WHAT IS IN-VITRO FERTILIZATION (IVF)?
IVF is a technique where several eggs are retrieved from a woman's ovaries and then fertilized by the husband's sperm outside the body in a specially controlled environment of the laboratory. The fertilized eggs then develop into embryos and these are transferred to the woman's uterus, by a procedure called embryo transfer (ET).
WHO WILL BENEFIT FROM IVF?
- Women with both Fallopian tubes blocked, absent (due to surgery) or damaged due to disease.
- The husband has a reduced sperm count (Oligozoospermia), reduced motile sperm (asthenozoospermia ) increased abnormal sperm (Teratozoospermia)
- Sperm antibodies in the wife's and or husband's serum
- Endometriosis i.e. the presence of endometrium (lining of the womb) outside the uterus
- Unexplained Infertility (refers to couples in whom no obvious pathology is found but who cannot conceive).
- Man with Azoospermia (no sperm is seen in semen)
- IVF also helps women who have absent ovaries or where there are no eggs in the ovaries (see Oocyte Donation).
- Women who have failed conception with Ovulation Induction and IUI
- Women who suffer from repeated abortion. In these cases, IVF with Pre-Implantation Genetic Screening (PGS) may help.
- Families who have a history of genetic disorder may be helped with IVF & Pre-Implantation Genetic Diagnosis (PGD)
IVF Program (Step-by-Step):
IVF involves several steps:
- Ovarian stimulation & Monitoring
- Egg collection (Oocyte Retrieval).
- Semen specimen collection / sperm preparation & insemination.
- Fertilization and Cleavage
- Cryopreservation of embryos
- Frozen Embryo Transfer (FET).
- Blood tests for pregnancy confirmation.
Ovarian stimulation & Monitoring:
Ovarian stimulation is done by drugs like recombinant FSH, Pure FSH, or HMG. The injections are usually started on 2nd or 3rd of menstrual cycle.
Monitoring the maturity of Eggs is done by periodic ultrasound examination of the ovaries. Patient has to report to the clinic every day from 2nd of menstrual cycle till the eggs are aspirated. This may require from 10 days to 15 days.
Ovarian stimulation is done by drugs like recombinant FSH, Pure FSH, or HMG. The injections can be started on 2nd or 3rd of menstrual cycle .If necessary stimulation can be started at a later date while continuing the down regulation.
Egg Retrieval or Ovum Pickup (OPU):
When follicles are mature HCG or GnRH-a is injected. This causes final maturation of the eggs. Eggs are collected 34- 35 hrs after this injection.
Eggs are retrieved transvaginally under the guidance of sonography.
Egg retrieval is usually done under Short General Anaesthesia. The process is done usually as OPD procedure and does not require overnight stay at the hospital.
Complications of the procedure occur in less than 1% of the cases. Some patients may experience vaginal spotting and mild lower abdominal pain. Rarely infection, haemorrhage, and lower bowel or bladder injury that may require additional surgery. Rarely if an attempt at the ultrasound retrieval is unsuccessful, a laparoscopic retrieval is performed.
Sperm Separation & Insemination: (In Vitro- Fertilization of Eggs):
After the retrieval, the husband is asked to provide semen sample. The eggs & sperms are placed together in the incubator (at a temperature i.e. 37 degrees centigrade and 5-6% CO2 atmosphere and 5% O2) (TRIPLE GAS INCUBATOR)
An extra semen sample is always collected at the beginning of IVF cycle. In case the husband is not able to attend clinic or provide the semen sample on the day of OPU, this sample works as a backup sample.
In cases of azoospermia the sperms are collected by putting a small needle in the testis. This is known as Testicular Sperm Aspiration (TESA). In these cases, or if the sperm count is very less fertilization is done with help of procedure called Intra Cytoplasmic Sperm Injection (ICSI)
Fertilization and Cleavage:
Fertilization is the process of a sperm penetrating the egg. The egg being fertilized is now called an embryo. These are observed further to be certain that they are dividing (cleaving) normally.
Cryopreservation of Embryo:
There was a time when we used to transfer embryos back into uterus 2-3 days after ovum pickup (OPU), but as the science has advanced, it was realised that excessive hormone production during stimulation decreases chances of pregnancy and it is best not to do embryo
transfer in same cycle.
Therefore, since 2012 we cryopreserve most of our embryos and prefer to transfer in further cycles. This gives us pregnancy rates up to 60%
Once the embryo reaches the 8 cell on Day 3 or blastocyst stage on Day 5, these are preserved in liquid nitrogen at -196°C, by a process called Vitrification.
Frozen Embryo transfer (FET):
In the cycle, in which we decide to transfer, medicines are given to prepare uterus (Endometrium). Time to time hormones and TVS are done to check the progress. Once the endometrium is 7 mm or above, with good volume and vascularity, embryos are placed inside
the uterus under ultrasound guidance.
The procedure is done on an outpatient basis. The patient takes rest for 1 (one) hours at the centre and then, is allowed to go home.
Blood Tests for pregnancy confirmation:
Blood test is performed for confirmation of pregnancy approximately 10-12 days following embryo transfer.
HOW LONG THE COUPLE HAS TO STAY IN GUWAHATI?
The couple usually requires three visits at the institute. In the first visit, preliminary investigations are done. The couple has to stay at Guwahati for 2-3 days.
In the second visit the wife has to stay at Guwahati for 15 to 20 days. The wife has to report to clinic on 2nd day of the menstrual cycle.
In the third visit wife has to come during Embryo transfer. In this visit she has to stay in Guwahati for about 7-10 days.
WHAT ARE OTHER RISKS OF IVF PROCEDURE?
- Chances of multiple pregnancies are about 20%.
- Miscarriage rates in patient undergoing IVF is similar to any infertile patient conceiving through other fertility treatment. (15-20%).
- There was a time when we used to talk about risk of Ovarian Hyper Stimulation Syndrome (OHSS) but due to advancement in science, now our clinic is OHSS FREE CLINIC since 2012.
YOUR IVF CYCLE MAY HAVE TO BE CANCELLED BEFORE OVUM PICKUP:
The aim of the intensive monitoring of IVF cycle is to obtain good number of healthy mature eggs. If the cycle is unsatisfactory, it may have to be cancelled at any stage.
The reasons for cancellation are:
- Too few follicles are developing which would decrease the chances of obtaining at least one mature egg.
- There are no follicles developing at all. This is rare but may occur.
HOW MANY TIMES IVF CAN BE REPEATED?
IVF can be repeated as many times as a couple can afford.
UP TO WHAT AGE THE IVF IS POSSIBLE?
IVF is preferable up to the age of 35 years (wife). It may be extended up to the age of 38 years (to be done only after ovarian reserve tests, which are done before your IVF cycle). After the age of 38 years females are usually unable to produce good quality eggs. In these cases pregnancy can be achieved by using donor eggs. IVF by Donor Eggs can be done up to the age of 52 years provided the wife is physically and mentally fit. Pregnancy in post menopausal women can be achieved by IVF using donor eggs.
The success rate of IVF / ET at our centre is 50 to 60%. It varies with the age of patient and decreases as the patients age increases. It is only 10 to 15% in patients above 38 years with self egg.