In Vitro Fertilization

IVF is one of the most common and effective ART techniques. It involves the fertilisation of eggs outside the body. A couple facing infertility for years can opt for this method at a clinic or hospital that specialises in IVF. The reproductive endocrinologist (hormones specialist), embryologist and nurses at the clinic coordinate with the couple to start the process. 

The woman is usually given medications to regulate her menstrual cycle and to maximise the production of eggs or oocytes. Once the woman is ovulating, her eggs are extracted and so is a sperm sample from the man. The egg and the sperm are manually combined in a laboratory, and once fertilisation occurs and an embryo is formed, the embryo is put back in the uterus of the woman to get implanted.

If the implantation is successful, the embryo will gradually mature into a foetus and then a baby. (Note: light implantation bleeding occurs in some cases, and is nothing to worry about.)

If the implantation is unsuccessful, which is quite likely, the process will have to be attempted again. This is why most clinics procure multiple eggs and enough sperm samples so as to fertilize the embryo and freeze it in case it’s needed. Many clinics also insert multiple fertilised embryos into the woman’s uterus in the hope that implantation will occur with at least one. This also increases the chances of twin pregnancy or multiple births through IVF.

If the couple does not have viable eggs or sperm, they can check if donor eggs and sperm are available. If the woman’s uterus is inhospitable and cannot support fetal development, then the couple can check if surrogacy is a viable option. It’s important to keep a track of donor and surrogacy laws in the country if you’re choosing either of these options.

Read more: Best time to get pregnant

There are strict guidelines for who can access IVF to have a baby, and which clinics can offer this type of treatment all over the world. You should consult the reproductive laws of India and consult your reproductive endocrinologist to find out if you are eligible. If your doctor feels that your infertility can be treated by cheaper and less intensive means, you can opt for those treatments. Medically, IVF is recommended to patients who have infertility due to the following causes:

• Blocked or damaged fallopian tubes
• Male factor infertility: decreased sperm count and low sperm motility
• Ovulation disorders or premature ovarian failure
• Uterine fibroids
• Women who have had fallopian tubes removed due to untreated pelvic inflammatory diseases, chlamydia, endometriosis, etc.
• Genetic disorders
• Unexplained infertility

Read more: Semen analysis test

The entire process of IVF can take a month or two. The process is done in different stages, and it includes a few invasive procedures that the woman has to go through. According to the American Pregnancy Association, the following five steps are involved.

• Step 1: Fertility medications are prescribed to the woman to stimulate the production of eggs. This is done because using just one egg might not be enough for successful fertilisation. Once the woman starts taking fertility medications, the growth of eggs in the ovaries is monitored through a transvaginal ultrasound and blood tests are done to monitor the hormone levels.
• Step 2: A minor surgical process is done to retrieve the eggs:
  • Medication is given for managing the pain and discomfort that the woman might experience during the procedure.
  • Then, a hollow needle is inserted into the pelvic opening, guided to the ovaries using ultrasound imaging, and the eggs are removed.
• Step 3: The man is asked to give a sperm sample, which is then prepared to be combined with the eggs.
• Step 4: This step is also called insemination, and as indicated, the eggs are mixed with the sperm in a petri dish to encourage fertilisation.
  If the chances of fertilisation are considered to be too low, then the sperm is directly inserted in an egg in a process called intracytoplasmic sperm injection.
  The eggs are closely monitored to see if fertilisation occurs and cell division starts. Once the fertilisation occurs, the eggs are called embryos.
  Next, genetic testing is done at this stage to determine the chances of the embryo surviving and maturing without any risks of genetic defects. Some clinics also specialise in this.
• Step 5: The embryo is placed in a catheter or small tube, and then inserted into the uterus of the woman. This process usually takes place within three to five days of egg retrieval and fertilisation and should be painless. Some women, however, may experience some pain.

If the entire process is successful, it can take a few more days for the embryo to attach to the uterus. The embryo gets implanted in the uterus within six to ten days since the egg was harvested. A beta hCG test or pregnancy test is usually given after two weeks to confirm if the pregnancy is positive.

