MotherToBe fertility clinic offers IVF treatment. In IVF (In Vitro Fertilization), the fertility specialist removes eggs from the ovary and fertilizes them with the partner’s sperm, in the laboratory. The eggs and sperm unite and the resultant embryos (fertilized eggs) are then transferred to the uterus.
IVF treatment is recommended for those with:
- Blocked Fallopian tubes
- Unexplained infertility-where routine tests do not indicate any abnormality in the couple
- Male factor severe abnormalities in the sperm parameters including very low sperm count/ motility
- Moderate/severe Endometriosis
- Advanced female age
- Poor ovarian reserve
Process of IVF treatment
In a normal menstrual cycle, only one follicle (sac containing egg) usually reaches maturity and releases an egg each month. However, in an IVF cycle, we aim to stimulate the growth of several follicles so that many eggs are available for fertilization and this increases the chances of success.
Injections called gonadotropins are the most commonly used injections to develop a good number of follicles in the ovary. From the first or second day of periods, they are given daily till the follicles reach a diameter of 18 mm or more. The stimulation injections are usually given for between 10 to 14 days. Some of the injections are given subcutaneously, which means it is injected under the skin and other injections into the muscle.
The most common side effects noted are a little inflammation at the injection site, transient fever and joint pains.
Monitoring Follicle Growth
On average, 3-4 scans will be carried out while you are taking the stimulation injections to monitor the growth and number of follicles in the ovaries. When at least 3 follicles reach 18mm in size, the egg collection procedure can be planned. Monitoring the follicle growth is very important to adjust the dose of medication and also to identify excessive stimulation of ovaries which may result in potentially serious side effect known as ovarian hyperstimulation syndrome (OHSS). Hormonal assays in the blood might be performed if there is evidence of excessive response to guide management.
A drug called Human Chorionic Gonadotropin or HCG is given once the follicles reach the desired size, which is necessary for final maturation of the egg. This injection will trigger the process of final maturation of the egg and the next step i.e. oocyte retrieval is then scheduled at 36 hours after administration of HCG. This injection is given late in the evening 2 days before the day of egg retrieval.
Egg collection procedure
The collected multiple eggs are kept in special culture media in the incubator in the laboratory. The incubator mirrors as closely as possible the body environment in terms of temperature and pH. Most women find the process of egg collection uncomfortable rather than painful. There may be mild cramps (pain) or slight bleeding from the vagina which usually subsides in a few hours. Oral antibiotics are given as prophylaxis against infection. You are allowed to go home 2-3 hours after the procedure.
On the day of egg collection, the husband is required to produce a semen sample by masturbation in a clean wide-mouthed container supplied by the lab. Though a fresh sample of semen is ideal, if the husband cannot be present at the scheduled time a semen sample can be collected in advance and the semen is frozen for use during the IVF treatment.
If the husband has difficulty in producing the sample please inform us in advance so that we will be able to freeze a few samples prior to starting the IVF cycle. This is called back up sperm freezing. The semen sample is processed to obtain a clean concentrated highly motile sperm which is used to inseminate the eggs. It is only necessary to add a relatively small but a decent amount (number) of sperm to inseminate the eggs.
A measured volume of the prepared sperm suspension is added to the dish containing the eggs 3-6 hours after egg collection. The following day the dish is checked for fertilized eggs. They are then placed in fresh dishes of culture medium and replaced in the incubator. ICSI (IntraCytoplasmic Sperm Injection) is a procedure where a single selected sperm is injected into the cytoplasm of the egg to fertilize the egg. This is usually advised for male factor subfertility and in a few other indications as well such unexplained subfertility. Your doctor will advise you if you need this procedure in order to obtain fertilization of the egg.
Embryo transfer (ET), Implantation and Outcome
- ET is carried out on any day, between the 2nd day and 5th day after oocyte retrieval. ET is a simple and straightforward procedure done under aseptic conditions.
- No sedation is required. The embryos are gently placed in the uterine cavity through a fine cannula introduced directly into the uterus via the vagina and cervix.
- Normally 2 -3 embryos are placed in the uterine cavity. You do not need complete bed rest for the following two weeks and you can carry on with your routine activities and regular diet as usual. You are advised not to have sexual intercourse during this period. In order to support conception, progesterone in the form of vaginal gel is given.
- Once the embryos are transferred, it should follow the natural event of implantation. The embryo hatches out of its shell covering (zona pellucida) and implants into the endometrium by burrowing into it. It then continues to develop to the foetus.
- Once implanted, the embryo starts producing the hormone human chorionic gonadotropin (hCG) revealed in a pregnancy test.
- Detection of this confirms the presence of a pregnancy. A blood test indicating Beta hCG levels to confirm pregnancy is done the 12th day after embryo transfer. If Beta hCG is positive we advise you to visit two weeks later for an ultrasound. However, if it is lower than the ideal value, we repeat Beta hCG values to monitor the pregnancy. In cases of a failed outcome, normal menses will usually resume within a day or two after the negative result.
In general, with one cycle of IVF, the pregnancy live birth rate is around 50%. However, the cumulative pregnancy rate after 3 cycles of IVF is very good.
IVF is a multi-step process and couples who are about to undergo IVF have concerns regarding their individual chances of success and here are some factors which influence the success rates!
Female age is the most important factor which influences the success rates of IVF. Female age is an important factor in influencing the chances of natural conception or following any fertility treatment be it IUI or IVF. Though the success rates with IVF is high in women less than 35 years of age, even as women ages the maximum chance of conception is only after following IVF treatment compared to other treatments.
Indication for IVF
Certain indications such as male factor, anovulation (PCOS), tubal disease and endometriosis have better rates of success with IVF compared to couples undergoing IVF due to poor ovarian reserve, unexplained subfertility, problems in both partners such as low sperm count and poor egg reserve, a prolonged period of subfertility and genital tuberculosis.
Women with a history of previous pregnancies, either a miscarriage or ectopic or a live birth in the past seem to have better chances than others indicating successful implantation.
Women with a good number of eggs indicating good ovarian reserve have a better chance of pregnancy compared to others.
Choice of Clinic
One of the most important factors determining the success rate of IVF is the choice of the IVF centre where you choose to have treatment. Proper research with regards to the expertise of the doctor performing IVF and their credentials and training matter most. In addition, the IVF lab has to be state-of-the-art and the expertise of the scientists who perform the procedure is also equally important. Evidence-based treatments along with quality control and witnessing procedures go a long way in making the difference in pregnancy rates between an average clinic and the best one.