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In Vitro Fertilization (IVF): Procedure And FAQ

While a majority of couples can have a child the natural way, there are many who require assisted reproduction techniques. Today, many childless couples are opting for the procedure known as In Vitro Fertilization (IVF), or fertilization outside the human body [1] .

Until a few years ago, there were very few options available for couples who were unable to conceive the natural way; with recent technological advancements, infertile people need not necessarily be childless as well. In addition to such couples, certain celebrities are also opting for IVF in a bid to become a single parent.

In IVF, commonly known as 'test tube baby' procedure, eggs taken from a woman are fertilized with the sperm from the male partner or that of a donor in a test tube or petri dish in a laboratory. This fertilized embryo is transferred to an incubator and later implanted directly onto the womb of the mother. From this point onwards, the pregnancy continues as any other regular pregnancy, with the embryo developing in the womb till full term. The first test tube baby was Louise Brown [2] , born in 1978 by IVF.

How Is IVF Done?

One round of IVF treatment is referred to as an IVF cycle. Beginning on the first day of your period, you will also be expected to follow a fertility plan which includes medications prescribed or injected by your doctor.

Day 0

The beginning of your period (Day 0) is considered to be the first day of your IVF procedure. As each body has a different response to the medications prescribed or injected prior to IVF, medical professionals are the best people to consult regarding the accuracy of your menstrual cycle. As any confusion on this point might jeopardize the procedure, it is better to ask your doctor or nurse rather than assuming your first day of the period.

Day 1

Day 1 marks the commencement of the stimulation phase. In this phase, your ovaries receive stimulation and follicles are made to produce more than the regular number of eggs. The course of the medications used for stimulating ovaries can be from around 8 to 14 days.

In a routine menstrual cycle, your ovaries produce one egg per month. Medication to increase production of eggs is given as an injection, to be either taken one or two times per cycle, or even once or twice a day. Your doctor will tell you about the time and place of administration of the injection.

Once the injection is administered, you are closely monitored to gauge the growth of the eggs. At this point, you might have to get some blood tests as well as ultrasound scans are done. Towards the end of the medication, a trigger injection will be given to you. This trigger injection readies the eggs for release or ovulation.

The eggs are retrieved before the ovulation. Around eight to fifteen eggs can be retrieved at one time. Performed under general anaesthesia, the retrieval of eggs is done using ultrasound technology and by guiding a needle into the ovaries. Once the procedure is completed, you might be needed to remain in the hospital for another 30 minutes, after which you are free to walk out on your own.

The best quality of eggs collected from a woman's ovaries are then placed with the man's sperm in a petri dish for the fertilization to occur. Prior to this, the sperms are washed down by a special mixture that slow down the sperms, thus making it easier to isolate the best quality sperm from the others.

The process of combining the sperm with the eggs is referred to as the insemination procedure. In situations where there is a low sperm count, Intracytoplasmic Sperm Injection (ICSI) [1] is done, which involves the injection of one sperm into each egg, on a special microscope. This is then cultured for around 16-18 hours in a special incubator.

Once 16-18 hours have elapsed, the eggs are checked for fertilization by the scientists in the laboratory. Embryos are formed only from fertilized eggs. These embryos are then placed in an incubator, where they remain for another five to six days.

Day 2

Daily monitoring starts from Day 2, where scientists in the laboratory keep tabs on the development of the embryo. An embryo is considered to be developing normally if it is a four-cell mass on the second day and an eight-cell mass on the third day, and by the fourth day, the cells become discernible. The embryo is now called a morula [1] . The fifth day sees a cavity forming in the centre, signifying that the embryo is now a blastocyst [1] .

The embryo is transferred into the womb of the woman by the second, third or fourth day from fertilization. You will be advised by your doctor to drink a lot of water before the procedure. A full bladder is important as the embryo is implanted in the best possible place in the womb using ultrasound.

It is the prerogative of the doctor to decide the most appropriate time for the transfer.The implantation process takes about five minutes. No anaesthetic is given. You can get up and move around once the procedure is done without there being a risk of the embryo dislodging or anything.

