Everything you need to know about In-vitro Fertilization - Dr Sulbha Arora

Egg and sperm are normally fertilized inside a woman’s body. If the fertilized egg attaches to the womb lining and grows, a baby is born nine months later. This is known as natural or unassisted conception.

In vitro fertilization (IVF) is a type of assisted reproductive technology (ART). It indicates that special medical procedures are used to help a woman in becoming pregnant. It is usually tried after other, less expensive fertility treatments have failed, or in cases where those are not likely to work.

What is in-vitro fertilization?

IVF or In Vitro Fertilization is also known as the test tube baby process. It involves the retrieval of mature eggs from a woman’s ovaries and their fertilization in a laboratory by the sperm. A successful procedure allows the fertilized embryo(s) to be gently placed in the uterus of the prospective parent or sometimes, if required, a surrogate.

Who may require IVF?

IVF may be required when simpler treatment options such as IUI have not worked. It may also be required as the first option when simpler options would not work, for example blocked fallopian tubes or low sperm counts.

Also in cases of advanced age or diminished ovarian reserve it is preferred as the first option to expedite the chances of conceiving and reduce the time to conception, as time is of essence in such cases.

How does IVF work?

Here are the steps involved in the IVF process:

1. Ovarian stimulation: To undergo this process, the woman is given a course of gonadotropin injections for approximately 10 or 11 days from the start of her period cycle. These are thin needle subcutaneous injections that usually do not cause much pain or lasting side effects.

2. Patient monitoring: During these 10 days, serial transvaginal ultrasound scans are done to monitor the growth of the follicles.

3. Maturing eggs: Human chorionic gonadotropin (hCG) or a GnRH agonist trigger is injected once the follicles have reached a ready size, to trigger the final maturation of the eggs, and the retrieval is done about 35 hours later.

4. Egg retrieval: This is a simple process that takes only about 5 or 10 minutes in most cases. It is not a surgery, rather it is much like doing a blood test. Just as a needle is inserted into your vein to draw a blood sample, similarly a needle is inserted into the vagina to retrieve the eggs.

However, as we do not want you to feel the needle, this procedure is done under short general anaesthesia so you are fast asleep, and will wake up only once the procedure is completed. You will then rest at the clinic for 2-3 hours for the drowsiness to wear off, and can head back home after that.

5. Sperm collection: The sperm is collected from the male partner, washed to remove unwanted fluid, debris, weak sperms and collect the best ones, and prepared for the next step.

6. Egg fertilization: Mature eggs are incubated in a nutritive liquid or a culture medium. They are combined with sperm and kept in the incubator, where they will develop into embryos over the next 5 or 6 days.

Not every mature egg will necessarily reach the embryo stage, which is why we start with multiple eggs. Intracytoplasmic sperm injection or ICSI is preferred over conventional IVF in some cases, where the sperm is directly injected into the egg to increase the chances of fertilization.

7. Embryo transfer: After 5 days, the embryos are transferred into the woman’s uterus for implantation. The doctors insert a catheter, which is a long, thin, flexible tube, into the vagina, through the cervix, and into the uterus.

A syringe with one or maximum two embryos suspended in a small amount of fluid is attached to the catheter’s end. The doctor inserts the embryo or embryos into the uterus with a syringe. This step is gentle and completely painless, requiring no anaesthesia or sedation.

8. Pregnancy test: Nine days after the embryo transfer, a beta HCG test is advised for the woman to confirm the pregnancy. If the results are positive, an ultrasound is done after another two weeks. The progesterone medication is continued for roughly 8 weeks after a positive pregnancy test.

If the test is negative, the medication is stopped, and the periods usually arrive within a week. Your doctor will be able to guide you with the next course of treatment for you in case the embryo transfer is not successful.

What are the side effects or risks of IVF?

Over the last few years, IVF has evolved into an overall safer and smoother process than it was in the past. Side effects, if at all any, are usually minor and disappear soon after the procedure is completed and any additional hormone medications are discontinued.

OHSS used to be the most serious complication of IVF in the past, where due to the formation of large number of eggs or very high estradiol levels, and women getting pregnant in such a scenario, their health could deteriorate with side effects such as bloating, and collection of fluid in the abdomen and chest.

Due to newer and safer stimulation protocols and the efficacy of the newer embryo freezing techniques, most clinics are now successfully OHSS-free, though in rare cases they might still encounter it, however measures are then taken to tackle it early.

Careful medical team monitoring, as well as a customized fertility medication schedule, dramatically reduces the risks.

Progesterone supplements may occasionally cause side effects such as bloating or mood swings, however, not everyone experiences them.

Another side effect is multiple pregnancy, which can be avoided by limiting the number of embryos being transferred at a time to one or maximum two.

How successful is IVF?

Factors like age, reproductive health, lifestyle habits, and the reason behind infertility determine the rate at which IVF can happen successfully. IVF success rate in India ranges from 30 to 70 per cent, depending on the factors listed above.

It is also essential to consult the best health professionals, a physician experience and lab quality are also major determinants of your chances of success.

Discuss with the doctor the factors that apply and how they may affect successful pregnancy. The doctors will advise on the available fertility tests, treatments, and programs most suitable for you.

Disclaimer: The views expressed in this article are of the author and not of Health Dialogues. The Editorial/Content team of Health Dialogues has not contributed to the writing/editing/packaging of this article.