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IVF

IVF Meaning/ IVF Definition: IVF i.e., In-Vitro Fertilization has proven to be the most effective form of ART (Assisted Reproductive Technology). It includes a complex set of procedures that can be used to get assistance with the conception of a child or to get help with fertility or even to prevent any genetic problems. In this process, eggs that are mature are retrieved from the ovaries and then fertilized with sperm under laboratory settings. These fertilized eggs are then transferred into a uterus. A complete cycle of IVF usually takes around three weeks. Sometimes this process may take a longer time when these steps are split into different parts. IVF can be done with either the couple’s own eggs and/or sperm or with donor eggs and/or sperm. The donor can be a known person an unknown one. At times, in some cases, a gestational carrier can also be used who keeps the embryo implanted in their uterus. The baby produced as a result of an IVF procedure is known as an IVF baby. The chances of you having a healthy IVF baby are dependent on several factors like your age, cause of infertility, health condition, etc. IVF may, therefore, at times, become an expensive procedure and time-consuming process.

Why is IVF done?

IVF has been an effective treatment for many problems related to both, genetic and fertility abnormalities. In cases where IVF is being used to treat infertility, the couple may try other fertility treatments which are less invasive in nature like IUI which is a procedure involving direct releasing of sperm in the uterus using an injection around the time of ovulation. IVF can also be presented as a primary treatment for infertility for women over the age of 40 or in case the person is having any kind of health condition. In both cases, the chances for pregnancy are significantly reduced and hence, IVF, being the most effective treatment, seems to be the best alternative for such cases.

IVF can be used in the following cases/ Indications of IVF:

  • Blocked/ Damaged Fallopian Tube: In case the fallopian tube is either damaged or blocked, the chances for the egg being fertilized get fairly reduced, and even if the egg gets fertilized and becomes an embryo, then the embryo becomes unable to travel in such abnormally functioning embryo
  • Disorders Related to Ovulation: If the ovulation is infrequent (i.e., irregular) or absent, this may lead to fewer eggs being available for fertilization.
  • Endometriosis: Endometriosis refers to the condition in which the uterus-like tissues grow outside the uterus that affects the ovaries, uterus, and fallopian tube functioning. 
  • Uterine Fibroids: As the name suggests, uterine fibroids refer to the condition in which fibroids (benign tumors) are found in the uterus. These fibroids are mostly seen in women belonging to the age group of 30-40. Such fibroids can play a hindering role in the pregnancy as these can interfere with the implantation process.  
  • Tubal Sterilization/ Removal: Tubal sterilization refers to the process in which fallopian tubes are sterilized or removed using surgical intervention. For example, tubal ligation is one such type of sterilization procedure in which fallopian tubes are cut and tied/ blocked, in order to prevent the pregnancy permanently. IVF is the best procedure for people who have undergone tubal sterilization.
  • Compromised sperm production or function: If the sperm is below average in terms of concentration, has poor mobility or has abnormalities in terms of size and shape, then it may be difficult for it to fertilize the egg. If such abnormalities are found in the sperm, you may need to visit an infertility specialist who can then suggest a few alternatives for you that can help you in getting pregnant.
  • Unexplained Infertility: There are also cases where no cause for infertility can be found yet, the person is not able to get pregnant.
  • Genetic Disorders: If either you or your partner are having any genetic disorder then, there are risks of you transmitting the disorder to your child. You can go for pre-implantation genetic testing which involves screening the eggs (after getting fertilized) for any kind of genetic abnormalities. There are, however, conditions/ genetic problems which cannot be found in such tests. Hence, using eggs without any inherited genetic problems is mostly suggested by the doctors which are done by using embryos without any problems.
  • Fertility Preservation for cancer or other conditions: If you are about to undergo treatment for cancer like chemotherapy, you become prone to fertility problems as such treatment can harm your fertility. IVF becomes your best option to consider for preserving your fertility in such cases as the eggs can be harvested and then frozen in an inactive stage for being used in the coming future. These eggs can also be fertilized in form of embryos also if the male is undergoing such treatments.

