In vitro fertilization (IVF) is the most commonly used Assisted Reproductive Technique (ART) which is a series of complex procedures used to help infertility treatment and conceiving a pregnancy.
As the name suggests In-vitro (Procedure is done outside the body) Fertilization (mating of gametes) involves fertilization of sperm and egg outside the body in a controlled lab environment and the resulting embryo is then transferred in the uterus of the female partner Or in some cases the surrogate(If the female can not bear the child in her own uterus.)
IVF is the buzzword in the fertility treatment, According to science daily since the conception of the first IVF baby in 1978 there have been more than 8 million babies born from IVF,
This only comprises of the live births and not the failed cycles of IVF which together constitute a lot of IVF procedures being performed each day every year.
One IVF cycle takes about 3 weeks but the time can vary from case to case based on several factors. The success of IVF depends on several factors such as age and cause, We will be discussing all the factors in this blog.
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- Why is IVF done?
- IVF Process (What to expect?)
- How to increase the chances of successful IVF?
- Cost of IVF
- Risks of IVF
Why is IVF done?
IVF is the most performed assisted reproductive technique though you might not always require IVF to treat infertility.IVF is used to treat infertility and genetic disorders, It is offered as primary treatment in the case you are over 40 years of age.
Know in detail about other infertility treatment
IVF is done to treat :
- Fallopian tube damages and blockages: If the tubes are blocked they restrict or prevent the sperm from reaching the egg and further it can restrict the fertilized egg to travel from the fallopian tube to the uterus.
This problem can be treated with surgery but like any other surgery, there is a risk of infection and bleeding making IVF a suitable option.
- Fewer eggs available for fertilization: The number or quality of eggs can decrease due to several reasons like age or some underlying disease. Going for an IVF in such a case increases your chances of getting pregnant.
- Endometriosis: Sometimes uterine tissues start to implant and grow in regions other than the uterus that damages the functioning of the fallopian tube and the ovary.IVF can be used to counter such situations.
- Poor Sperm: If the male partner has a lower sperm count or lower sperm quality (Low mobility of sperm) the chances of pregnancy decrease.
In a healthy male of the total sperm produce, only 40% have good mobility and even all of these also don’t reach the egg, So a low sperm production or poor sperm quality decreases the chances significantly. In such cases, IVF can be really effective.
- Genetic Disorders: If any of partner has a genetic disease which can get transferred to the baby IVF can be a procedure to prevent such an event.
The embryos are formed outside the body which can be analyzed for any genetic disorders and the embryos that do not have any issue are then transferred in the uterus of the female partner or the surrogate.
It’s important to note that not all genetic disorders can be detected.
- If you are planning to go for cancer treatment: Cancer treatment like chemotherapy and radiation can lead to infertility so if you are planning on starting this treatment you can preserve your gametes (sperm and egg) for future use.
- Uterine Fibroids: fibroids are benign tumors that are often found in the walls of the uterus of women in their 30s-40s which can cause difficulty in pregnancy.
- If either of the partners has undergone sterilization: If you have undergone vasectomy or tubectomy you can still get pregnant with the help of IVF.
Before going for an IVF you should undergo all the infertility tests.IVF is a costly process so it’s really important to wisely choose your IVF clinic and doctor.
You should evaluate a clinic on various parameters like the previous cases of IVF the clinic has treated, a case of someone similar to you, their success rate and treatment approaches.
Read in detail about how to choose an IVF clinic
Before going for an IVF you and your partner will have to undergo several screening examinations to determine the quality and health of your sperm and egg along with the health of the uterus of the female companion.
- Semen Analysis: if you have not undergone a semen analysis as part of your infertility checkup the clinic will take a semen analysis to determine the potency of the sperm
- Ovarian Reserve Analysis: This involves multiple tests to check the quality and quantity of the eggs in the ovary.
The tests check the concentration of Follicle Stimulating Hormone (FSH), estrogen and the concentration of the anti-mullerian hormone in your blood during the initial days of our menstrual cycle.
An Ultrasound of the ovaries is taken to determine how your ovaries will respond to the treatment.
- Disease Screening: screening for infectious diseases like HIV may be done.
- Uterine Exam: A sonohysterography is performed to analyze the inner lining of the uterus prior to IVF and an ultrasound to create visuals of your uterine cavity or a hysteroscopy might be performed.
- Mock Embryo Transfer: A mock embryo transfer might be
performed to check the depth of the uterine cavity and to determine the right embryo transfer technique
IVF Process (What to expect?)
A typical IVF cycle is 3-4 weeks long which is equal to the length of a normal ovulation cycle. The cycle begins with the first day of your periods but as part of your fertility treatment, few medications and injections can be given prior to it.
Step 1:Determining Day 1 of your cycle
The official start of your IVF cycle will be day 1 of your periods. Your Fertility nurse will assist you in determining your 1st day of the cycle.
Step 2: Ovary Stimulation (8-14 Days)
Naturally each month your ovary produces one egg. You will be given medication or injection
- For Ovarian Stimulation: To promote the production of more eggs using Follicle-Stimulating Hormone (FSH), luteinizing hormone (LH) or combination of both.
