnancy causes much anxiety and stress. This is counter-productive and poses a greater obstacle. While most couples eventually do succeed in getting pregnant by calculating the fertility window and having intercourse accordingly, some couples will have a harder time. After at least a year of trying to conceive and not succeeding, they need to consult with a Fertility Expert and find the underlying cause of the problem.
The doctor will investigate and assess the fertility of both husband and wife before suggesting treatment. For the doctor to chart out the right course of action, the couple must give a proper medical history, including past/present medical conditions and a list of medications taken/ being taken. There are certain medications that impact fertility; your doctor will be the best judge on whether you need to stop taking them or what alternative medication you need to go for.
WHO NEEDS IVF?
In Vitro Fertilization is a method of assistive reproductive technology for couples unable to conceive naturally or who have tried other fertility methods and failed.
Couples choose IVF for the following reasons:
UNDERSTANDING THE IVF PROCEDURE
Today, IVF has become quite a common procedure, and the success rate is high. Poor lifestyle choices, environmental changes and postponement of pregnancy are some of the reasons why more and more couples are finding it hard to conceive. However, advances in reproductive medicine continue to give them hope of having their own biological child through various assisted reproductive techniques.
The IVF Procedure can be fundamentally broken down into the following steps:
Ideally, during each natural cycle, the ovaries produce just one mature egg. In IVF treatment, the woman is given hormone injections to stimulate the ovaries such that many eggs mature simultaneously, instead of just one. Once the hormone injections are administered your doctor will monitor the response of your ovaries to see how many eggs are growing. A final shot is given to finalise the maturation of the eggs in preparation for the next step.
The mature eggs are then extracted from your ovaries. A needle is guided through the vagina towards the ovaries. The needle is attached to a suction device that gently pulls out the eggs. The retrieved eggs are then transferred to a dish with a special solution and stored in an incubator until the time of fertilization.
The fully mature eggs are then injected with sperm which is called as sperm intracytoplasmic injection (ICSI). 70% of the mature eggs will get fertilized.
During the retrieval stage often, immature eggs are also extracted. However, Immature eggs cannot be injected. They are placed in another dish with sperm and nutrients. If at all they mature, the sperm in the dish can attempt to fertilize them – but this is quite rare.
The fertilized eggs are the ones that develop into embryos. Over the next four to five days the fertilized eggs are observed, and the development of the embryos is closely monitored. Three days after fertilization the embryo will have 6 to 10 cells. By the sixth day, it develops into a blastocyst embryo, which is a ball of rapidly growing and dividing cells. 50% of the eggs fertilized in Step 4, will develop into blastocyst embryos that are suitable for transfer into the uterus.
In this stage, the blastocyst embryos are transferred into the uterus. There are two types of embryo transfers: Fresh Transfer and Frozen Transfer.
Fresh Transfer of the embryos takes place within three to seven days of the egg retrieval process. However, at the time of transfer, the woman’s hormonal levels and the menstrual cycle needs to be assessed. If her progesterone levels are high, this will impede the implantation process. If the ovarian stimulation medication is still having an impact on her ovaries, this could prove a major hazard. Both these obstacles are eliminated with the Frozen Transfer of embryos.
A frozen embryo transfer takes place six to eight weeks after the embryo is frozen. In the meantime, the woman’s menstrual cycle is observed. When she is ready for implantation, she is given pills to mimic her natural cycle and the frozen embryo transfer date is picked according to the cycle for optimized implantation. The success rate of live births from frozen embryo transfer is higher than from fresh embryo transfer and is hence the choice of most doctors.
Nine to fourteen days after the embryo has been inserted into the uterus, a blood test is conducted to determine if implantation is successful, and the patient is pregnant. Depending on the overall health of the mother, the doctor will suggest what medication she needs to take at every stage of her pregnancy and how much physical activity is allowed. In case the IVF procedure has failed to result in pregnancy, the couple may try again. The ideal duration to wait before the next attempt is one complete menstrual cycle or as suggested by the doctor.
IVF SUCCESS AND MATERNAL AGE
The success rate of IVF treatment is dependent on the age of the birthing parent (the mother). The chances of getting pregnant are higher in women below the age of 35 and lower in women aged 40 and above. Likewise, the live birth rate when the mother is under 35 is 46% and only 22% if she is older than 38 (assuming she is using her own eggs). This makes it important to determine the cause of a delayed pregnancy and to opt for the right kind of treatment as soon as possible.
Given the many steps and variables involved in the IVF procedure, choosing the right doctor and the best hospital for IVF treatment is especially important. Find a hospital that is staffed with doctors who are experts, have many years of experience and are knowledgeable in the field. The hospital itself must have all facilities under one roof to reduce the stress and pressure on the patients. Every woman who desires to be a mother deserves the right to her own little miracle.
CONSULTANT – FERTILITY SPECIALIST
MS(OG),Fellowship in Andrology & Reproductive Medicine