Invitro Fertilization

IVF is a form of assisted reproductive technology where the gamate (Egg and sperm) are retrieved and brought together to form the embryo outside of the body, incubated in the Lab and subsequently transferred into the womb.

IVF is the most effective form of assisted reproductive technology. The procedure can be done using a couple’s eggs and sperm. Or IVF may involve eggs, sperm, or embryos from a known or anonymous donor. A gestational carrier (a surrogate) might sometimes be used.

WHY IT’S DONE

IVF is a treatment for infertility or genetic problem. Sometimes, IVF is offered as a primary treatment for infertility in women over age 40. IVF can also be done if you have certain health conditions. For example, IVF may be done as an option if you, or your partner has:

1. Fallopian tube damage or blockage.
2. Ovulation disorders, if ovulation is infrequent or absent, Fewer eggs are available for fertilization
3. Endometriosis as this often affects the function of the ovaries, uterus, and fallopian tubes.
4. Previous tubal sterilization or removal
5. Impaired sperm production or function
6. Unexplained infertility – No cause of infertility is found
7. A genetic disorder, in this case, Pre Genetic Testing can be done (PGT for short )
8. Fertility preservation for cancer or other health problems, as a precaution for against Age-related infertility especially in women

HOW YOU PREPARE

Before beginning a cycle of IVF you and your partner will likely need various screenings, including

1. Ovarian Reserve Testing: This is done to determine the quantity and quality of your eggs- MEASURE FSH, AMH (Anti -Mullerian Hormone) During the first few days of your menses. Test results, often used with ultrasound scans of your ovaries can help predict your response to fertility medications
2. Pelvic Scan or Uterine Exam: to check your uterus, and your cervix – check for fibroids, polyps, and any other uterine abnormalities. Further testing done on the uterus is a procedure called Hysteroscopy ( A procedure where cameras are used to visualize inside of the womb usually to rule out abnormalities that cannot be detected on ultrasound scans ) instead of focusing on just the seeds (gametes) the soil (womb ) should be given equal importance because if the soil is defective the seed might struggle. We have lots and lots of patients who have highly benefited from Hysteroscopy and most of them end up having a successful IVF treatment afterwards. subtle abnormalities can be corrected hysteroscopically; Like uterine polys ( growths inside of the womb ) , fibroids too sitting directly inside the womb can be removed without necessarily having an open surgery. intrauterine septum maybe from adhesions can be broken down.
3. Semen Analysis
4. Infectious Screening.

Before beginning a cycle of IVF, consider important questions like:

– How safe is the procedure for me?

1. How many embryos will be transferred?
2. What will you do with any extra embryos; Freeze, discard, or use them for research purposes?
3. How will you handle a multiple pregnancy? Is it something you desire?
4. your chance of success. often times we get questions like “What is your success rate “.

it is vital that couples discuss THEIR OWN individual success rate rather than a General success rate as this varies from person to person.

some factors that determine success rate are:

Age

1. The cause of infertility
2. The expertise of the provider
3. Laboratory. if the IVF center has a good and well-functioning laboratory.

WHAT YOU CAN EXPECT

One cycle takes an average of 3 weeks. In some cases, More than one cycle may be needed.

IVF VARIOUS STEPS

STEP 1

Ovulation Induction: Several medications may be used such as:

1. Medications for ovarian stimulations: use of hormones to stimulate the ovaries to produce multiple eggs.
2. Medications for oocyte maturation
3. Medications to prevent premature ovulation
4. Medications to prepare the lining of the uterus (progesterone supplement)

Typically, on an average you need 10-14 days of ovarian stimulation before your eggs are retrieved.

A vaginal ultrasound is done to examine your ovaries to monitor the development of follicles.

What are the challenges of this stage?

Sometimes, IVF cycles can be canceled before egg retrieval for any of the following reasons:

1. Inadequate Number of follicles developing.
2. Premature Ovulation
3. Too many follicles developing, creating a risk of OHSS
4. inability to retrieve eggs, it could be that the ovaries are lying below the uterus and very close to blood vessels.
5. poor fertilization Rate.

Stimulation Protocols Used; Generally the Antagonist and Agonist protocol are used. 

STEP 2

EGG Retrieval and sperm collection:

1. Sedation, using intravenous medications
2. Transvaginal Ultrasound-Guided aspiration
3. After the Egg retrieval, Hormonal Support medications are given to help prepare for the embryo transfer. Sperm collection is done at this stage too.

Step 3

Fertilization

1. Conventional Insemination: Healthy sperm and matured eggs are mixed and incubated overnight.
2. Intracytoplasmic Sperm Injection (ICSI) where individual sperm are injected into the egg.

STEP 5

Embryo Transfer: 3-5 days after egg retrieval ET is done under vision: Ultrasound-guided, and you don’t need to be sedated for an embryo transfer.

After the transfer, you can resume minimal activities, and avoid rigorous activity, which would cause discomfort. A list of dos and don’ts will be given to you to guide your actions and to know what to expect. Patients are required to continue their hormone-support medications even after the transfer.

RESULTS

if successful and implantation occurs that will be the beginning of pregnancy.

PT test is done 10-14 days after the ET.

If you are pregnant, continue with your medications and an ultrasound scan will determine the viability of the fetus 2- 3 weeks after you got the transfer. Sometimes when you scan too early you might not be able to demonstrate cardiac activities.

If you are not pregnant, you will stop taking progesterone and likely get your period within a week.

RISK:

1. Ovarian hyperstimulation Syndrome ( OHSS)
2. Multiple Birth; in advanced countries, multiple birth is seen as an adverse effect of IVF because of the rest to the mother and baby. However, multiple birth seems to be Celebrated, it is actually celebrated as people see it as a Blessing from  God for the long wait.
3. Egg retrieval complications: Damage to blood vessels, infections, or damage to bowel and bladder. ( such risk can is minimised if the procedure is done by proficient hands )
4. Risks associated with sedation and anesthesia used.

SUCCESS RATE

A clinic’s success rate depends on many factors. This Includes:

Patient’s ages and medical issues as well as clinical treatment population and treatment approach.