What is an IVF (In Vitro Fertilization )

In cases where the couple is unable to conceive naturally, or following ovulation induction, intrauterine insemination (IUI), or fertility enhancing surgery. For these couples, the next step is the Assisted Reproductive Technologies (ART) like In Vitro Fertilization (IVF) popularly known as Test Tube Baby.

The fertility specialists retrieve the eggs and sperms and fertilize them manually outside the human body. The fertilized egg after a few days of monitoring is implanted in the woman’s uterus to ensure a successful pregnancy. To help increase the chances of success for the couple, the fertility specialists fertilize more than one embryo during an IVF cycle, allowing the selection of the genetically healthiest embryo to be transferred in the uterus. However, the chances of a successful conception and a healthy baby through IVF treatment depends on several other factors as well, such as age, cause of infertility, number of previous cycles, etc. In cases where eggs or sperms cannot be retrieved from the couple or are of poor quality, the procedure can also be performed using eggs or sperm of a donor, whose details are maintained confidential for the benefit of both the patient and the donor.

Who should undergo an IVF treatment?

The IVF procedure is best suited for couples with:

Fallopian tube damage or blockage.

Unexplained infertility

Ovulation disorder

Premature ovarian failure

Endometriosis

Uterine fibroids

Previous tubal sterilization or removal

Impaired sperm production or function

Genetic disorder

Fertility preservation for cancer or other health conditions.

Stepwise Protocol

Consultation, pre-treatment testing & regularization of the menstrual cycle.

Preparing ovaries for producing several eggs.

Ultrasound and hCG injection for final maturation of eggs

Collecting eggs and sperms.

Fertilization inside the laboratory.

Transfer of embryo into the uterus.

Tests to check the status of conception/pregnancy.

Following menses once patient is checked for proper downregulation by certain blood test and ultrasound her stimulation starts with daily injections for 9-11 days .When the 2-3 ovarian follicles have reached 17-18mm size, induction of final oocyte maturation is performed, by an injection known as the "Trigger Shot".

Egg retrieval is performed at a time usually between 34 and 35 hours after trigger injection, that is, just prior to when the follicles would rupture. The eggs are retrieved from the patient using a transvaginal technique called transvaginal oocyte retrieval, ultrasound-guided needle piercing the vaginal wall to reach the ovaries under sedation or general anaesthesia.

Through this needle, follicles can be aspirated, and the follicular fluid is passed to an embryologist to identify ova.

Egg and sperm preparation:

In the laboratory, the eggs are identified and prepared for fertilisation

An oocyte selection may be performed prior to fertilisation to select eggs with optimal chances of a successful pregnancy.

In the meantime, semen is prepared for fertilisation by removing dead sperms and seminal fluid in a process called sperm washing.

Sometimes on the day of IVF the Husband may fail to produce semen by masturbation , due to psychological pressure . Hence our unit always request the husband to produce one more semen sample, a few days prior to the egg pick up and freeze that semen sample as a back up sample.

Fertilisation:

The sperm and the egg are incubated together at a ratio of about 75,000:1 in the culture media for about 18 hours.

In most cases, the egg will be fertilized by that time and the fertilized egg will show two pronuclei.

Embryo Culture: :

Typically, embryos are cultured until having reached the 6 to 8 cell stage three days after retrieval.

However, embryos are placed into an extended culture system with a transfer done at the blastocyst stage at around five days after retrieval, especially if many good-quality embryos are still available on day 3. Blastocyst stage transfers have been shown to result in higher pregnancy rates.

Embryo Selection:

Laboratories have grading methods to judge oocyte and embryo quality..

In order to optimize pregnancy rates, proper morphological scoring is done for the selection of embryos.

Embryo Transfer:

The number to be transferred depends on the number available, the age of the woman and other health and diagnostic factors.

The embryos judged to be the "best" are transferred to the patient's uterus through a thin, plastic catheter, which goes through her vagina and cervix .

Complications in the IVF Procedure:

Ovarian hyperstimulation.

During egg retrieval, there’s a small chance of bleeding, infection, and damage to surrounding structures like bowel and bladder (transvaginal ultrasound aspiration).

During embryo transfer, if more than one embryo is transferred there’s always a risk of multiple pregnancies.

Ectopic pregnancy may also occur if a fertilised egg develops outside the uterus, usually in the fallopian tubes and requires the immediate destruction of the fetus.