In Vitro Fertilization is an ART Treatment commonly referred to as IVF. IVF is the process of fertilization by extracting eggs, retrieving a sperm sample, and then manually combining an egg and sperm in a laboratory. The resultant embryo(s) is then transferred to the uterus.
Other forms of ART include gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT).
IVF is suggested to treat infertility in the following patients:
A patient undergoing IVF should call fertility clinic on day 1 or 2 of her period. A medical consultant will advise the patient on instructions as to when to come to the clinic of the first shots of IVF for an Antagonist cycle or visit on day 21 of menstrual cycle in case of a down regulated cycle.
Each patient’s medication plan is individualized, but most IVF regimens include one or more of the following:
Spontaneously a cycling woman will ovulate only one egg each month. To increase the chance of obtaining pregnancy, an effort is made to obtain as many eggs as possible. This goal is achieved by fertility drugs.
GnRH Agonist is used to help create equally mature eggs. Some statistics indicate that GnRH Agonist may be associated with higher success rates and lower IVF cycle cancellation rates.
HMG (Human Menopausal Gonadotropin), is administered through intramuscular injection
This ultra-pure FSH product, is made by genetic engineering. From a treatment point of view, it will be similar to pure FSH in all respects. Staff of our partner facility will advise the patient and her partner to reconstitute the different medications and administer the injections at their places through physicians at their place, if the patient is from out- of- station. Most of the patients and their partners have little trouble getting used to these shots. Placing an ice-pack on the injection site, before and after the injection is administered will help reduce any related discomfort.
The growth and development of the eggs is closely monitored by repeated ultrasound studies and blood tests for hormone levels (Estradiol and Progesterone)
Patients are usually advised to come to our partner facilities for blood tests and sonograms to determine the maturity of their developing eggs beginning on cycle Day 3, 5, 7 or 9. Further monitoring will becarried out as needed until the eggs are determined to be mature. Occasionally, some patients will need daily monitoring near the end of the ovarian stimulation phase of the cycle.
Patients usually have to undergo 2 or 3 blood tests during the course of the monitoring process.
Estradiol (Estrogen) and Progesterone levels are monitored. Estradiollevels allows us to approximate the relative maturity of the eggs. Generally, the tests displays between 100 and 200 units of estrogen for every matured egg. Progesterone tells us if the eggs are becoming overripe, the patient’s progesterone level, which depends on the number of egg follicles created, should generally be below 2 units.
The maturity of the follicles developing in the ovaries is monitored via vaginal ultrasound. During this painless procedure, a radiologist inserts a small probe into the vagina. This enables him/her to visualize the ovaries and the uterus, to evaluate the maturity of the Endometrium (the inner lining of the uterus), and to count and measure the follicles developing in each ovary. A mature follicle measures from 16 to 22 millimetres. An Advance technology of Color Doppler study is used at our partner centres to monitor the blood in the follicle and Endometrium.
When blood tests and sonograms indicate that the eggs are mature(size of 18mm or more), the patient will be administered a final injection called HCG (Human Chorionic Gonadotropin) to complete the maturation process of the egg. The HCG shot must be taken at our partner facility on the date specified, and the retrieval will be scheduled later after around 36 hours after the HCG injection.
(Example: if a patient’s Monday monitoring showed her follicles to be of the appropriate size and her estrogen levels were found to correlate with maturity, she would be instructed to take her HCG between 9:00 PM and 11:00 PM Monday evening. Her egg retrieval will then be performed on Wednesday morning.)
The timing of the retrieval after the HCG injection is very critical, since HCG may cause the egg follicles to release prematurely, making IVF retrieval impossible.
The patient is advised to abstain from solid foods after midnight, prior to the procedure. It is advisable to abstain from sexual activity for two days prior to the procedure to ensure the highest possible sperm count from the male.
The procedure itself is performed at the partner hospital by a Trans-vaginal route. A needle guided by ultrasound imaging, is inserted through the vaginal wall into the ovaries, where the follicles containing the eggs are punctured and aspirated. The released eggs are transferred to the lab where their developmental stage is assessed. General anesthesia is usually used for this simple and minimally invasive day care procedure. The procedure takes about 10-15 minutes and the patient can return home a few hours after it.
Sperm is obtained by natural masturbation in case of no male infertility factor in a semen sample room. It then undergoes a series of lab procedures to prepare it for interaction with the egg.
If the treatment involves treating the “male infertility factor”, i.e. those couples where the male cannot produce good quality sperm in the required concentration. Novel techniques are present through which a single sperm is injected into the egg. This procedure is referred to as ICSI (Intra Cytoplasmic Sperm Injection) and can accomplish fertilization with minimal number of viable sperm. ICSI has been one of the scientific accomplishments of the century and has helped millions of infertile couples from across the globe to become parents.
Eggs prepared for Fertilization are kept in dishes to which sperm is added at the proper concentration. The dishes are kept in an incubator where the environment (temperature, humidity, gas composition) is carefully monitored. In given time intervals the eggs are assessed for fertilization, and subsequent divisions.
The fertilized egg divides into two daughter cells, which continue to divide rapidly. This assessment is based on morphology.
Hence the detailed chromosomal composition of the embryoscannot be addressed without further tests.
Embryos which have satisfactorily divided are transferred to the uterus on day 2-3 (in case of cleavage stage) OR on day 5 or 6 (in case of Blastocyst Stage) after fertilization. This is a painless procedure and does not require sedation or anaesthesia. The embryos are loaded on a small plastic catheter, which is gently introduced through the cervix into the uterus. Once in the uterine cavity, the embryos are gently released and the catheter is withdrawn. The patient can return home after a couple of hours of rest.
Generally, we advise that in days following embryo transfer the patient should refrain from physical exertion, however complete bed rest does is not needed and in-fact maybe counter affective. Just take it as a routine with no physical exertion and hope & pray for good news. Given the nature of cycle stimulation, we prescribe medications to support the young embryos hormonally.
Pregnancy is established by using a sensitive test for Human Chorionic Gonadotropin (HCG), which is the hormone secreted by the placenta. If pregnancy is established, monitoring is continued, until ultrasound imaging allows a direct visualization of the developing fetus and heart beat at day 28 following embryo transfer.
The specific chance of success varies with a number of factors including the indication for the procedure, the patient’s age, the number of embryos transferred and a variety of other such factors. Your chances of success with IVF will be discussed on an individual basis with your fertility specialist post initial assessment and then a decision on the scope of treatment will be derived at.
The success rate with IVF must be viewed considering the natural fertility rate in fertile couples that is approximately only 10% to 25% per ovulation cycle. We advise you to be mentally prepared to undergo at least 3 cycles, so that finally we can ensure you at least 85-90% success rate. Appropriate concessions are given in the financial aspect of treatment if you undertake 3 full cycles