IVF Risks:

There are also a few risks related to IVF. These risks include the following:

  1. Early or premature delivery: Various researches have found that IVF can cause an increment in the risks of one having an early delivery resulting in the baby being a premature one and hence, being born early and/or having low weight. 
  2. Multiple Births: IVF has also been found to increase the chances of one having multiple births if the number of the transferred embryo is more than one. Such pregnancy involving a multiple number of fetuses increases the risk of abnormal deliveries like premature delivery.
  3. OHS (Ovarian Hyperstimulation Syndrome): There is an increased risk of OHS in the case of individuals where injectable fertility drugs are used to induce ovulation. In OHS, the ovaries can become painful and swollen. These OHS symptoms may persist till a week (typically) including symptoms like mild pain in the abdomen, diarrhea, bloating, and nausea. These symptoms can, however, may stay for a few weeks if you get pregnant. One can, however, experience symptoms like swift weight gain and breath shortness if the OHS gets severe.
  4. Miscarriages: Although, the rate of miscarriage is the same in both natural and IVF pregnancies (15-25%) yet there has been an increased risk of miscarriage seen with advancing age.
  5. Ectopic Pregnancy: 2-5 out of every 100 women who use IVF treatment have been found to have an ectopic pregnancy normally.
  6. Birth Defects: The primary risk factor is the age of the mother when we talk of any birth defects being presented by the child. However, there is a need for more studies to be done to find whether IVF can increase the risk of a baby being with birth defects as compared to a naturally born baby.
  7. Stress: IVF can be a cause of stress also, as for some people, it can be draining in financial, physical, and emotional sense. You should talk/decide with your partner in such cases as the IVF process can be a lot at times when you don’t have someone to talk with.
  8. Egg retrieval complication: In the process of egg collection from the ovaries, there are chances of any damage being caused by the aspirating needle, as a result of which, bleeding and infection cause also be caused in the bladder, blood vessel, etc. There are also other risks involved with the sedatives/ general anesthesia used in this procedure.
  9. Cancer: Earlier studies have found that the drugs used for stimulating the growth of the eggs in the ovulation induction process of IVF have a role to play in the development of certain types of tumors in the ovaries. Although, the recent studies/ findings have rejected this theory.

IVF Process

1) Preparing for an IVF:

Before IVF, you’ll have an evaluation to make sure that your ovaries and fallopian tubes are alright. Pre-cycle testing involves

  • hormonal evaluation is done to test the thyroid functioning and ovarian reserve
  • screening both the partners for any STDs
  • screening for any infections
  • semen analysis to check the semen quality

Most women have to take fertility drugs for ovarian stimulation for 8-14 days. Ovarian stimulation is used for maturing the eggs for good retrieval.  Even if there is normal ovulation, fertility drugs can be used to produce the eggs in number so as to improve the chances of pregnancy. Your healthcare professional will be the one responsible for designing a protocol that aims for obtaining maximum number of eggs while protecting the woman against OHS. She/he then makes sure that the drugs have not caused any abnormality using ultrasound testing. Once, the ultrasound shows you have enough large follicles and you have normal estrogen levels then you will be given a trigger shot of HCG. This replaces the LH (Luteinizing hormone) surge found in the woman naturally that stimulates the final egg maturation stage making the eggs capable of getting fertilized.

2) Egg Retrieval: This includes the surgical removal of the eggs from the follicles in the ovaries. This is performed 34-36 hours after the trigger shot has been given to the woman before the eggs ovulate. For this, an ultrasound is used guiding the small needle through the vagina into one ovary and then the other one. This is done under the effect of general anesthesia. This whole process takes 30 minutes. One may experience minor cramps on the day of the procedure is being carried out which usually goes the next day.

