Infertility is a dark, lonely situation which is hard to experience. It is difficult to live with the reality which comes with the countless trying, investigations and failure to conceive even after the various procedures. Medical science with its increasing advances has created a reproductive assistance to the infertile couples. In Vitro Fertilization or popularly known as IVF wherein the egg and sperm are fertilized in a laboratory dish and then transferred to the uterus.
Sir Robert Edwards and Patrick Steptoe are the pioneers of IVF in 1978. Louise Brown is the first test tube baby born by IVF. Infertility can be due to both male and female factors which needs to be assessed carefully.
Which are the couples who can go for In Vitro Fertilization?
IVF can be useful in the patients with following conditions:
- Women with blocked fallopian tubes
- Male having low sperm count or abnormal structure and motility of sperms
- Women with Endometriosis , ovarian failure, and ovulation disorders
- Couples having genetic diseases in which conceiving is difficult
- Unexplained infertility
What are the procedures of In Vitro Fertilization?
A couple has to undergo five steps in IVF:
- Stimulation of ovaries for egg production:
Fertility drugs are given to stimulate the ovaries for ovulation or known as egg production. Normally, only one egg is released from ovaries. Fertility drugs cause the ovaries to produce many eggs. Follicular studies are done to monitor the follicular growth and development through transvaginal ultrasounds. Blood tests are also done to check levels of hormones.
- Retrieving of eggs
A small outpatient procedure is carried out to retrieve the eggs/follicular fluid aspiration from woman’s ovaries .The woman is put under anaesthesia. There is continuous monitoring of the woman’s reproductive system by ultrasound imaging. The doctor inserts a needle connected to a suction device into the vagina and then in the follicles of ovary. The device pulls the eggs from the follicles one by one. This step is repeated with the other ovary
In cases where a woman cannot produce their own eggs, they are taken from egg donors from ART banks
- Combining and fertilization:
The combining of the sperm and the egg is known as insemination. This is stored in a controlled temperature in the laboratory. Fertilization occurs when the sperm enters an egg which happens within few hours.
Intracytoplasmic sperm injection (ICSI) is the process where the sperm is directly injected into the egg. This is carried out when the chances of fertilization might be low.
- Embryo culture:
Division of the fertilized egg results into an embryo. A constant check is done on the growth of the embryo. A normal and healthy embryo is which divides actively. If there are chances of a strong genetic disorder transferring to the child, a pre-implantation genetic diagnosis (PGD) is done 3-4 days after fertilization. Genetic material from the embryo is screened for the disorders.
- Embryo transfer:
The final and important step in IVF is placing the embryos in the uterus after about 3 to 5 days from fertilization.
A catheter (thin tube) containing the embryos is inserted through the vagina, then cervix and up into the uterus. The woman is awake during this procedure.
When the embryo gets implanted in the uterine lining and grows, woman gets pregnant.
Chances of twins, triplets increase when more than one embryo is transferred into the uterus. Doctors can store the unused extra embryos in frozen form . If first embryo transfer fails , frozen embryos can later be used in next attempt .
What are the benefits of In Vitro Fertilization and why should couples consider IVF?
- When couples who are trying to conceive are tired with the various failed infertility treatments, IVF techniques offers them their best chances for success. Due to everincreasing developments and new technology in the field of this procedure, IVF success rates are now even better.
- IVF is also used during surrogacy especially for woman who is physically unfit to carry a full-term pregnancy .
- IVF is carried out in couples who have a low ovarian reserve or low or nil sperm count. In such cases donated eggs/sperms are used for IVF and the pregnancy chances increase with donor gametes
- Couples who are much focused on careers can store (cryopreservation) their eggs and sperms to carry out IVF in future.
- IVF decreases the chances of genetic disorders (Down’s syndrome, sickle cell anemia to name a few) due to PGD carried out during the procedure. Hence the possibility of healthy baby increases.
- IVF has reduced the number of abortions which occurs most often due to genetic abnormality.
- PCOS is the most common cause of hormonal imbalance and irregular ovulation in females. IVF has been successful in such cases where the ovulation is facilitated by giving fertility drugs.
- Women aged more than 40 years having low ovarian reserve are the suitable patients for in vitro fertilization.
Even though with many benefits of in vitro fertilization, there are few complications which can occur. Fertility medicines may give rise to abdominal pain, headaches, acidity, mood swings and bloating. Over-response to these medicines in rare circumstances can cause ovarian hyper-stimulation syndrome (OHSS ).
Success rate of IVF:
IVF has been noted to have a high success rate over other assisted reproductive technology. However, IVF may not be successful in each and every case.
Risks associated with IVF procedure:
There is a chance of bleeding, rupture of bowel or bladder and infection during egg retrieval step.
IVF carries a risk of multiple pregnancy when many embryos are transferred which in turn may give rise to low birth weight baby and premature delivery.
The major impact of in vitro fertilization on patients is on their finances due to its high cost. Emotionally couples are drained in case of In Vitro Fertilization failure.