In Vitro Fertilization

In Vitro Fertilization

  • What is In Vitro Fertilization (IVF)?

    These days, there is a rising incidence of couples are unable to conceive naturally due to various reasons. However, scientists are constantly coming up with new medical advancements that enable older women, irrespective of their age, to give birth to their own biological children. Read – Recent advances in fertility treatment. Medical practitioners in the field of infertility, from all around the world recommend IVF or In Vitro Fertilization as the primary treatment for infertility.

    In non-medical terms, In Vitro Fertilization (IVF) can also mean a “test tube baby”. To be more specific, it’s a procedure that involves the picking up of eggs from a woman, fertilizing them outside the body with the male partner’s sperm, and replacing the resultant embryos into the female partner’s uterus.

    Origin of IVF

    As early as the 1950s, Robert Edwards had the vision that IVF Treatment could be the answer for infertile people. He worked systematically to realize this goal, discovered important principles of human fertilization, and succeeded in accomplishing fertilization of human egg cells in test tubes (or more precisely, cell culture dishes). His efforts finally got recognition on 25th July 1978, when the world’s first “test tube baby” was born. During the following years, Edwards and his co-workers refined IVF treatment technology and shared it with colleagues around the world. Approximately 4 million individuals have so far been born following IVF.

    Robert Edwards received the Nobel Prize in 2010 for the development of human in vitro fertilization (IVF) therapy. His achievements have made it possible to treat infertility, a medical condition afflicting a large proportion of people including more than 10% of all couples worldwide. (Source: Nobel Prize Summary)

    IVF treatment is a boon for couples with infertility or genetic disorders, helping such couples achieve pregnancy. Quite clearly, IVF may be the solution for either male or female infertility.

    Procedures for IVF Treatment

    IVF is not just a procedure – it is a sequence of processes to follow to achieve pregnancy.

    IVF Treatment usually involves the following steps:

    1. Monitoring and Stimulation of Ovaries using hormones
    2. Collecting the eggs from the ovaries
    3. Fertilization of the ovum with sperm in a culture dish – a zygote is formed
    4. The fertilized zygote continues to grow in the lab for 5-6 days and then follows the embryo implantation in the uterus of the prospective mother

    Pregnancy tests using blood samples can determine the progress of pregnancy after two weeks of implantation.

    Indication

    In Vitro Fertilization (IVF) is the treatment of choice for couples with blocked fallopian tubes, severe abnormalities in the semen parameters, low sperm count, genetic diseases in either parent resulting in miscarriages or stillbirths, women whose ovaries are failing due to age or even unexplained infertility.

    The following stages briefly explain the steps in IVF:

    Downregulation

    Down-regulation is a process by which your doctor shuts off your ovaries, temporarily to be able to control ovulation and egg maturation during treatment. Down regulation is accomplished by administering drugs called GnRH antagonists and GnRH agonists suppress your body’s production of FSH and LH. FSH and LH are hormones that trigger egg development and ovulation. Blood tests and ultrasound scans can be helpful in monitoring the response during this phase of IVF. The duration of down regulation may vary between 8 to 21 days depending on the individual response.

    Ovarian Stimulation

    Your physician usually prescribes an injection called Gonadotropins to enable the development of a good number of follicles in the ovary. Your physician will be giving these injections on a daily basis; Starting on Day 2 of the menstrual cycle till the follicles reach a diameter of 18 to 22 mm. This takes on an average 10 to 12 days of IVF treatment. On some occasions, the use of tablets such as clomiphene citrate along with gonadotropins helps in ovarian stimulation. Patients have to undergo hormonal assays in the blood and ultra sound scans regular intervals to assess the body’s response to these drugs. At the same time, it is also vital to assess the endometrial lining.

    Ovulation Trigger

    Human Chorionic Gonadotropins or HCG is another drug, which is necessary for final maturation and the process of ovulation or release of the egg.

    Oocyte Retrieval or Ovum Pick-up

    This stage is a short, safe, outpatient procedure performed vaginally under Ultrasonography guidance. The process of oocyte retrieval follows 34 to 36 hours after the administration of HCG. This process requires sedation, but general anaesthesia is also helpful at times. The patient needs to be fasting for at least 5 hours prior to the procedure. The procedure is carried out in sterile surroundings under aseptic conditions. The aspirated fluid is examined under the microscope to identify the eggs. The eggs are removed, washed and placed in small dishes containing the culture medium, which is stored in a special incubator in IVF treatment.

    After the oocyte retrieval, the patient may experience mild, cramp-like pain or slight bleeding from the vagina which will subside in a few hours. Oral antibiotics are given to the woman as prophylaxis against infection. The patient can go home 2 to 3 hours after the procedure.

    This is the usual process during IVF Treatment. In case you have any medical conditions leading to infertility and need IVF treatment it would be better not to waste time. A solution may be just around the corner.

    Sperm Preparation

    On the day of egg pick-up, the husband will have to produce a semen sample in a clean wide-mouthed container supplied by the lab. There is a period of abstinence for 2 to 3 days. If the husband cannot produce his semen sample at the scheduled time, he can provide a sample in advance. This sample can be frozen and used during the IVF treatment.

    Fertilization

    About 3 to 6 hours after the oocyte retrieval, the embryologist adds a measured volume of the sperm suspension to the dish containing the oocytes. The following day the embryologist checks the dish for fertilization of the eggs. This is followed by placing the eggs in fresh dishes of culture medium and replacing in the incubator.

    Embryo Transfer (ET)

    ET is carried out on any day, between the second day and fifth day after oocyte retrieval. It is a simple and straightforward procedure under aseptic conditions that requires no sedation. The embryologist gently places in the uterine cavity through a fine hollow tube (cannula) introduced directly into the uterus via the vagina and cervix. After the ET, the patient is advised bed rest for about 6 hours. After that, she can resume her normal activities.

    Implantation

    After the transfer of embryos in the uterus, it should follow the natural event of implantation. The embryo hatches out of its shell covering and implants into the endometrium by burrowing into it. It then continues to develop and transforms into a fetus. However, within two weeks after embryo transfer, the embryo starts producing a hormone called Human Chorionic Gonadotropin (HCG). Detection of this confirms the presence of a pregnancy.

    Outcome

    A blood test indicating HCG levels to the confirmed pregnancy is done on the 28th day of the cycle. In order to support a conception, the woman is given progesterone in the form of injections, oral tablets or vaginal pessaries.

    Doctors recommend IVF treatment in the following conditions:

    • Blocked or damaged Fallopian tubes
    • Decrease in Sperm Count
    • Uterine fibroids with unusual menopause
    • In absence of fallopian tubes
    • Genetic disorders
    • Unexplained infertility

    Beneficial for patients with the following problems:

    • Blocked or Damaged fallopian tubes
    • Low sperm count
    • Ovarian issues
    • Reproductive health problems
    • Ovulation disorders in women
    • Uterine Fibroids
    • Advanced age group (Aged more than 35)

    If you have been diagnosed of having any of the above mentioned symptoms or medical conditions, the next step is to look for fertility clinics that can provide an apt solution based on the reported medical conditions. For more information, visit our blogs section for more articles on infertility management.

    Also Read – Future after diagnosis of infertility

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