3) Fertilization: Once the eggs have reached the laboratory, they are then examined to determine the quality and maturity. These mature eggs are then arranged in an incubator and fertilized with sperm in just a few hours afterward the egg retrieval process. These eggs can be fertilized using two methods:

  • Conventional Method: For this, the sperm is placed in a culture medium, both of the gametes (egg and sperm) are then kept in an incubator within just a few hours of the egg retrieval process. This duration allows the sperm to enter the egg.
  • ICSI: In this procedure, the best sperm is extracted and then injected using a needle into the cytoplasm. The doctor then checks for the fertilization the next day.

4) Embryo Transfer: This process is done anywhere in 1 to 6 days (usually 3-5 days) after the egg retrieval has been done. However, a biopsy from the embryo would be needed first (mostly done on the 5th or 6th culture day) if genetic testing is to be done. Typically, 3 to 8 cells are sent for the testing while. Once the embryos are frozen results come, the selected embryo is thawed after getting selected and then transferred for maximized success which often results in twins or rarely, triplets. A thin catheter (usually soft and flexible) is used for transferring the embryo into the uterus. Pain and discomfort are witnessed very rarely.

5) Assisted Hatching: At times, this additional process is also used to deliver further assistance for women who are older, for couples who have had failed IVF or frozen embryos experiences in the past. It involves micromanipulation where a hole or crack is made in the stretchy shell which environs the cells of the early embryo. This membrane or shell gets dissolved on its own as this is needed for successful embryo implantation. This is done just before the embryo transfer process.

6) Pregnancy Test: About 12 days later of the embryo transfer process, you’ll be recommended to have a blood pregnancy test which, if confirmed, will be succeeded with other blood tests and then an ultrasound test to check the viability of the pregnancy and to see whether it is a multiple pregnancy. If the pregnancy seems to be a normal one (or even if it’s not), you’ll be referred to your gynecologist.

How to increase chances of success for your IVF:

You can do the following things to increase the possibility of your IVF being a success:

  1. Maintain a healthy weight: Experts say that you should have a healthy weight for your fertility and the IVF also. Studies have found that if someone is obese (having BMI >35), the time taken for their conception is increased by 2 times and if someone is underweight (having BMI <19) then it becomes 4 times. Having abnormal/ unhealthy weight can seriously affect your IVF success rates. Being overweight also makes it very difficult to observe the ovaries during the IVF.
  2. Improve sperm health: You can improve or optimize your sperm health by using multivitamins, having an optimal weight, and exercising.
  3. Find a good doctor and laboratory: You need to have an excellent doctor who will be able to do a good diagnosis and reach a better treatment option/plan for your infertility. Along with that, you also need to have a laboratory which has good equipments so that the readings are accurate.   
  4. Reduce stress: Stress levels can not only affect natural conception rates but even assisted conceptions. Although, reducing the stress seems to be a  very difficult task to do when you are undergoing IVF as it seems to be draining. You should take the help of acupuncture and similar techniques that have been found to reduce the stress levels in an individual.
  5. Quit smoking: Smoking has been found to cause a drastic and decrease in the rates of success for IVFs. This is because of the reason that smoking causes serious effects on your sperm and egg quality.
  6. Take supplements: Taking supplements like DHEA and CoQ10 have shown a positive effect on egg quality as well as quality.

Conclusion:

IVF is a boom for people who, otherwise, would not be able to get pregnant. You just need to have a competent doctor by your side. Searching for “IVF center near me” and “Best IVF hospital in Delhi” does not help. You need to have a doctor/gynecologist who has shown results, who has their fair share of clinical experience to share with you, and who thinks about their patient first unlike most of the others who think about their payment first. IVF can be a draining process itself so you should make sure that the doctor you are consulting does not add as another factor of stress and she/he has been here and done something worth being praised. Dr. Vaishali Sharma is one such highly praised name in the IVF world   

 

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