In Vitro Fertilization (IVF)

In vitro fertilisation (IVF)
In vitro fertilisation (IVF) is a process where sperm fertilises the eggs in the laboratory (rather than in the woman’s fallopian tube). This involves:
1. Placing the egg from the woman together with many thousands of sperm (typically 100,000).
2. The fertilised embryos grow in the laboratory over two to five days (blastocyst stage) before being transferred into the woman’s uterus in a simple procedure called embryo transfer.
3. The embryo transfer process involves passing a very fine tube containing the embryo through the cervix and into the uterine cavity. Usually one embryo at a time is transferred with additional embryos stored by freezing for use in subsequent treatments.

Who is it for?
IVF was initially offered to patients with bilateral tubal block. Today, its indications include mild to moderate male factor, couples who are unable to conceive after first and second line procedures like ovulation induction (OI) and intra-uterine insemination (IUI), patients with endometriosis, Poly Cystic Ovarian Syndrome who have not conceived with routine treatment and those with unexplained infertility.
IVF is also the treatment option for couples requiring donor oocytes and / or surrogacy.
For many couples or individual’s in vitro fertilisation (IVF) offers the best chance of achieving a pregnancy. IVF treatment may be recommended in a range of conditions affecting fertility, including sperm abnormalities, endometriosis, tubal damage, unsuccessful ovulation induction and unexplained infertility. IVF may also be an option for single women and same-sex couples who choose to use donor sperm to have a baby.
If the sperm profile is poor the process of fertilisation is carried out by intracytoplasmic sperm injection (ICSI), where a single sperm is injected into each egg. Fertilisation then takes place over a number of hours in a culture dish maintained under ideal conditions in the laboratory.

Treatment
a. Commencement of the Treatment
You must come for a check up on the specified day of your menstrual cycle between 9 am to 12 pm at a Nova IVI Fertility centre.
b. Ovarian Stimulation
Medications will be administered to stimulate the ovaries to produce several eggs in order to increase the chances of pregnancy. You could undergo one of two protocols based on your case history and reports. Your doctor will discuss this with you.

In the Long Protocol - You will given injections from the 21st day of the previous menstrual cycle. You will need to come back on the second or third day of your next menstrual cycle to start the actual ovarian stimulation.

The Antagonist Protocol requires fewer injections and the entire treatment begins on the second day of the menstrual cycle.

In both protocols, injections have to be taken at approximately the same time every day. It is advisable to come to the hospital for your injections, but if you can't, our medical staff will teach you how to self-administer the injections or you can have them taken locally by a doctor. These medications can cause mild side effects like acidity and some discomfort.
c. Ultrasound Examination
A vaginal ultrasound examination is conducted at regular intervals to assess the response of injections on your ovaries . If the response is poor, there is a possibility that your doctor might advise you to cancel the IVF cycle. This will be a joint decision between yourself and your doctor.
d. HCG Injection/GnRH Injection
This is given to trigger the final maturation of the eggs and make them ready for collection, which happens about 34 to 36 hours later.
e. Ovum Pickup (Egg Collection)
Eggs are removed from the ovaries under general anaesthesia, with the help of transvaginal sonography. The procedure takes 15 –30 minutes and the number of eggs collected will depend upon your response to the injections. You can go home approximately 2 to 3 hours after the procedure. Occasionally one could have some vaginal spotting and some abdominal discomfort, but this settles in a day or two.
f. Sperm Collection
Usually, a fresh semen sample is collected on the day of ovum pick-up (egg collection). Some men find it difficult to produce a semen sample on request, so it may be collected at home/elsewhere and brought to the centre within 30 minutes of collection. Generally, to produce the best sample, abstinence of three to five days is recommended and lubricants should not be used. However, if a fresh sample cannot be produced on the same day or if the husband is not available on the day of egg collection, a previously frozen sample can also be used; in fact we encourage you to have a semen sample frozen for this eventuality.
g. After Ovum pickup
Following ovum pick-up, the eggs will be fertilised in the lab either by standard IVF or by ICSI. On the next day, the embryologist will examine the eggs for fertilisation and later on for further development of embryos.
If there are more than three well-developed embryos, it is possible to freeze them for a later transfer, if necessary.
h. Embryo Transfer
This is performed two or three or five days after egg collection. The day of embryo transfer and the number of embryos to be transferred will be discussed with you. In this procedure the embryo is transferred through the cervix into the uterus via a thin, soft plastic tube guided by sonography. After the transfer, you will be given a course of medication to support the luteal phase.
If there are excess good quality embryos, it is possible to freeze them for a later use.
i. Pregnancy Test
About two weeks after the embryo transfer, you will be given a beta-HCG test to check if gestation has been achieved. If the test is positive, a vaginal ultrasound scan will be performed 1 week later to confirm the pregnancy and view the gestational sac.
If the beta-HCG test is negative, further treatment will depend on whether you have frozen embryos or not.

