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All about In Vitro Fertilization
In Vitro Fertilization (IVF), the most common and effective type of Assisted Reproductive Technology (ART) is a treatment to cure infertility in which oocytes i.e. a woman’s eggs are made fertilized by man’s sperm in a Petri dish. After fertilization, it is then transferred into the woman’s uterus in hope that the implantation will be followed by a healthy pregnancy.
When and who should consider In Vitro Fertilization?
This process is usually opted by the couples who have-
- Blocked or no fallopian tubes.
- Serious male infertility issues including low sperm counts, low sperm motility or the sperms need to be extracted from the testicles surgically.
- Advanced reproductive age makes conception time-critical and pregnancy rates become low even with other therapies.
- Couples going through other causes of infertility including PCOS, endometriosis, ovulation disorders and unexplained infertility and when these are unable to be treated with other treatments.
- When suffering from severe diseases like cancer, and need to preserve fertility.
- When couples wish to avoid genetically inherited diseases to be passed on to their offspring, in such cases, IVF procedure is combined with Pre-implantation genetic diagnosis, which means the embryos or sometimes the eggs directly are tested for the disease to be diagnosed and only the ones who are diagnosed disease free are then transferred into the uterus.
- Ovarian failure, though donor eggs are a must in this case. Though IVF has a high rate of success in helping couples building families as compared to the other techniques but it also possess chances of multiple gestations of bearing twins or triplets. Women who are thinking to opt for IVF should discuss all of their doubts with their healthcare provider be it the risks, benefits, after transfer precautions, procedure and alternatives before the treatment begins.
So, where do you begin your Eggs-perience?
The first thing you need to do is to get a referral from a general practitioner for both of you to see your desired fertility specialist or clinic. Your first consultation will include a complete history of your journey so far, including your trying period, menstrual cycle, medical, surgical and gynecological details. Also, questions about habits like smoking, drinking, etc. to gain insight on your current fertility status. After taking in all the information, your fertility specialist will conduct several infertility tests for the problems which have been unknown for long and potentially interfering with conception.
Path to Infertility Treatment- Types of Tests involved-
The very first fertility test would be a simple blood test for the couple followed by a number of tests, including antenatal testing, Anti-Mullerian Hormone (AMH), hormonal profile, including (pituitary, ovaries and thyroid) and karyotype (checking chromosome-genetic material) to check whether the number of chromosomes is correct and sequenced in the right order. Additionally, your doctor will go with a pelvic ultrasound to know about the structure of the pelvis, uterus, how they look, about ovaries and their positioning and also, if there are any other complications that require further investigation. Neither of the mentioned tests is painful but may be uneasy. Also, the male partner will undergo a semen analysis test during this infertility treatment.
Follow up consultation
Two weeks post initial consultation, with all the required tests done, you will have to visit your doctor for follow up. Based on your results, your doctor will formulate the most appropriate treatment plan, best suited to your situation. Depending on the individual circumstances, treatment will begin on the first day of your period, whether you are going ahead with ovulation tracking, IVF treatment in Aligarh or IUI. The first day of the menstrual cycle is a sign to commence the treatment.
Procedure of In Vitro Fertilization step by step-
The IVF Procedure is as follows-
- Education and Information
- Ovary Stimulation
- Egg Retrieval
- Embryo Transfer
After all the initial practices done, the IVF treatment will be followed. The first injection is an FSH injection which stands for Follicle Stimulating Hormone and as the name says, it exactly stimulates the ovaries to create follicles. Follicles are sacs filled with fluid and contain eggs. In natural conditions, only one egg is produced every month but during IVF procedure in Aligarh, it produces more than one. You, yourself will administer these injections for the next five days and share how your body responded to these injections with the doctor so as to avoid under or over stimulated ovaries, based on which the doses will be increased or decreased.
If you are on the right track with your injections, you will have a follow up ultrasound scan and blood test to confirm your body following the right direction for your IVF cycle. Your eggs will be counted so as to make sure that they are growing at a good rate and size. Once the favorable conditions are attained, you will then receive Trigger injection which makes the eggs mature and ready to be collected.
