In vitro fertilization (IVF), commonly known as Test tube baby treatment, is a technique where the fertilization process happens inside the laboratory instead of the female partner’s body. The woman’s eggs are surgically removed from ovaries and are combined with the husband’s sperms outside the body. After a few days, fertilized eggs (embryos), incubated and cultured under specific conditions, are placed inside the woman’s uterus, thus bypassing the fallopian tubes. The transfer is followed by implantation inside the uterus which then results in a pregnancy once successful. This is by far the most successful assisted reproductive treatment available and definitely the most logical step next to basic treatments like ovulation induction & IUI. For some scenarios like damaged tubes or diminished ovarian reserve, it can also be proposed as the first line therapy.
Anmol IVF & Fertility Centre provides couples with the maximum amount of clinical, emotional, and administrative support they will need to complete their cycle successfully and help them realize their dream of parenthood.
Around one in 8 couples has difficulty conceiving and it’s not necessarily because of the woman. As a matter of fact, women and men can both be diagnosed with infertility. Many couples who are willing to have their own biological baby still struggle to become pregnant. Once all the basic forms of treatments are attempted, one needs to explore the next higher form of therapy which is IVF( In Vitro Fertilization) popularly known as Test Tube Baby treatment. It is a little complex procedure than the basic treatments, needs expertise, patience, meticulous cycle management and also incurs expense.
Beginning an IVF cycle is an exciting at the same time very anxious time for a couple. The following explanation is meant to simplify what occurs during the journey of IVF.
Anmol Fertility & IVF Centre is always there to handhold you through this entire process & make it completely stress free.
What is IVF?
IVF, In Vitro Fertilization, literally means fertilization “in glass”/in test tube/ outside the body”, the term originated from the test tube experiments of biology & refers to the process where a woman’s eggs are fertilized outside of her body in the laboratory.
Unlike the simpler process of artificial insemination in which sperm is placed in the uterus and conception happens otherwise normally, IVF involves combining eggs and sperm outside the body in a laboratory. Once an embryo or embryos form, they are then placed in the uterus where implantation takes place resulting in pregnancy if successful.
Who is IVF suitable for?
- IVF is specifically recommended for women with absent, blocked or damaged fallopian tubes due to disease or surgery.
- It is also often used in cases of unexplained infertility(couples in whom no obvious pathology is found), in some cases of male factor infertility( low sperm counts/motility) and can be used in combination with ICSI (intracytoplasmic sperm injection) in cases of severe male factor infertility
- Some of the causes of infertility are; problems with ovulation, severe endometriosis, antibody problems that harm sperm or eggs.
- Escalation process in case of multiple IUI failures
- It is also the fundamental technology used in case of embryo donation (donor egg IVF), and embryo adoption cycles.
Your step by step guide to IVF:
Patients may get at times intimidated by the concept of IVF, and think of it as being a very complex treatment .However, the basics of IVF are very simple !
All we are doing is helping to kick-start a pregnancy , so that we imitate in the test tube in the IVF lab what would normally happen naturally in the fallopian tube for fertile couples for 5 days . Once we put the embryo back in the uterus, you then have a completely normal pregnancy !
The possibilities choice of medications and treatment protocol, and of course success rates with an IVF treatment vary from patient to patient.
At Anmol Fertility & IVF Centre, we finalize the treatment cycle only after a thorough careful evaluation. This includes reviewing your history and prior responses to fertility medications, a thorough physical examination and drawing up a plan to prepare for your treatment, and going over the treatment plan with you including the expected outcomes and the challenges if any.
There are four general steps involved in an IVF cycle:
- Stimulation of the ovaries to encourage development and maturation of the eggs.
- Retrieval of the eggs
- Fertilization of the eggs and culture of the embryos
- Transfer of the embryos back into the uterus
These steps are described more fully below:
- Stimulation of the ovaries to encourage development and maturation of the eggs (Controlled ovarian hyperstimulation to boost the egg supply)
The first step in IVF involves injecting hormones so you produce multiple eggs each month instead of only one. Under the care of a fertility specialist, the woman is given daily fertility medications(Fertility drugs through injections), usually for 10-12 days duration, to stimulate her ovaries to produce many follicles.
