In-Vitro Fertilization (IVF)

Tests recommended in Females:

• Ovarian Reserve Testing where a blood test is done to check the levels of Follicle Stimulating Hormone (FSH). This gives information regarding the size and quality of eggs.
• Uterus Examination may be carried out using ultrasound and/or placing a scope through the vagina into the uterus. This tells us the health of the uterus and thereby determine the best way for the implantation of embryos.

Tests recommended in Males:

• Sperm testing by collecting semen sample and analyzing it in a lab. This gives information regarding the number, size, and shape of the sperm. Helps determine whether ICSI (intracytoplasmic sperm injection- direct sperm delivery into the egg) would be required. 

Procedure:

1. Stimulation or Superovulation: Fertility drugs (which contain FSH) are given to increase the number of eggs produced by the body instead of 1 egg per month that happens during the menstrual cycle. The more the number of eggs produced, the higher will be the probability of successful fertilization. Ultrasound and blood tests are done regularly to check the ovaries and hormone levels in your body. Generally, 8-14 days are required for this phase. This may take longer if the follicles take longer to mature

2. Egg Retrieval or Follicular Aspiration: Surgically, a hollow needle is inserted through the vagina into the ovary (through the guidance of ultrasound) and the egg-containing follicle. The egg and the fluid are suctioned out. This step is done to remove the mature eggs which will later be used to combine with the sperm. Anaesthesia/sedation is used during this procedure. Minor cramping may be experienced post the procedure (which usually subsides within a day). Mostly done as an outpatient procedure

3. Insemination: A semen sample will be collected from your male partner on the same day. Sperm from the sample is separated and mixed with eggs in a petri dish. This is done to form the embryo. If the sperm quality is not as per the recommended standards, ICSI (intracytoplasmic sperm injection) may be done to inject the sperm directly into the egg. It usually takes a few hours for the fertilization to occur and post-fertilization they are now called embryos 

4. Embryo Culture and Transfer: Implantation is done using a catheter into the uterus via the vagina and cervix. Embryos are released into the uterus. This step is done to implant the embryo into the uterus and establish a pregnancy. Medication may be administered beforehand to prepare the uterine lining for implantation, done in the doctor’s office and generally, multiple embryos are transferred to improve the probability of implantation of at least one. Usually, takes 3-5 days post fertilization or 6-10 days post egg retrieval phase

5. Pregnancy Test: A blood test is done to determine if the embryo has been implanted into the uterus. This step is done generally 2 weeks post embryo transfer to determine whether pregnancy has occurred.

The total Timeline for an entire cycle is approximately 4 weeks

While IVF is a procedure to conceive a baby, freezing an egg (often termed cryopreservation of egg/oocyte) may also be recommended by your doctor. The eggs are extracted in a similar fashion as steps 1 and 2 mentioned above and frozen with the intention that in the future, the woman may choose to have the eggs thawed, fertilized, and transferred as an embryo to the uterus to facilitate a pregnancy. Clinical trials have demonstrated that the reproductive outcomes are similar after IVF and intracytoplasmic sperm injection (ICSI) with cryopreserved eggs when compared with IVF and ICSI with fresh oocytes.

Cryopreservation of eggs/oocytes is recommended for the following:

• Women with cancer (chemotherapy and radiation treatment can often have a harmful effect on fertility, rendering many of these women menopausal).
• Women who are at risk of early menopause
• Women who have a genetic disorder that could limit fertility
• Women who wish to have children at a later date
• Women who have ethical and moral beliefs regarding freezing extra embryos

Choosing an IVF Clinic: While choosing an IVF is difficult, find below some pointers regarding how to go about choosing an IVF clinic.

Credibility: 

• The clinic should be following guidelines set up by a recognized regulatory authority and the laboratory should be accredited. 
• The physicians should be board certified and qualified in the field

Cost: 

• Overall cost, advance payments required, modes of payment accepted, eligibility, and extent of insurance coverage

Convenience:

• Approximate days regarding work leaves for a working couple
• Any help/assistance/support services that will be provided pre-, during, and post-procedure
• Waiting time to be anticipated during appointments

Procedure details and working modalities

• Number of doctors to be involved
• Whom you should contact if any emergency that happens post-procedure
• How many embryos will be transferred?
• Are the embryos frozen?

It is advisable to seek opinions from more than one doctor before deciding which IVF clinic to go ahead with. 

Questions to Ask Before the Procedure:

• How many embryos/fertilized eggs will be transferred?
• What if the sperm quality is poor?
• What if the eggs are not healthy?
• Is it possible to freeze extra embryos?
• What are the chances of miscarriage/complications after conceiving?
• Expected timeline of the procedure

IVF is an advanced technology that has helped countless couples cope with infertility. The global estimation is that in the past 40 years more than 8 million babies have been born using this technology. 

Side Effects:

1. Immediate:

•  Of Fertility Drugs may include Headache, Mood swings, Abdominal pain, Hot flashes, Abdominal bloating. Rarely can have Ovarian hyperstimulation syndrome (OHSS).
•  Of Egg Retrieval include bleeding, infection, and damage to the bowel or bladder
•  Of Embryo Transfer include multiple pregnancies may occur which may, in turn, increase the chances of premature delivery and low birth rate
•  Procedure-related Side Effects: Fluid discharge (may be clear or blood-tinged), mild cramping, mild bloating, constipation & breast tenderness

2. Side effects that require immediate doctors attention

• Heavy vaginal bleeding
• Pelvic pain
• Blood in the urine
• A fever over 100.5 °F (38 °C)

Risks of IVF Procedure:

• Occurrence of ectopic pregnancy(fertilized egg implants outside the uterus and thus the embryo is not viable): 2-5%
• Nausea or vomiting
• Decreased urinary frequency
• Shortness of breath
• Faintness
• Severe stomach pains and bloating
• 4-5 kg weight gain within three to five days
• Significant financial, emotional and physical commitment on the couple’s part
• Multiple pregnancy and premature deliveries 
• Miscarriage 
• Egg retrieval complications as mentioned above