Risks

• Multiple births. IVF increases the risk of multiple births if more than one embryo is implanted in your uterus. A pregnancy with multiple foetuses carries a higher risk of early labour and low birth weight than pregnancy with a single foetus does.
• Premature delivery and low birth weight. Research suggests that use of IVF slightly increases the risk that a baby will be born early or with a low birth weight.
• Ovarian hyperstimulation syndrome. Use of injectable fertility drugs, such as human chorionic gonadotropin (HCG), to induce ovulation can cause ovarian hyperstimulation syndrome, in which your ovaries become swollen and painful. Signs and symptoms typically last a week and include mild abdominal pain, bloating, nausea, vomiting and diarrhoea. If you become pregnant, however, your symptoms might last several weeks. Rarely, it's possible to develop a more-severe form of ovarian hyperstimulation syndrome that can also cause rapid weight gain and shortness of breath.
• Miscarriage. The rate of miscarriage for women who conceive using IVF with fresh embryos is similar to that of women who conceive naturally — about 15 to 25 percent — but the rate increases with maternal age. Use of frozen embryos during IVF, however, may slightly increase the risk of miscarriage.
• Egg-retrieval procedure complications. Use of an aspirating needle to collect eggs could possibly cause bleeding, infection or damage to the bowel, bladder or a blood vessel. Risks are also associated with general anaesthesia, if used.
• Ectopic pregnancy. About 2 to 5 percent of women who use IVF will have an 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, no matter how the child is conceived. More research is needed to determine whether babies conceived using IVF might be at increased risk of certain birth defects. Some experts believe that the use of IVF does not increase the risk of having a baby with birth defects.
• Ovarian cancer. Although some early studies suggested there may be a link between certain medications used to stimulate egg growth and the development of a specific type of ovarian tumour, more recent studies do not support these findings.
• Stress. Use of IVF can be financially, physically and emotionally draining. Support from counsellors, family and friends can help you and your partner through the ups and downs of infertility treatment.

Success Rate
This depends on various factors like: age of the patient, type and duration of infertility, ovarian response, type of procedure [ fresh or vitrified embryo transfer, self or donor eggs ]. Your consultant will be able to give you a prognosis after proper evaluation. While there is no guarantee, we do our best to ensure you find happiness.

Precautions after an IVF treatment

• Any vigorous exercise, heavy lifting and other activities that involve jarring or potentially jarring movements ( bicycle riding, jogging, skiing, tennis etc. ) are generally discouraged. All routine day to day activities are allowed.
• Take medications as prescribed by the treating doctor as these have been prescribed to improve your chances of achieving pregnancy. If you become pregnant you might be asked to continue some of these medications until the twelfth week of pregnancy, when the body usually starts producing enough.
• Avoid, smoking, exposure to cigarette, alcohol, exposure to X-ray.
• Please consult your doctor before taking any medication.