IVF Treatment (In-Vitro Fertilization)
IVF (in vitro fertilization) is also known as Test tube baby is the most common form of ART (Assisted Reproductive Technology) it involves combining eggs and sperm outside the body in a laboratory. If the fallopian tubes are damaged or the sperm is poor, this treatment is the most effective and only acceptable treatment. The eggs are fertilized in the laboratory, and the resulting embryos are placed into the uterus 2 to 5 days later. It is a complex and expensive procedure; only about 5% of couples with infertility seek it out and achieves remarkable pregnancies even in women with damaged fallopian tubes, seemingly sterile husbands, and even “unexplained” infertility.
WHO SHOULD CONSIDER IN VITRO FERTILIZATION TREATMENT (IVF)?
This treatment is usually considered by couples who have:
- If the fallopian tubes are absent or blocked.
- Severe male factor infertility (sperm counts or sperm motility is low, or sperm needs to be extracted surgically from the testicles).
- An inherited genetic disease that they wish to avoid passing on to their child – In this case, IVF is combined with a pre-implantation genetic diagnosis. This means that the embryos (or in some cases, just the eggs) are tested for the disease, and only those without the disease are transferred to the uterus.
- Advanced reproductive age, as the time to conception, is very critical and pregnancy rates with other therapies are low.
- All other causes of infertility, after failing treatment with other therapies (eg, endometriosis, ovulation disorders, unexplained infertility).
- Ovarian failure, although donor eggs would be required in this case.
When choosing an in vitro fertilization (IVF) clinic, you should keep in mind that the success rate of this treatment depends on many factors, including patients’ ages and medical issues, as well as the clinic’s treatment population that you will choose for your treatment and treatment approaches. Before beginning the cycle of In Vitro Fertilization Treatment using your own eggs and sperm, you and your partner will likely need various screenings, including:
- Ovarian reserve testing. Your doctor might test the concentration of follicle-stimulating hormone (FSH), estradiol (estrogen) and antimullerian hormone in your blood during the first few days of your menstrual cycle to know the quality and quantity of your eggs,. The test results are often used together with an ultrasound of your ovaries that can help predict how your ovaries will respond to fertility medication.
- Semen analysis. Your doctor will conduct a semen analysis shortly before the start of an IVF treatment cycle If not done as part of your initial fertility evaluation.
- Infectious disease screening. Your partner and you will both be screened for any infectious diseases, including HIV.
- Practice (mock) embryo transfer. To determine the depth of your uterine cavity and the technique most likely to successfully place the embryos into your uterus your doctor might also conduct a mock embryo transfer to know the depth of your uterine cavity and the technique most likely to successfully place the embryos into your uterus.
- Uterine cavity exam. Your doctor will check your uterine cavity before you start IVF. This might involve a sonohysterography — in this procedure fluid is injected through the cervix into your uterus — and an ultrasound to create images of your uterine cavity. Or it might include a hysteroscopy — in which a flexible, thin, lighted telescope (hysteroscope) will be inserted through your vagina and cervix into your uterus.
The IVF procedure consists of several steps that take place over a period of weeks:
- Educate the couple about the complex steps involved in this treatment, its risks and benefits, and techniques for giving injections at home
- To produce several eggs stimulation of the ovaries is done
- Retrieving eggs from the ovaries and obtaining a semen sample
- Growth of the embryos and Fertilization of the eggs with sperm in the laboratory
- Transferring of one or more embryos into the uterus
- Step 1- The first step of the IVF procedure involves the use of fertility medications. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval and to increase the number of eggs (follicles) that develop in the ovaries and control the time of ovulation. The stimulation is selected based upon the woman’s diagnosis. It is probable to perform the treatment without ovarian stimulation known as “natural cycle IVF” or “unstipulated IVF;” usually only one egg is retrieved.
- Step 2- Approximately 32 to 36 hours after injecting hCG, a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity to remove the eggs. Medication is given to reduce and remove potential discomfort. Your doctor will insert an ultrasound probe into the vagina and then uses a needle to withdraw the egg from each follicle. The procedure takes approximately 15 to 30 minutes, depending upon how many follicles are present. This is generally done while the woman is sedated. After the transfer, you are required to rest, do blood tests and ultrasounds to verify if there is a possible pregnancy.
- Step 3- The male partner is asked to produce a sample of sperm, which is prepared for combining with the eggs.
- Step 4: Then the sperm and eggs are mixed together and stored in a laboratory dish to encourage fertilization in a process called insemination. In some cases where there is a lower probability of fertilization, Intracytoplasmic sperm injection may be used. By this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. The eggs are continuously monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered as embryos.
- Step 5: After three to five days following egg retrieval and fertilization the embryos are transferred into the woman’s uterus. With the help of a catheter or small tube inserted into the uterus to transfer the embryos. It is a painless procedure for most women, although some may also experience mild cramping (If the procedure is successful, implantation typically occurs around six to ten days following egg retrieval.
After the procedure, you would typically stay in bed for some hours and be discharged four to six hours later. Your doctor will most likely perform a pregnancy test on you about two weeks after the embryo transfer.
In the cases where the sperm count of man is extremely low, doctors may combine IVF with a procedure called intracytoplasmic sperm injection-in which sperm is taken from semen – or in some cases taken right from the testicles – and inserted directly into the egg. Once a viable embryo is produced, it is then transferred to the uterus using the usual IVF procedure.
RISK AND COMPLICATIONS
There are specific steps of an in vitro fertilization (IVF) cycle carry risks, including:
- Multiple births
- Premature delivery and low birth weight
- Ovarian hyperstimulation syndrome
The signs and symptoms of this treatment typically last a week and include mild abdominal pain, vomiting, bloating, nausea, and diarrhea. If you become pregnant, however, these symptoms might last several weeks. In rare cases, it’s possible to develop a more severe form of ovarian hyperstimulation syndrome that can also cause rapid weight gain and shortness of breath.
The average cost of an IVF treatment varies depending on where you live, the number of medications you’re required to take, the number of IVF cycles you undergo. Success rates of the treatment depend on a number of factors, including the reason for infertility, where you’re having the procedure done, and your age. A woman’s age is one of the major factors in the success of IVF for any couple. However, according to the CDC, the success rate is increasing in every age group as the techniques are refined and doctors become more experienced