For implanting the embryo onto the uterine wall, the embryo is placed in a catheter which is then inserted into the uterus through the cervix. If, for any reason, the pregnancy is unsuccessful, another embryo will be selected and placed similarly. This process is repeated until the pregnancy is confirmed.

Often, despite single-embryo transfer (SET) [3] being the standard urged upon clinics, there have been many cases of clinics transferring more than one embryo at a time. The rate of complications goes up considerably when more than one embryo is transferred.

Among children born through IVF, twins are said to be around 12 times more predisposed to be born prematurely, 16 times more likely to have low weight at birth and have around five times more likelihood of developing jaundice or respiratory disorders as compared to their single-born counterparts. [3]

After the implantation, you will be given a two week period to wait. A blood test is done after two weeks to check for the presence of human chorionic gonadotrophin (hCG) [4] in your blood. If hCG is found in your blood, pregnancy is established.

Are You A Good Candidate For IVF?

Recently, with celebrities going in for IVF to become single parents, there is much interest in the procedure. While the procedure might seem glamorous and simple on the outside, it is both expensive as well as quite complicated. Moreover, usually more than one cycle of IVF is required for a successful pregnancy. Keeping all this in mind, you must first ascertain if IVF is the only option available for you.

Due to the high costs involved, many clinics mislead their clients to go in for IVF despite there is no pressing need for the same. In such a scenario, always get a second opinion before you invest your time and money in something that has only around 40% chance of success anyway. Before you decide on IVF, consider the following:

1. How long have you been trying to conceive?

If it has been less than two years since you have been trying to conceive naturally, IVF is not for you. Unless you know for a confirmed fact that the woman's fallopian tubes are indeed blocked or that the man's sperm count is low, you should keep trying naturally. Never jump to IVF impulsively as miracles happen every day.

2. How old are you?

The criterion of age comes into play especially if you are in your late thirties. The closer that you are to menopause, the lesser time you have to conceive naturally.

3. Are your fallopian tubes blocked?

Blockage of fallopian tubes, the tubes connecting the ovary and uterus, is the main reason why infertile women opt for IVF. Nevertheless, IVF is not the only solution as the blockage can also be removed by surgery or microsurgery.

4. Have you considered artificial insemination?

The process of introducing sperm in the uterus by artificial means is a much easier and less expensive treatment when compared to IVF. Artificial insemination can be considered if the male partner does not have a low sperm count.

5. Endometriosis and Polycystic Ovarian Syndrome (POS)

Women with such conditions are advised to go in for IVF.

6. Abnormal ovulation cycle

Women with an abnormal ovulation cycle usually face difficulties in conceiving the natural way. Even if such women do opt for IVF, medications are prescribed to promote healthy eggs and regularize ovulation. Women who do not have healthy eggs fit for fertilization might use donor eggs along with the sperm of their partner.

7. Low sperm count

While for men with regular sperm count, artificial insemination might be enough; IVF is recommended for men who have a low sperm count.

All things considered, as it is an expensive procedure, IVF should only be opted for when all else fails and it is the only option remaining.

Who Should Opt Out Of IVF?

1. If you have unhealthy eggs and do not wish to use donor eggs.
2. If you are over 37 years of age.
3. Chances of miscarriage go up in women who are above 40 and do get pregnant with IVF.
4. Abnormalities of the uterus, ovarian dysfunction, fibroid tumours and abnormal hormone levels all, either individually or in combination, can lead to a very low rate of success of IVF.

View Article References
  1. [1] Chanda A. (2010). The miracle of IVF. Journal of advanced pharmaceutical technology & research, 1(3), 365.
  2. [2] Templeton A. (2014). IVF Treatment and Single Embryo Transfer. Facts, views & vision in ObGyn, 6(1), 5-6.
  3. [3] Klitzman R. (2016). Deciding how many embryos to transfer: ongoing challenges and dilemmas. Reproductive biomedicine & society online, 3, 1-15.
  4. [4] Chard, T. (1992). Pregnancy tests: a review. Human reproduction, 7(5), 701-710.
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