IVF popularly known as “Test Tube Baby”. In vitro literally means outside human body (i.e. a laboratory dish or test tube).
IVF (In Vitro Fertilisation)
IVF is worldwide known as Test Tube Baby. In vitro literally means in glass (i.e. fertilisation in a laboratory dish outside human body).
For couples, unable to conceive after first line therapy such as ovulation induction, intrauterine insemination, or reproductive surgery the option is In Vitro Fertilization (IVF). IVF can increase the chances of having a baby than the first line treatment.
In IVF process several eggs are retrieved from the wife’s ovaries and then the husband's activated sperm is put all around the ovum in culture media in the controlled environment of the laboratory for fertilisation. The eggs then develop into embryos and then 2-3 embryos are implanted in the wife's uterus, by a procedure called embryo transfer & rest embryos are stored for future use.
IVF may be considered for couples with the following fertility issues:
- Blocked Fallopian Tubes
- Pelvic Adhesion
- Low Sperm Count
- Advanced Female Age
- Poor quality eggs
- Unexplained infertility
IVF may be a good option for women whose ovaries have stopped producing eggs or who have damaged or no ovaries.
IVF Procedure Step by Step:
IVF may seem complicated & frightening to a couple ignorant of the procedure. At our Centre we try to explain the process in a simple way so patients may understand what they are going through. First of all the couple will be counselled & explained thoroughly regarding their treatment plan which is based upon their need. From the beginning till the embryo transfers our Consultant & IVF team will guide you all the way simplifying the procedure by thorough explanation & systematic step by step action plan.
Super Ovulation by Stimulation: In this process called Super-Ovulation the ovaries are stimulated to form multiple follicles by medications & hormonal injections. This is an important process which helps produce good quality multiple ova thus enhancing the chances of conception. Usually one Ovum is formed in a female body in a natural cycle. In this process with the help of fertility drugs the ovary is stimulated to grow more no. of eggs so they may be fertilised in vitro in the lab.
In the Stimulation process hormone injections are used to imitate the hormones released by the body. Before super-ovulation down regulation is conducted to make sure the eggs do not ovulate on their own & to ensure that the eggs at the time of collection are mature.
Benefit: Maturation, collection and fertilisation of multiple eggs at one time increases the chances of pregnancy. Good quality extra embryos can be frozen for use in future IVF cycles.
Ovum Pickup: This is a significant step of the IVF process requiring skill & precision. Through close monitoring, once the eggs are mature dose of Human Chorionic Gonadotropin(hCG) is given to trigger the ovulation and after 36 hours the Ovum Pick up is done. Then the Eggs(Ova) are retrieved by needle aspiration guided by ultrasonic imaging with the help of Trans Vaginal Sonography under anaesthesia. The eggs obtained are immediately placed in a culture dish containing nourishing culture media. One to two hours after the egg retrieval the patient may go home.
Fertilisation: Fertilization is the process of sperm penetrating the egg. On the morning of Ovum Pick up Semen collection of the husband is done, the sperm cells are separated from the seminal fluid, washed & enhanced in culture media. Then one million of highly motile concentrated sperm is put all around each ovum in culture media. Each dish is placed inside the CO2 Incubator for fertilisation to occur. Next day these dishes are checked for evidence of fertilisation, successfully fertilised eggs are identified at this stage and restored in the incubator.
Once fertilisation takes place, cell division begins. The fertilized egg is called an embryo. The embryos are checked at regular intervals to monitor proper cell division (cleaving).
Embryo Transfer (ET): Embryo Transfer is a delicate procedure, done with care. At our Centre Embryo transfer is done between day 2 to day 3 depending upon number and quality of embryos available. The embryos are implanted gently into uterus using a soft thin canulla through the Cervix. The best quality embryos are selected for embryo transfer based on formation, size & growth. It takes us at least 10 minutes to do each embryo transfer. Generally 2 to 3 embryos are transferred and rest embryos, are preserved for future use with patient's consent. This procedure does not require anaesthesia, patient may go home 1 hour after the procedure.
After the transfer, in order to improve implantation of embryo in uterus, pure progesterone is given as luteal support in the form of vaginal tablets or injectables along with other medications. The patients are advised to take it easy for next 14 days with restriction on strenuous activities.
Result: The outcome of any IVF (In Vitro Fertilization) cycle will always be uncertain. While embryos are made in the lab and then transferred, whether they implant successfully is in God's hands.
Blood test for beta HCG is performed to confirm pregnancy approximately 14 days after embryo transfer to measure the amount of HCG as this help in detecting pregnancy. If the pregnancy is detected an ultrasound scan is done after one month for confirmation of normal pregnancy & no. of foetus.
If you are pregnant, progesterone treatments will be continued for a period of time. Also you will need regular Obstetric checks for complete prenatal care.
In case of failure or pregnancy has not taken place, all medications are stopped and cycle is ended. If you want to opt for another cycle, it is advisable to wait for one to two months and then start fresh treatment. This allows you time to recuperate and also gives us time to review our treatment plan for you in detail and if required do some changes. Also in case you have decided to freeze the extra embryos which we suggest our patients, the ovulation induction phase will not be required in the consequent IVF cycles.
Risks: Multiple Pregnancies can be a complication of IVF as during IVF, 2-3 good quality embryos are transferred for better success. OHSS may be another complication.
Success Rate (Take Home Baby Rate) is about 30-40% per cycle in most of the centres, but in our centre is more than 50% per cycle.