In vitro fertilization (IVF) is a complex process in which the gametes i.e. eggs from sperms are fertilized outside the body in a culture medium by a trained embryologist. The procedure can be done using the couple’s own eggs and sperms. Or it may involve eggs, sperm or embryos from an anonymous donor. The resulting embryo is transferred into the uterus of the female partner for implantation. This complete process takes about 3 weeks.
IVF is generally offered to a couple who is having trouble conceiving even after trying less invasive modalities such as intrauterine uterine insemination where the sperms are placed directly into the uterus around the time of ovulation.
However, in the following conditions, IVF is offered as the primary treatment mode:
The procedure will be explained to the patient as it has multiple steps:
Medications for oocyte maturation: When the follicles are ready for egg retrieval, generally after eight to 14 days, human chorionic gonadotropin (HCG) or other medications are given to help the eggs mature.
Egg retrieval usually planned 34 to 36 hours after the final injection and before ovulation. This procedure is done under sedation to make it pain-free.
If a partner’s sperm is used, he’ll provide a semen sample through masturbation the morning of egg retrieval. Other methods, such as testicular aspiration — the use of a needle or surgical procedure to extract sperm directly from the testicle — are sometimes required or donor sperm also can be used.
Fertilization can be attempted using two common methods:
Intracytoplasmic sperm injection (ICSI): In ICSI, a single healthy sperm is injected directly into each mature egg. ICSI is often used when semen quality or number is a problem or if fertilization attempts during prior IVF cycles failed.
After the embryo transfer, the patient can resume normal daily activities. However, since ovaries may still be enlarged, the vigorous activity could cause discomfort and should be avoided.
It is best to contact the doctor if the following side effects are experienced:
About 12 days to two weeks after embryo transfer, blood test (beta-hCG) is used to detect whether the patient is pregnant.
If b-HCG negative i.e. not pregnant, the woman is advised to stop taking progesterone and is likely get period within a week. If she has any remaining embryos frozen, then she will be offered frozen embryo transfer in next cycles.
Ovarian Hyperstimulation Syndrome
When women undergo ovulation stimulation, they take injectable hormone medications to increase the production of eggs. The problem arises when there are too many hormones in the system which could lead to Ovarian Hyperstimulation Syndrome (OHSS). It is a condition where the ovaries become swollen and cause an immense amount of pain. The patient could experience abdominal pain, vomiting, and shortness of breath.
Multiple pregnancies: when more than one embryo is transferred, there is a risk of multiple pregnancies, which carry a risk of early labour and delivery of low birth weight babies.
Ectopic pregnancy: when the fertilized egg implants outside the uterus, usually in a fallopian tube. The fertilized egg can’t survive outside the uterus, and there’s no way to continue the pregnancy.
Birth defects: The age of the mother is the primary risk factor in the development of birth defects.