Read more: Sperm DNA fragmentation test

Since IVF involves five different steps or stages - and the woman has to go through a medication routine and two procedures - there may be different side-effects for each of them. The following are some side-effects of the hormone medications prescribed to women:

• Headache
• Mood swings
• Abdominal pain
• Hot flashes
• Bloating
• Ovarian hyperstimulation syndrome (OHSS): A painful condition in which the ovaries become swollen, OHSS can have further symptoms like:
• Tenderness in the area around the ovaries
• Nausea and vomiting
• Rapid weight gain
• Severe stomach ache and/or tightness in stomach
• Less frequent urination
• Shortness of breath

The following are some known side-effects of the IVF procedures:

• Discharge of clear or blood-tinged fluid after the procedure
• Mild cramping
• Mild bloating
• Constipation
• Breast tenderness

Some side-effects can be potentially dangerous and can lead to complications. If any of the following side-effects show up, visit the doctor immediately:

• Heavy vaginal bleeding
• Pelvic pain and severe abdominal cramps
• Blood in urine
• A fever of over 100.5 degrees Fahrenheit or 38 degrees Celsius

The success of IVF depends on many factors, including the age of the woman, medical and reproductive history, causes of infertility and lifestyle factors. While these determine the rate of successful pregnancies through IVF, they do not account for the rate of successful births.

According to the UK-based Human Fertilization and Embryology Authority (HFEA), the following are the success rates of IVF based on maternal age:

• Women under 35 years: 29%
• Women between 35-37 years: 23%
• Women between 38-39 years: 15%
• Women between 40-42 years: 9%
• Women between 43-44 years: 3%
• Women over 44 years: 2%

There is a common misconception that bed rest after an IVF procedure increases the chances of pregnancy. Research has disproved this idea: while doctors discourage any activity that could cause a jerk to your body - like walking or running on a potholed street - they say that it is absolutely safe to continue working and going about the daily chores.

We all know that IVF does not necessarily result in a successful pregnancy. But what most people do not acknowledge is that it is also physically, emotionally and financially draining. This is the reason why many couples are also offered counselling along with the IVF treatment - so that they can deal with it better.

Apart from this, there are many risks involved in the IVF procedures themselves, and the pregnancy resulting from them can also have complications. The following are some of the major risks associated with IVF:

• The egg retrieval process can cause bleeding, infections and injury to abdominal organs like the bladder and bowels, etc.
• Twins and multiple pregnancies are more common, which can lead to premature labour and low birth weight (under 2.5 kilograms), etc.
• Higher rates of miscarriage, due to advanced maternal age.
• 2-5% risk of ectopic pregnancy, where the implantation of the embryo occurs somewhere other than the uterus.
• Ovarian hyperstimulation syndrome (OHSS) can occur as a result of hormonal therapy.
• Depression, stress and anxiety in case of failure of IVF procedures, especially after multiple attempts.

IVF treatment, whether in India or abroad, is quite costly because there are advanced technology, endocrine specialists and experts like embryologists involved in the process. Yet, the process is comparatively cheaper in India, where the cost ranges from Rs 1.25 lakh to Rs 2.5 lakhs for each round of IVF.

However, this amount is not easy to access for all, so many couples resort to taking loans in the hopes of having a child. This is also because general health insurance does not always cover the expenses of IVF. Currently, only some schemes like the Bharatiya Mahila Bank’s Nirbhaya scheme cover procedures like hormone assessment, basic fertility testing, operation expenses and anaesthetic procedural charges.

The age of the expecting mother is an important factor in the success of IVF, of course. But what is just as important as this is the quality of the eggs - this quality also tends to deteriorate with age. For this reason, doctors say that women who may want to have children in later years can opt to freeze their eggs for IVF in the future.

Eggs and sperms can also be frozen in cancer patients before they undergo chemotherapy or radiation therapy. This improves their chances of becoming parents later in life - if they choose.

Watch our video interview with a leading IVF specialist, to know the answer to most frequently asked questions about fertility.

IVF (टेस्ट ट्यूब बेबी) कराने से पहले ये 7 ज़रूरी बातें जान लें

	Dr. Archana Nirula
	December 24, 2019