IVF Treatment or as learned in schools In Vitro Fertilization (IVF) is a collection of several different complex procedures for the conception of a child. The most common and widely known way is to collect (retrieve) mature eggs from the ovaries and fertilize it under simulated conditions with the collected sperm. All this takes place in a fertility lab. Then the embryo(s) (fertilized egg) is transferred to the uterus. This one full cycle takes three weeks. A couple can opt to undertake this process in different parts, but then it will take longer. In many parts of the world the term ‘IVF treatment in India’ is always seen to be as a low-cost and effective solution for their problem.
People who require IVF
Louise Brown, born on 25th July 1978, is the first baby to be born through IVF. As of 2018 more than eight million births have been documented through this mode of conception. Every IVF center in India will agree that in recent times there has been significant increase of awareness in India and also the treatment seekers. Infertility and genetics are the reasons behind IVF treatment. The former two have many effects on a person's health, some of which are:
- Fallopian tube damage or blockage- It makes it difficult and sometimes impossible, for an egg to be fertilized or for an embryo to travel to the uterus.
- Ovulation disorders- Ovulation is the reason for the availability of a mature egg for fertilization or menstrual. This disorder means fewer eggs are available, hence causing an inconsistency in ovulation or no ovulation at all.
- Endometriosis- It is the occurrence of a tissue growing outside of the uterus, which usually grows inside of it, in the fallopian tubes. It can grow on ovaries, fallopian tube or intestines. It causes sperm and egg from uniting even if it's on the ovary or fallopian tube.
- Previous tubal sterilization or removal- As in this type of sterilization, fallopian tubes are cut or blocked. In many cases, IVF acts as an alternative for its reversal.
- Impaired sperm production or function- It means below-average sperm concentration, poor sperm mobility or abnormalities in the size and shape of sperm. All this makes it difficult for sperm to fertilize an egg.
- Unexplained infertility- If the couple passes all the test and is still unable to conceive then it's called unexplained infertility.
- A genetic disorder- If anyone from the couple is going through a genetic problem, which is likely to be passed to the child then through IVF the resulting embryo can be tested for that disease and will only be inserted if no signs are found.
- Fertility preservation for cancer or other health conditions- Some diseases or their cures can cause infertility, so IVF also has a medium for fertility preservation. For future use, women can preserve their unfertilized eggs an egg freezing center. At an embryo freezing center, embryos (fertilized egg) can be preserved for years in the frozen state. (A fertility clinic can have egg freezing and embryo freezing options)
- Women whose uterus isn't functional or will be facing health issues if got pregnant might choose IVF. In this case a woman's eggs are fertilized with her partner's sperm. The embryo is then inserted into another woman (carrier).
- Same way if a man’s sperm quality is too low, a sperm donor is contacted.
- In some cases, donors are obtained for both the egg and the sperm. The embryo from them is inserted in the patient or a carrier. (Note: Donors are available for both, sperm as well as egg, also a carrier i.e. women to carry the fertilized egg and give birth to baby. Donors and carrier can be known or anonymous, as per your choice)
Process of IVF:
Theoretically, IVF is performed by collecting mature eggs from a woman's fallopian tubes or uterus, mixing it with sperm and then reinserting the embryo into the uterus. This is common knowledge about IVF, but in real life there's a lot more. The mentioned process is broken down to a few small steps which are carried out individually.
- Ovarian hyperstimulation- is the technique of achieving ovulation by multiple ovarian follicles through fertility medications. This means for retrieval doctor needs more than one egg. Women under normal circumstances produce a single egg. With the help of injected hormones more than one oocyte (cells which later grow into the egg) are released.
- Final maturation induction- In this, a 'trigger shot' (details to be taken by the doctor) is injected. Till now, oocytes were in their natural process of maturation and with this shot, they turn into eggs by thirty-eight to forty hours.
- Egg retrieval- Doctors start this process two hours early from the expected maturation period, i.e. thirty-six hours. The eggs are retrieved from the patient using a transvaginal technique called transvaginal oocyte retrieval. It is common to remove between ten to thirty eggs, still, it depends upon the number of mature follicles. Mature eggs are placed in a nutritive liquid and incubated, however, not all eggs might be fertilized.
- Egg and sperm preparation- The collected eggs are examined for their chances and only selected ones are taken into consideration. Meanwhile, the male's semen has also been retrieved. Inactive cells and seminal fluid are removed through a process called sperm washing.
- Co-incubation- It is the mixing of sperm and egg for fertilisation and is broadly done in two ways:
- Conventional insemination- Both are mixed and left to incubate for about 16-24 hours. The ratio in which they are mixed is 75,000:1.
- Intracytoplasmic sperm injection (ICSI)- Male with low sperm motility have to go with this option. A single sperm is introduced directly into the egg.
(In both cases, the fertilised egg is passed to a special growth medium and left for about 48 hours until the egg consists of six to eight cells, this is called embryo freezing.)
- Embryo transfer- As the doctors have more than one fertilized egg and only one embryo is to be transferred (sometimes more but not many), so they have to select the best one(s). This generally takes three to five days. Then the transfer starts which is usually painless. Embryos inserted into the uterus. If successful, an embryo will implant in the lining of the uterus in about six to 10 days after egg retrieval.
Preparations are done before this procedure:
We understand your curiosity before and satisfaction after getting the knowledge of the IVF procedure. Still, some important steps left to be discussed. Before beginning the cycle of IVF using the couple's eggs and sperm, partners may have to undergo the mentioned below examinations-
- Ovarian reserve testing- It is to examine the quantity and quality of the eggs. The doctor tests the concentration of follicle-stimulating hormone (FSH), estradiol (estrogen) and anti-mullerian hormone in the blood from the recent menstrual cycle. To make a more accurate prediction of the response from ovaries to fertility medication, an ultrasound might be taken.
- Semen analysis- Usually it is done as part of the initial fertility evaluation. If not, then the doctor will surely conduct it before the start of an IVF treatment cycle.
- Infectious disease screening- It will test for those diseases that might get passed on to your baby.
- Practice (mock) embryo transfer- For embryo transfer, the doctor needs to know the depth of the uterine cavity and determine the best technique according to your body structure.
- Uterine exam- The inside lining of the uterus is examined. As embryo will be implanted here, and also grow.
One common goal of every couple is to give birth and raise a healthy child. IVF treatment and doctors from all around the globe feel fortunate to be a part of this process. Before starting, it is important to discuss the risks, costs, and timeline of the procedure with your doctor. 'Choose your fertility clinic' only after receiving all the necessary information. Still having some doubts, 'consult us'.