In Vitro Fertilization: IVF

In Vitro Fertilization (IVF): What Is It? In Vitro Fertilization is an assisted reproductive technology (ART) 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 dish with hope that sperms will fertilise oocytes. The embryo(s) is then transferred to the uterus. It requires highly specialised laboratory which maintains temperature, humidity, clean air with oxygen, carbon dioxide and nitrogen concentration as per human body.

Why is IVF used? IVF can be used to treat infertility in the following patients:

Blocked or damaged fallopian tubes

Male factor infertility including decreased sperm count or sperm motility

Women with ovulation disorders

Premature ovarian failure

Uterine fibroids

Women who have had their fallopian tubes removed or ligated for family planning operation

Individuals with a genetic disorder

Unexplained infertility

What is involved with IVF? There are five basic steps in the IVF and embryo transfer process:

Step 1: Fertility medications (Injections) are prescribed to stimulate egg production from day 2 of your menstrual cycle. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. A transvaginal ultrasound is used to examine the ovaries, and blood test samples are taken to check hormone levels. After 10 - 12 days of injections, last injection is given which is called Ovulation Trigger.

Step 2: Between 32 - 36 hours of ovulation trigger eggs retrieval is done. Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity to remove the eggs. This procedure is done under short general anesthesia.

Step 3: The male is asked to produce a semen sample, which is prepared for combining with the eggs.

Step 4: In a process called insemination, the sperm and eggs are mixed together and stored in a laboratory dish to encourage fertilization. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.

Step 5: The embryos are usually transferred into the woman’s uterus three to five days following egg retrieval and fertilization. A catheter or small tube is inserted into the uterus to transfer the embryos. This procedure is painless for most women, although some may experience mild cramping. If the procedure is successful, implantation typically occurs around six to ten days following egg retrieval.

Side effects of in vitro fertilization

Although you may need to take it easy after the procedure, most women can resume normal activities the following day.

Some side effects after IVF may include:

Passing a small amount of fluid (may be clear or blood-tinged) after the procedure

Mild cramping

Mild bloating

Constipation

Breast tenderness

If you experience any of the following symptoms, call your doctor immediately:

Heavy vaginal bleeding

Pelvic pain

Blood in the urine

A fever over 100.5 °F (38 °C)

Some side effects of fertility medications may include:

Headaches

Mood swings

Abdominal pain

Hot flashes

Abdominal bloating

RARE: Ovarian hyper-stimulation syndrome (OHSS)

What are the risks associated with in vitro fertilization? As with most medical procedures, there are potential risks. The most dreaded one is Ovarian Hyperstimulation Syndrome (OHSS). More severe symptoms, typically from OHSS, include the following:

Nausea or vomiting

Decreased urinary frequency

Shortness of breath

Faintness

Severe stomach pains and bloating

Ten-pound weight gain within three to five days

If you experience any of these symptoms above, contact your doctor right away.

Additional risks of IVF include the following: Egg retrieval carries risks of bleeding, infection, and damage to the bowel or bladder. The chances of a multiple pregnancy is increased with the use of fertility treatment. There are additional risks and concerns related to multiple pregnancy including the increased risk of premature delivery and low birth weight. Though the rate of miscarriage are similar to unassisted conception, the risk does increase with maternal age. The Mayo Clinic reports that the risk of ectopic pregnancy with IVF are 2-5%. An ectopic pregnancy is when a fertilized egg implants anywhere outside the uterus and is not viable. Assisted reproductive technology (ART) involves a significant physical, financial, and emotional commitment on the part of a couple. Psychological stress and emotional problems are common, especially if in vitro fertilization (IVF) is unsuccessful. IVF is expensive, and many insurance plans do not provide coverage for fertility treatment.

How successful is in vitro fertilization? The success rate of IVF clinics depends on a number of factors including reproductive history, maternal age, the cause of infertility, and lifestyle factors. It is also important to understand that pregnancy rates are not the same as live birth rates.

What if I don’t produce healthy eggs or my husband is sterile? You may choose to use donor eggs, sperm, or embryos. However, make sure to talk with a counselor experienced with donor issues. You will want to be informed about various legal issues related to gamete donation including the legal rights of the donor.

How many embryos should be created or transferred? The number of embryos transferred typically depends on the number of eggs collected and maternal age. As the rate of implantation decreases as women age, more eggs may be implanted depending on age to increase the likelihood of implantation. However, a greater number of eggs transferred increases the chances of having a multiple pregnancy. Make sure to talk with your doctor before the procedure so you both agree on how many embryos to implant. We usually transfer 2-3 embryos.