July 19, 2018
In Vitro fertilization (IVF) is one of several assisted reproductive techniques (ART) used to help infertile couples to conceive a child. If after one year of having sexual intercourse without the use of birth control a woman is unable to get pregnant, infertility is suspected. Some of the reasons for infertility are damaged or blocked fallopian tubes, hormonal imbalance, or endometriosis in the woman. In the man, low sperm count or poor quality sperm can cause infertility.
IVF is one of several possible methods to increase the chance for an infertile couple to become pregnant.
Success rates vary widely between clinics and between physicians performing the procedure and implantation does not guarantee pregnancy. Therefore, the procedure may have to be repeated more than once to achieve pregnancy. However, success rates have improved in recent years.
Dr Devika Gunasheela, director of the very reputed Gunasheela Surgical & Maternity Hospital, Bengaluru, answers Frequently Asked Questions (FAQs) on IVF.
What is Assisted Reproductive Technology [ART]?
A: ART includes all fertility treatments in which both eggs and sperms are handled. In general, ART procedure involves eggs retrieval from the ovaries, combining them with sperm in the laboratory and returning them to uterus.
What is IVF?
A: In IVF procedure eggs are combined with partner’s sperm in a laboratory dish, once fertilized, resultant embryos are transferred into uterus in hope for implantation.
What is ICSI?
A: Intracytoplasmic sperm injection is a procedure where a single sperm is injected into an egg with the help of micromanipulator instrument, and once fertilized embryos are placed into uterus.
When should one consider IVF?
A: Following are the indication for IVF consideration.
• Tubal problem
• Male factor
• Uterine problems
• Unexplained infertility
• Previous IUI failure
• Ovulatory problems
• Antibody problems that harm sperm or eggs
• Cervical inhospitality
What is the procedure steps involved in an IVF cycle?
A: These are the basic five steps of an IVF cycle.
• Ovulation induction: Injectable medicines is used to stimulate development of multiple mature follicles
• Egg retrieval: When the follicles are mature, the egg aspiration procedure is performed to remove the eggs. An ultrasound guided vaginal aspiration with special ovum pick up needle is simple and easy procedure.
• Fertilization and embryo culture: sperms are either mixed or injected into an oocyte on various times interval, depending upon the maturity of the oocyte. The resultant embryos are cultured for 3 or for 5 days.
• Embryo transfer: With the help of embryo transfer, catheter embryos are delicately transferred near the top of the endometrial cavity.
• Pregnancy test: About 11 days after embryo transfer a blood test is done for pregnancy hormone.
Are the procedures involved in IVF painful?
A: Pre-cycle tests are some of blood test, and scanning which can be done at any infertility clinic with minimal discomfort. Once you are already to start the IVF process you have to take few medicines and injections. Injections are administered subcutaneous with a short needle and discomfort should be tolerable. Only progesterone injections are given intra muscularly.
The main procedure involved in IVF is the egg retrieval and this is performed through the vagina with ultrasound and a fine needle. Patients at our center are asleep during this procedure and are cared for by a team of anesthesiologists. Patients have no pain with this procedure and they wake up very quickly with the egg retrieval lasting 20-30 minutes. The embryo procedure is again a very simple one. A very light anesthesia is required when there are specific problems with the cervix.
When will my egg retrieval be scheduled?
A: The exact date of egg retrieval will not be known until two days prior to the procedure. It is estimated to be about 12-14 days from the start of your IVF cycle.
How successful is in vitro fertilization?
A: The chances of successful pregnancy with in vitro fertilization are directly related to the age of the woman who provides the egg. Most in vitro fertilization programs divide their success rates according to age. For example, clinics will report pregnancy rates for women under and over the age of 35 years. There is certainly deterioration in the quality of eggs from the mid-thirties onwards.
Success rates are further influenced by the number and quality of eggs that are retrieved from the ovary, by the quality of the uterus, including the endometrial lining and the presence or absence of uterine fibroids, by the number of embryos that are transferred and also by maternal weight. Obviously, there are patients in all categories who may have poorer chances of pregnancy success than others of equivalent age. Such patients would include those with a history of previous in vitro fertilization failures, as well as those with limited ovarian reserve and other pelvic factors such as uterine fibroids and tubal disease or endometriosis.
What side effects can I expect on the IVF medications?
A: The fertility drugs used do not seem to cause direct side effects, and the side effects are therefore related to the actual effects that these drugs have on the ovaries. As the ovaries begin to swell, there can be some pelvic and abdominal bloating. Some women do experience minor mood changes, headaches and nausea – although all of these are uncommon.
What treatment options are available for women over the age 40?
A: When the egg provider is over the age of 40 years, the chance of success using her own eggs decreases significantly, as we approach the age of 43/44. Between the ages of 40 and 42, the chances for successful pregnancy per cycle are around 30% if three embryos are available for transfer. By the age of 43 to 44, the chance of pregnancy falls to about 10 %. There is also a significantly increased risk of miscarriage, approaching 50%- 75% by the time someone is 43 years old. In vitro fertilization with egg donation is an option for all patients when egg production or embryo quality appears to be a major factor. This is especially relevant for patients over the age of 40 with decreased ovarian reserve.
Is there a higher risk of birth defects with a child born from IVF?
A: The simple answer is no. Children born from IVF are no more inclined to any particular birth defect than those conceived naturally.
Dr Devika Gunasheela
MRCOG (Lond.) Fellow in Reproductive Medicine (RGUHS),
Director - Gunasheela Surgical & Maternity Hospital
No. 1, Dewan N Madhava Rao Road,
Basavanagudi, Bengaluru – 560 004
Ph: (080) 26673585 / 41312600