- For Oocyte Maturation: Usually, take after 8-14 days to promote maturation of the produced eggs using human chorionic gonadotropin (HCG) or some other drug.
- For Preventing Premature Ovulation
These hormones and eggs are naturally present in your body the medications only promote more production
The ovaries and follicles under development will be regularly monitored using ultrasound and blood tests and the medications will be altered if needed. The tracking will increase more when your cycle will start approaching the end of the stimulation phase.
A “trigger injection” is given to prepare the eggs for ovulation (The release of an egg from ovaries is called ovulation) before the next step of the process “The Egg Retrieval”
Your fertility nurse will help you determine your egg retrieval date and the injection is given accordingly.
Step 3 Egg Retrieval (Mid Cycle)
The egg retrieval is a hospital day procedure that takes about 20-30 Mins. You will be asleep the whole process while your fertility expert will retrieve eggs from your ovaries using ultrasound-guided needles. Retrieval of the egg is one of the most crucial steps which needs to be done with great precision which requires a great amount of experience.
At a time usually, 8-15 eggs are retrieved from the ovary
You would require an additional 30 mins recovery time after this procedure.
Step 4 Sperm Retrieval (Mid Cycle)
The sperms are retrieved on the same day of egg retrieval. The sperm can be fresh or the couple can use already preserved sperm. The sperm retrieved are analyzed and the best sperms of all are selected for the fertilization process.
Step 5 Fertilization and Development
The sperm and eggs are put together under a controlled environment for fertilization. It’s important that the eggs are fertilized right after retrieval.
If the eggs fertilize the resulting embryo is placed in an incubator that has all the necessary environment for the development of the embryo. The embryos are regularly observed to monitor their growth for 5-6 days.
The embryo grows from a 2 celled structure to a 4 celled structure on the 2nd day and 8 celled structure on the 3rd day
If at the end of 5-6 days the embryo reaches the blastocyst stage of about 200 cells you will be prepared for the embryo transfer.
Not all eggs fertilize and become an embryo, therefore, this process might be repeated until a successful embryo is formed
Step 6 Embryo Transfer
One the day of egg transfer you could be recommended with progesterone supplements to help you prepare the lining of your uterus.
The transfer of embryos is a hospital day procedure and no anesthesia is given, you will be wide awake. The embryo formed is put on a small tube-like structure called a catheter and inserted in your uterus through the cervix.
If multiple embryos are formed you can freeze these embryos for future use.
You can continue with your day to day activity. The embryo will not fall when you stand or do your daily activities.
Step 7 Blood Test
After two weeks of the transfer, a normal pregnancy test is done to check for pregnancy. A typical pregnancy test looks for the presence of human chorionic gonadotropin (hCG) in your body.
If you get pregnant: You will be further referred to an obstetrician.
If you do not get pregnant: You will be asked to stop taking fertility medications and you may expect your natural period within a week. If you miss your period or experience unusual bleeding contact your doctor.
If you wish to try again your doctor will help you by suggesting a few steps to improve the chances of the next IVF cycle.
How to increase the chances of successful IVF?
To know how to increase the chances of IVF we need to understand the factors on which IVF success rate depends
- Women’s Age: The younger you are greater is the success rate of IVF. According to WebMD, The success rate of IVF for women under the age of 35 is about 40% and 11.5% for women age more than 40.
- Status of embryo while transfer: More developed the embryo is greater are the chances of pregnancy. Embryos after 2-3 days of development have a lesser success rate compared to that after 5-6 days
- Maternal History: The chances of IVF for a woman who has previously given birth or women who have previously had IVF is more than that of someone who has never had an IVF or history of pregnancy
- Cause of infertility: Women who face unexplained infertility have a lesser chance of successful IVF.
- Lifestyle factors: Tobacco, Alcohol, Caffeine consumption can lower the success rate of pregnancy. Obesity can also lower the chances of pregnancy.
Cost of IVF
IVF is a costly procedure around the world
|Name of Country||Approximate Cost|
|United States||10,000$ (7,60,000 INR)|
|UK||7500$ (5,70,000 INR)|
|Saudi Arabia||6475$ (4,90,000 INR)|
|India||1300$ (60,000-1,50,000 INR)|
Due to the lower cost of IVF in India people from around the world travel India for IVF.
Read in detail about the cost of IVF in India
Risks of IVF
- Multiple Pregnancy
- Premature Birth
- Ovarian Hyperstimulation Syndrome: fertility drugs that induce ovulation can lead to ovarian hyperstimulation syndrome in which your ovaries become swollen and painful.
- Ectopic Pregnancies: In about 2-5% cases of IVF ectopic pregnancy is observed in which the fertilized egg gets implanted outside the uterus (Like in the fallopian tube) where the embryo can not develop and the pregnancy fails
- Stress: IVF procedures can have great mental and emotional stress.
- Birth Defects: IVF might increase the risk of certain birth defects although more research would be needed to confirm this.
IVF and fertility treatment can be really stressful and partners should look out for each other and themselves in these times.
The key is to never lose hope.