IVF

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The first successful IVF pregnancy occurred in 1978 with the birth of Louise Brown in the United Kingdom. Since then, IVF has helped millions of couples worldwide to achieve their dream of having a baby, and it continues to be a widely used and successful fertility treatment option. In India alone, it is believed that over 100,000 IVF cycles are done per year.

In IVF, eggs are retrieved from the woman’s ovaries and fertilized with sperm in a laboratory dish to create embryos. The resultant Embryos are typically cultured in the laboratory for a few days before being transferred into the woman’s uterus. IVF can be used to overcome various causes of infertility, including fallopian tube blockages, endometriosis, male factor infertility, and unexplained infertility.

IVF has evolved over the years with advancements in techniques such as ICSI, blastocyst culture, time-lapse embryo monitoring, and embryo biopsy for genetic testing and preimplantation genetic testing (PGT), which allows for genetic screening of embryos.

IVF in India is governed by the Indian Council of Medical Research (ICMR) guidelines, which provide ethical and procedural frameworks for fertility treatments, including IVF. These guidelines aim to ensure the safety and well-being of patients undergoing IVF.

  • Overview
  • Complications in IVF
  • Pre IVF

Overview

While Basic treatment options like Ovulation Induction, Time Intercourse, and IUI overcome some of the hindrances to conception process, these procedures still require a healthy uterus, fallopian tubes and healthy sperm. In-vitro fertilization offers hope to a couple when the basic treatment methods fail to give the desired results.

IVF can be used to overcome various causes of infertility, including

  • Bilateral Tubal blocks
  • Anovulation
  • Poor Ovarian reserve
  • Endometriosis
  • Severe male factor infertility
  • Unexplained infertility

Besides Couples with infertility issues, IVF is also helps in other non-infertility related causes like

  • If the partner is undergoing chemotherapy and has preserved the gametes before undergoing chemotherapy
  • For couples with genetic problems who do not wish to pass on the same to their offspring and assist them with the conception of a healthy child.

Complications in IVF

Serious complications from IVF procedures or medicines are rare. However, there can be possible side effects of injectable fertility medicines, risks of the egg retrieval or embryo transfer, and pregnancy that include:

  • Risk of multiple pregnancies
  • Ovarian hyperstimulation syndrome (OHSS) that involves nausea, bloating, or ovarian discomfort
  • Soreness or mild bruising at the injection sites
  • Mood swings and fatigue

Pre IVF

The decision to undergo an in vitro fertilization cycle depends on a variety of circumstances. A woman’s eligibility for IVF is determined by a series of tests that are done before.

These IVF tests make sure that issues like miscarriage, anomalies in the embryo or any type of general illness or disease that might impair the health and likelihood of a successful pregnancy are completely checked out. These IVF tests can be classified into numerous groups:

  • Ovarian reserve testing (to find out the number of eggs remaining in a woman’s body)
  • Tubal Patency test (to evaluate the condition of the uterus)
    Semen evaluation (to examine the shape, motility, and concentration of the sperm)
  • Prolactin test (to decide on the drug regimen)
    Mock embryo transfer (optional test in the middle of your IVF cycle.)
  • Screening for infectious diseases like HIV, hepatitis B, Chlamydia, Rubella, Covid19 and varicella

Procedure

Steps in an IVF cycle

1Stimulation

Each menstrual cycle in a woman results in the production of one egg. But multiple eggs are necessary for IVF. The chances of creating a healthy embryo improve when more than one egg is used. Fertility medications are administered to boost a woman’s body’s egg production. The doctor monitors egg production during this period and will decide when to extract the eggs by routine blood tests and ultrasounds.

2Egg Retrieval

Follicular aspiration is the procedure used to retrieve eggs. Anesthesia is used throughout the surgical process. The physician inserts a needle into the vagina, into the ovary, and into an egg-containing follicle with the help of an ultrasound probe. Each follicle is extracted of its eggs and fluid by the needle.

3Insemination

A sample of semen must be provided by the male partner. In a petri dish, a technician combines the sperm and the eggs. The doctor could choose to employ ICSI (Intracytoplasmic Sperm Injection) if the procedure doesn’t result in embryos.

4Embryo Culture

The doctor keeps an eye on the fertilised eggs to make sure they are growing and dividing. At this point, the embryos could be referred to genetic condition testing.

5Transfer

The ability to implant the embryos depends on their size. Normally, this happens three to five days following conception. A small catheter is pushed into the vagina, past the cervix, and into the uterus in order to implant. The embryo is implanted by the doctor into the uterus.

6Implantation

The embryo’s implantation in the uterine wall leads to pregnancy. It can take six to ten days. A beta HCG test is carried out after 14 days of transfer to confirm pregnancy.

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FET – Frozen Embryo Transfer

MAS-L Laparoscopy

RIM-Reproductive Immunology

Frequently Asked Questions (FAQ’s)

IVF is a multi-step, challenging process. The procedure typically takes four to six weeks on average. This includes the period of time prior to egg retrieval during which a person takes fertility medicine up until a pregnancy test has been performed.

Some potential risks and side effects of IVF include:

  • Ovarian hyperstimulation syndrome (OHSS): In rare cases, fertility medications can cause the ovaries to become swollen and painful.
  • Multiple pregnancies: Transferring multiple embryos increases the chance of twins or higher-order multiples.
  • Ectopic pregnancy: The risk of implantation outside the uterus is slightly higher with IVF.
  • Emotional and financial stress: IVF can be emotionally and financially demanding for couples.

The number of IVF cycles needed varies for each individual or couple. Success can often be achieved within 3 to 6 cycles, but some may require more attempts. The decision to continue with additional cycles depends on various factors, including the age of the woman, the cause of infertility, and previous treatment outcomes.

