What is IVF?

IVF is the process of extracting eggs from a female, retrieving a semen sample from male and then manually combining egg and sperm in a laboratory dish. The resulting embryos are then transferred into the uterus.

When IVF is needed?

• Blocked or damaged fallopian tubes.
• Women who had their fallopian tubes removed.
• Decreased sperm count or motility. Sperms which are retrieved surgically from testis or epididymis.
• Women with ovulation disorders like a premature ovarian failure, poor ovarian reserve.
• Couples with genetic disorders.
• Unexplained infertility.

What tests are needed before IVF?

There are several factors which may adversely affect the outcome of IVF or pregnancy if not diagnosed and corrected before the procedure. The pre-IVF workup for female partner includes routine health checkup and blood tests, hormonal tests, hysteroscopy and other special tests if needed. For male partner blood tests pertaining to routine health are needed plus a semen examination is done.

What is the process of IVF?

The IVF consists of four basic steps

1. The first step aims at producing a large number of eggs with the help of fertility medicines. As some eggs may not develop after fertilization so multiple eggs are needed. When multiple eggs/embryos are obtained some can be frozen for future purpose. The growth of eggs in ovaries is monitored with the help of transvaginal ultrasound and hormone levels in the blood.
2. Ovum pickup- taking out eggs from ovaries. It is a minor surgical procedure. Under ultrasonographic guidance with the help of fine needles, all the eggs are removed. To reduce pain and discomfort mild sedation or anesthesia is given. A patient may go home after two hours of the procedure. The male partner is asked to produce a semen sample which is then prepared for combining with the egg.
3. Fertilization of eggs with sperm is done by two methods. In Insemination the sperms and eggs are kept together in a dish to facilitate fertilization. However in cases where less number of eggs is retrieved, sperm count is very low, sperms are immotile or large numbers of abnormal sperms are present in semen sample then the process of Intracytoplasmic Sperm Injection is used. The process of fertilization injection of one sperm into the cytoplasm of one egg is called Intra Cytoplasmic Sperm Injection ICSI.
4. Three to five days after fertilization the resulting embryos are placed in the uterus. The number of embryos transferred depends upon a number of embryos obtained and age of female partner. The procedure is again done under the sonographic guidance and is painless. If the procedure is successful the implantation usually occurs six to ten days after ovum pick up. The success of implantation can be determined by blood tests done 12-16 days after embryo transfer.

Side effects and Risks associated with IVF:

• Risks associated with fertility medicines- headache, mood swings, hot flashes, abdominal pain and bloating, OHSS (rare). Ovarian hyperstimulation syndrome (OHSS) causes symptoms like abdominal pain/ bloating, vomiting, decreased urine production, excessive weight gain within 3-5 days, edema etc. Most of the cases can be treated on OPD basis and a few require hospitalization. Only the supportive treatment is needed in OHSS.
• Ovum picks up carries a risk of infection, bleeding, and damage to nearby organs.
• Risk of multiple pregnancies is associated with IVF which may later on increases the risk of preterm birth and prematurity.
• A rate of miscarriages is not increased with IVF. It is same as in general population.
• Risk of ectopic pregnancies (fertilized egg implants outside the uterus) is around 2-5%
• Also, there is significant financial and psychological investment in IVF procedures.

Chances of success with IVF

Conclusion:

The IVF offers the best chance of conceiving to any infertile couple undergoing treatment. All over the world, the success rates of IVF have steadily increased in past years. Also with the advent of newer technologies and better medicines, the side effects associated with IVF are few and mild. As the Informed decision making is an integral part of IVF the couple should undergo IVF after thorough consultation with their doctors.