What is an IVF (In Vitro Fertilization)?
Millions of couples worldwide experience difficulties in conceiving naturally. Although this number has risen overtime, the cases of successful Assisted Reproductive Treatments have also increased. In Vitro Fertilization (IVF) is one such procedure that has helped several couples become parents. One of the most effective forms of assisted reproductive technology (ART), IVF is a series of procedures used to treat fertility or genetic problems and assist couples with the conception of child. In cases where the couple is unable to conceive naturally, the fertility specialists retrieve the eggs and sperms and fertilize them manually outside the human body. The fertilized egg after few days of monitoring is implanted in the woman’s uterus to ensure a successful pregnancy. To help increase the chances of success for the couple, the fertility specialists fertilize more than one embryo during an IVF cycle, allowing selection of the genetically healthiest embryo to be transferred in the uterus. However, the chances of a successful conception and a healthy baby through IVF depends on several other factors as well, such as age, cause of infertility, number of previous cycles, etc. In cases where eggs or sperms cannot be retrieved from the couple or are of poor quality, the procedure can also be performed using eggs or sperm of a donor, whose details are maintained confidential for the benefit of both patient and the donor.
Who should undergo an IVF treatment?
This IVF Fertilization treatment procedure is best suited for couples with:
- Fallopian tube damage or blockage
- Ovulation disorder
- Premature ovarian failure
- Uterine fibroids
- Previous tubal sterilization or removal
- Impaired sperm production or function
- Unexplained infertility
- Genetic disorder
- Fertility preservation for cancer or other health conditions
The IVF Journey to a Successful Conception
- Consultation, pre-treatment testing & regularization of menstrual cycle
- Preparing ovaries for producing several eggs
- Ultrasound and hCG injection for final maturation of eggs
- Collecting eggs and sperms
- Fertilization inside the laboratory
- Transfer of embryo into the uterus
- Tests to check the status of conception/pregnancy
Some women can’t use their own eggs for fertility treatment. Therefore, in that case, they might consider using an egg donor. Our egg donors are women who like to make a difference and choose to support those who need extra help starting or growing their family – and they are women just like you.
What does Egg Donation Involve?
A Female egg donation has now gained popularity in India. Here are the steps that are involved in the donor egg IVF done at the reproductive fertility center:
- Medical assessment
- Support and counselling
- Beginning the process
- Giving consent
- Egg collection
- After donation formalities
- Techniques that are routinely used in IVF include
- Controlled ovarian hyperstimulationto retrieve multiple eggs,
- Ultrasound-guided transvaginal oocyte retrieval directly from the ovaries,
- Egg and sperm preparation, as well as culture and selection of resultant embryos before embryo transfer back into the uterus
Protocols of IVF:
- There are two current main protocols for stimulating the ovaries for IVF treatment.
- The long protocol involves downregulation (suppression or exhaustion) of the pituitary ovarian axis by the prolonged use of a GnRH agonist.
- Subsequent ovarian hyperstimulation, typically using follicle stimulating hormone (FSH), starts once the process of downregulation is complete, generally after 10 to 14 days.
- Antagonist protocol: Prompt downregulation by supressing LH
Final maturation and egg retrieval:
- When the 2-3 ovarian follicles have reached 16-18mm size,induction of final oocyte maturation is performed, by an injection of human chorionic gonadotrophin (HCG). Commonly, this is known as the "Trigger Shot".
- HCG acts as an analogue of lutenizing hormone,
- Egg retrieval is performed at a time usually between 34 and 36 hours after HCG injection, that is, just prior to when the follicles would rupture.
- This avails for scheduling the egg retrieval procedure at a time where the eggs are fully mature.
- The eggs are retrieved from the patient using a transvaginal technique called transvaginal oocyte retrieval, involving an ultrasound-guided needle piercing the vaginal wall to reach the ovaries.
- Through this needle follicles can be aspirated, and the follicular fluid is passed to an embryologist to identify ova.
- The retrieval procedure usually takes between 20 to 40 minutes, depending on the number of mature follicles, and is usually done under sedation or general anaesthesia.
Egg and sperm preparation:
- In the laboratory, the identified eggs are stripped of surrounding cells and prepared for fertilisation
- An oocyte selection may be performed prior to fertilisation to select eggs with optimal chances of successful pregnancy.
- In the meantime, semen is prepared for fertilisation by removing inactive cells and seminal fluid in a process called sperm washing.
- The sperm and the egg are incubated together at a ratio of about 75,000:1 in the culture media for about 18 hours.
- In most cases, the egg will be fertilised by that time and the fertilised egg will show two pronuclei.
- Typically, embryos are cultured until having reached the 6 to 8 cell stage three days after retrieval.
- In many Canadian, American and Australian programmes however, embryos are placed into an extended culture system with a transfer done at the blastocyst stage at around five days after retrieval, especially if many good-quality embryos are still available on day 3. Blastocyst stage transfers have been shown to result in higher pregnancy rates.
- In Europe, transfers after 2 days are common.
- Laboratories have developed grading methods to judge oocyte and embryo quality.
- In order to optimise pregnancy rates, there is significant evidence that a morphological scoring system is the best strategy for the selection of embryos.
- The number to be transferred depends on the number available, the age of the woman and other health and diagnostic factors.
- The embryos judged to be the "best" are transferred to the patient's uterus through a thin, plastic catheter, which goes through her vagina and cervix.
- Several embryos may be passed into the uterus to improve chances of implantation and pregnancy.
Complications in the IVF Procedure:
- Ovarian hyperstimulation
- During egg retrieval, there’s a small chance of bleeding, infection, and damage to surrounding structures like bowel and bladder (transvaginal ultrasound aspiration)
- During embryo transfer, if more than one embryo is transferred there’s always a risk of multiple pregnancy,
- Ectopic pregnancy may also occur if a fertilised egg develops outside the uterus, usually in the fallopian tubes and requires immediate destruction of the foetus.