Sometimes, even before these fertility injections, you may be given a drug to suppress your natural cycle , which will be in form of daily subcutaneous injection for 2 weeks.( GnRH agonists like lupride)
Follicles are the small fluid filled structures which develop on the ovaries, each of which will hopefully contain an egg. These injections can be taken from our clinic or local general practitioner. We can train you or your husband to administer some of the injections. A clinic nurse could also be arranged to come home and give injections. The common medications are gonadotropins including injections FSH, (follicle stimulating hormone) or HMG (human menopausal gonadotropin).These include injection Recagon, gonal-F, Menopur, Menogon, Bravelle. The purpose of these injections is stimulating the development of multiple follicles in the ovaries. When you are on these hormone injections, most or all of these developing eggs are allowed to continue growing until they all reach maturity at the same time. In this way we make use of all the eggs, which would otherwise have been wasted. The number and size of the developing follicles is measured and monitored by trans-vaginal ultrasound scans. The exact number of follicles which develop varies between patients, but the average is about 10-15. Some blood tests are done to check hormone levels while follicle growth is monitored by ultrasound, so that we know when to go ahead with oocyte retrieval. There is another type of injection used during this stage. This is called as GnRH – agonist. (Gonadotropin releasing hormone agonist) egg. Luprolide/ Busarlin or a GnRH antagonist ( ganirelix/cetrotide) to prevent release of eggs before oocyte retrieval. You will then be tested to determine whether you’re ready for egg retrieval. The final preparation for egg retrieval involves a hormone injection which mimics the natural trigger for ovulation. You will be given injections of a medication that ripens the developing eggs and starts the process of ovulation. Injection HCG (Human Chronic Gonadotropin) is given 30-35 hours prior to oocyte retrieval. This causes final maturation of eggs in the follicle. Timing is very important; the eggs must be retrieved just before they emerge from the follicles in the ovaries. If the eggs are taken out too early or too late, they won’t develop normally. Your doctor may do blood tests or an ultrasound to be sure the eggs are at the right stage of development before retrieving them. Egg retrieval will take place 36-38 hours after this injection. The instructions for each medication vary from patient to patient. The medical team at Anmol Fertility & IVF Centre will analyze your case closely to determine which medications to use, what dosage to take, when to administer the medications and how long to take them.
- Retrieval of the eggs(Oocyte Retrieval / Ovum pick up)
When the eggs are mature, they are retrieved by an ultrasound guided procedure that is performed under light anesthesia. You will be advised to come fasting 12 hours, given short general anesthesia and a needle will be placed through vaginal opening and into the ovaries. During the procedure, your doctor will locate follicles in the ovary with transvaginal ultrasound and remove the eggs with a hollow needle. All the eggs are aspirated into sterile tubes along with the follicular fluid. There are no abdominal incisions or suturing. The process takes about 20-30 minutes. The risks are minimal and recovery takes an hour or two although postoperative cramping is common. The eggs are then evaluated at the onsite embryology lab, once there they are fertilized with sperm from your partner. During this time efforts are taken to keep the eggs at body temperature at all times. After identification, the eggs are washed and transferred into special culture medium in Petri dishes in an incubator. The male partner is advised to keep abstinence of no more than 48 to 72 hours only before day of retrieval. This ensures the sperm of good morphology and good motility.
Patients usually recover within one to two hours following oocyte retrieval and are then discharged. Some other medications like progesterone supplementation is initiated from the day of the retrieval.
- Fertilisation of the eggs and culture of the embryos in the lab.
Once the follicular fluid arrives in the embryology lab, our skilled, trained embryologist will look for the eggs, separate them and score the eggs according to their maturity and quality. The eggs are then placed in fresh special nutrient media and quickly transferred to the incubator. At this time partner is asked to collect fresh sample, which is analyzed. A semen sample is provided by the male partner and, in the laboratory, a concentrated preparation of the best motile sperm is extracted from the semen sample. This sperm preparation (containing approximately 150,000 sperm) is added to the dishes containing the eggs in case of IVF. The sperm is thus mixed with the egg in an appropriate proportion (IVF) as mentioned above or sometimes alternative form of insemination is required called ICSI, which involves injecting a single sperm into each egg using a very fine needle, rather than mixing the eggs and sperm in a dish. Irrespective of the method of insemination used, on the morning after egg retrieval, the inseminated eggs are placed in special nutrient media called fertilization media and incubated overnight and then the eggs are examined to see which have fertilised. It takes approximately 18 hours to determine if fertilization has occurred and 24-72 hours to establish if a viable embryo is growing. During a successful IVF process, the oocytes and embryos will stay in the lab for approximately 2-5 days. You can tell the difference between a fertilized egg and unfertilized egg by 2 faint spheres visible in an egg, after fertilization. These 2 spheres (pro-nuclei) hold DNA of sperm and egg and will fuse to form the nucleus of the embryo.
While you and your partner go home, the fertilized eggs are kept in the clinic under observation to ensure optimal growth. Fertilised eggs (zygotes) are then routinely cultured in the IVF laboratory until day 3, at which time the best 1-3 embryos are selected and transferred back into the woman’s uterus. For some patients, a blastocyst cycle may have been recommended in which case embryo culture is extended to day 5. So depending on the case, one may wait 3 days( Cleavage stage) or even up to five days until the embryo reaches a more advanced blastocyst stage.
After egg collection, you bare given medications like pessaries, gel or injections to help prepare the lining of the womb for embryo transfer.
Any additional embryos that are not transferred on either day 3 or day 5 can be frozen.