After two days, the next part of treatment i.e. egg collection will be carried out. This process takes around 5-10 minutes in which you will be completely asleep when your IVF specialist using a small needle, will drain the follicles guided by an internal scan. These follicles will be immediately transported to an embryologist, who after counting the number of eggs in the fluid; will prepare them for fertilization with your partner’s or donor’s sperm in a dish.
The following day, the embryologist will look for the fertilized eggs. The fertilized eggs develop in an incubator over a 5 day period where they will hopefully divide and grow into Blastocysts. A Blastocyst is the optimal stage of embryo development in which ‘blast’ stands for ‘making’ and ‘cyst’ stands for ‘a pool’, which mimics a visual of this stage of development essentially.
After 5 days of egg collection process, the best suited embryo will be transferred in the uterus via a very fine catheter through the cervix. At this stage, you would ideally have a few embryos to choose between and this would be approximately 19th day of your IVF cycle. This decision would be monitored by a scientist and your IVF specialist.
How many embryos to transfer?
The number of embryos to be transferred completely depends on to the situation and the woman or the couple’s preferences, the history of their previous pregnancies and miscarriage, the age of the woman, and the quality of embryos. Woman under age 35 are usually encouraged to have only one or two embryos transferred during their first IVF cycle. If multiple attempts of IVF are unable to help in attaining pregnancy then a physician may recommend transferring more than one or two embryos to increase the chances of bearing pregnancy. Although, this also increases the risk and chances of multiple births.
Among women over the age of 40 years, Implantation rate becomes lower, due to which more number of embryos is usually transferred in this age group of women. Although, older women who are being transferred upon with eggs from younger donors, have the same implantation rate as younger women and the same are generally recommended to transfer not more than one or two embryos.
Storage of unused embryos-
A process in which the remaining embryos that are not transferred are stored by freezing them and this is known as cryopreservation. There is no difference between the chances of successful pregnancy from both frozen and fresh embryos.
There is no time limit for the remaining embryos to be cryopreserved. However, many couples are recommended to choose among one of these following options-
- Transfer the embryos at a later stage whenever needed.
- Donate the freezed embryos for research purpose
- Donate them to be used by another couple
Pre-Implantation Genetic Testing of Embryos-
There are times when both male and female partner may find that they are carriers of a gene for a disease that may be passed into their offspring. For example, if both the parents have genes for sickle-cell anemia or cystic fibrosis, each of their offspring will have a 1:4 chance of inheriting the genes and acquiring the disease. In such cases, couples often choose to have tested their embryos to find out whether the embryos have the disease prior transfer and then only transfer the ones who are disease free whereas, in other instances, the chromosomes of the embryo may be tested in an attempt to decrease the chances of chromosomal abnormalities including Down syndrome and a few others.
Patients need to understand it carefully and should be well aware of it that Pre-Implantation testing can be helpful in certain situations but may not be perfect. Women who bear pregnancy after such type of testing still need to go through a standard prenatal testing. Moreover, this process is considered inefficient and a vital number of embryos are still lost due to this testing. Hence, routine testing of the embryos before the embryo transfer is still not recommended.
What comes next? If during this cycle, you were unsuccessful, the next step is to sit with your IVF specialist and talk to them comprehensively about the previous cycle and why it may not have worked. Only after keeping all those points in consideration, the next cycle will be initiated.
About IVF Cost in India- The IVF cost, in other words, the test tube baby cost increases with increase in the types and number of times these techniques are used. The IVF cost in Aligarh including all surgical and diagnostic procedures, treatments and tests, normally range between 1 lakh to 1.25 lakh per cycle. It certainly varies from one person to another as some are fortunate enough to conceive in their 1st cycle whereas some may go through another cycle. Note- The IVF process may vary depending on the site, state of treatment and your individual needs.
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Gynaecologist & IVF Specialist
Every fertility centre should have a team of experts and a counselling team that educate and bring awareness about infertility and its treatments. Mor...