Maintaining a healthy lifestyle can potentially improve IVF success. It’s advisable to:

  • Maintain a balanced diet and a healthy weight.
  • Avoid smoking, excessive alcohol consumption, and recreational drug use.
  • Manage stress levels through relaxation techniques or counseling.
  • Follow the prescribed medication and treatment protocols.

There are no strict age limits for IVF treatment, but success rates tend to decline with increasing age. Fertility clinics may have their own policies regarding age limits, and individual assessments are conducted to determine suitability for treatment.

Yes, donor sperm or eggs can be used in IVF. This option is considered when there are issues with sperm or egg quality, genetic disorders, or single individuals or same-sex couples seeking to build a family.

No, IVF is not the only option for infertility treatment. Depending on the cause of infertility, other treatments like intrauterine insemination (IUI), fertility medications, surgical interventions, or specialized treatments may be recommended.

Most women can continue their usual work activities during an IVF cycle. However, it is important to follow the specific instructions given by your fertility clinic, such as attending scheduled appointments, taking prescribed medications, and managing stress levels. If your work involves physically demanding activities or exposure to potentially harmful substances, it is advisable to discuss any necessary modifications with your healthcare provider.

During the IVF process, some discomfort may be experienced, but the procedure itself is typically not painful as it is performed under anesthesia or with the use of local anesthesia. The most common discomfort is mild bloating or cramping after the egg retrieval procedure. Your fertility clinic will provide appropriate pain management options and guidance to ensure your comfort throughout the process.

embryo transfer. It is generally recommended to avoid strenuous exercises or activities that may cause excessive strain or impact on the pelvic area. However, light to moderate exercises such as walking or gentle yoga are often considered safe. It is best to consult with your fertility specialist for specific guidelines based on your individual situation.

After the embryo transfer, you may experience some mild cramping or discomfort. It is important to take it easy and rest for a brief period following the procedure. Your fertility clinic will provide specific instructions regarding post-transfer care, including any medications or lifestyle modifications. It is essential to follow these instructions carefully to optimize the chances of successful implantation.

The timing of a pregnancy test after IVF depends on the specific protocol and the type of test used. Typically, a blood test to measure the pregnancy hormone hCG (human chorionic gonadotropin) is conducted around 10-14 days after the embryo transfer. Some home pregnancy tests may be able to detect hCG levels earlier, but it is best to follow your fertility clinic’s instructions regarding the timing of the test.

If a woman does not produce enough eggs during an IVF cycle, it may affect the number of embryos available for transfer. The fertility specialist will assess the individual situation and make recommendations accordingly. In some cases, the cycle may be canceled, and an alternative treatment plan may be suggested. It is important to have open communication with your healthcare team to understand your options and determine the best course of action.

IVF itself does not significantly increase the risk of birth defects. However, certain factors, such as the age of the mother or underlying genetic conditions, can influence the overall risk. It is essential to discuss any concerns with your fertility specialist, who can provide personalized information and offer appropriate genetic

The chances of having twins or multiples with IVF are higher compared to natural conception. This is because multiple embryos can be transferred during an IVF cycle to increase the chances of pregnancy. The likelihood of having twins or multiples depends on factors such as the number of embryos transferred, the quality of embryos, and the age of the woman. However, advancements in IVF techniques have allowed for more precise control over the number of embryos transferred, reducing the risk of multiple pregnancies.

There is no specific age limit for using frozen eggs or embryos in IVF. However, the quality and viability of frozen eggs or embryos may decrease over time. It is generally recommended to freeze eggs or embryos before the age of 35 for better success rates. However, each case is unique, and the decision to use frozen eggs or embryos is made in consultation with the fertility specialist based on individual circumstances and the quality of the frozen specimens.

Adopting a healthy lifestyle can potentially improve the success of IVF. Some recommended lifestyle changes include maintaining a balanced diet rich in nutrients, regular exercise, avoiding smoking, reducing alcohol consumption, managing stress levels, and getting sufficient rest. It is important to consult with your fertility specialist for personalized recommendations based on your specific situation.

The male partner plays a crucial role in the IVF process. The male partner provides a sperm sample that is used for fertilization either through conventional IVF or intracytoplasmic sperm injection (ICSI). It is important for the male partner to undergo semen analysis to assess sperm quality. In cases of male factor infertility, advanced techniques like ICSI can be used to facilitate fertilization. Open communication and support from both partners are vital throughout the IVF journey.

The recommended waiting period between IVF cycles varies depending on individual circumstances, including physical and emotional recovery, the results of the previous cycle, and any specific treatment plans. Typically, a waiting period of one to three menstrual cycles may be suggested to allow the body to recover and optimize the chances of success in subsequent cycles. Your fertility specialist will guide you on the appropriate waiting period based on your unique situation.

Yes, IVF can be successful even after multiple failed attempts. Each failed IVF cycle provides valuable information that can be used to refine the treatment approach and increase the chances of success in subsequent cycles. It is important to have a thorough evaluation of the previous cycles to identify any potential issues or factors contributing to the lack of success. Adjustments to the treatment protocol, such as changes in medication dosage or different approaches to embryo selection, can be made to improve the outcomes.

The IVF process can be emotionally challenging for individuals and couples. It is common to experience a range of emotions including stress, anxiety, hope, and disappointment throughout the treatment journey. Seeking emotional support through counseling, support groups, or talking with loved ones can be helpful. Fertility clinics often have dedicated support services to provide guidance and support during this time. Taking care of your emotional well-being is an important aspect of the overall IVF process.