- Embryo transfer(ET)
About two to five days after oocytes are retrieved and fertilized in our lab, you will come to our clinic for embryo transfer procedure. This is lot quicker and easier than the retrieval of the egg. Relatively it is a simple thetre procedure and usually anesthesia is not required. On the day of the transfer, we discuss the number of embryos being transferred as well as their quality and grade. The best one or two embryos will be chosen for transfer. During actual procedure, a long, thin catheter containing the embryos and a small amount of media is passed through your cervix into your uterus. The correct positioning of the embryos is confirmed by abdominal ultrasound, so the woman is required to have a full bladder for the procedure. Usually embryo transfer is performed about 3 days after egg retrieval when healthy embryos reach the 6-8 cell stage i.e. if day 0 is day of retrieval then day 3 is day of embryo transfer. , and number of embryos transferred could be 1-3 depending on the case. If blastocyst transfer is planned for the case, embryos are grown for further 2 days and then the transfer is scheduled. The number of embryos is restricted because of the risks associated with multiple births. Remaining embryos may be frozen for future IVF attempts, if they are suitable.
At times, a fresh transfer is deferred due to endometrial lining issues or other issues like hormonal changes or PCOS, all the embryos are frozen on day 3 or day 5 and subsequently, FET ( Frozen embryo transfer ) is scheduled.
Cryopreservation: Embryos of sufficient quality that are not transferred can be cryopreserved. The embryologist will select embryos that are suitable for freezing.
After the transfer, the patient rests for two hours prior to discharge. Fourteen days after the embryo transfer, a serum based pregnancy test(beta HCG) is taken. During this period, patients are advised to perform light activity and remain in contact with the Center. If pregnancy does not occur, our team reviews the IVF cycle and makes specific recommendations for follow-up. The patient will speak with the clinical staff to review and if necessary, to discuss other options.
Are there any risks?
Usually, they are not commonly seen.
Specific steps of an in vitro fertilization (IVF) cycle carry risks, including:
- Multiple births. IVF increases the risk of multiple births if more than one embryo is implanted in your uterus. A pregnancy with multiple fetuses carries a higher risk of early labor and low birth weight than pregnancy with a single fetus does.
- Premature delivery and low birth weight. Research suggests that use of IVF slightly increases the risk that a baby will be born early or with a low birth weight especially when associated with multiple pregnancies.
- Ovarian hyperstimulation syndrome. Use of injectable fertility drugs, such as human chorionic gonadotropin (HCG), to induce ovulation can cause ovarian hyperstimulation syndrome, in which your ovaries become swollen and painful.
Signs and symptoms typically last a week and include mild abdominal pain, bloating, nausea, vomiting and diarrhea. If you become pregnant, however, your symptoms might last several weeks. Rarely, it’s possible to develop a more-severe form of ovarian hyperstimulation syndrome that can also cause rapid weight gain and shortness of breath.
- Miscarriage. The rate of miscarriage for women who conceive using IVF with fresh embryos is similar to that of women who conceive naturally — about 15 to 25 percent — but the rate increases with maternal age. Use of frozen embryos during IVF, however, may slightly increase the risk of miscarriage.
- Egg-retrieval procedure complications. Use of an aspirating needle to collect eggs could rarely cause bleeding, infection or damage to the bowel, bladder or a blood vessel. Risks are also associated with general anesthesia, if used.
- Ectopic pregnancy. About 2 to 5 percent of women who use IVF will have an ectopic pregnancy — when the fertilized egg implants outside the uterus, usually in a fallopian tube. The fertilized egg can’t survive outside the uterus, and there’s no way to continue the pregnancy.
- Birth defects. The age of the mother is the primary risk factor in the development of birth defects, no matter how the child is conceived. More research is needed to determine whether babies conceived using IVF might be at increased risk of certain birth defects. Some experts believe that the use of IVF does not increase the risk of having a baby with birth defects.
- Ovarian cancer. Although some early studies suggested there may be a link between certain medications used to stimulate egg growth and the development of a specific type of ovarian tumor, more recent studies do not support these findings.
- Stress. Use of IVF can be financially, physically and emotionally draining. Support from counsellors, family and friends can help you and your partner through the ups & downs that come with women and male infertility treatment.
Our expert team at Anmol Fertility & IVF Centre surely takes care of you at all the times and where ever possible, make it least complicated! We hope for the best but always be prepared for the worst.
How successful an IVF can be?
Chances of success vary between patients, particularly according to the age of the woman, but on average about 30-40% of patients will have a baby after one attempt at standard IVF. The cumulative success rates can climb up to 60-70% if frozen embryo transfer is done. More than one attempts of IVF may be required in some cases. Every case is different and so is every patient; so when you ask the doctor questions, see how they are relevant to you. Understand that the journey may not necessarily be a smooth one; build resilience, patience and have faith in your doctor.
Get all your queries answered from our experts at Anmol Fertility & IVF Centre, move through the journey of IVF in a seamless manner and with full knowledge and confidence!