In-Vitro Fertilization
What is IVF all about? See here the process, advantages and disadvantages of this fertility treatment.
IVF is the fertilization process that requires the removal of some eggs from your ovaries and later to be mixed with sperm in a laboratory dish. Fertilization actually takes place in this particular laboratory dish ("in vitro" is the Latin expression of "in glass").
The first "test-tube" baby, following IVF procedure, was born in 1978 and thousands of babies followed.
Who benefits from IVF?
Fertility issues sometimes require IVF procedure. Some of these problems are:
- Blocked or damaged fallopian tubes or similar, where IVF is the only treatment likely to result in pregnancy
- If the male partner has minor problems with his sperm (For those experiencing more serious problems – ICSI is advised.
- When IUI or fertility drugs treatments have been unsuccessful
- At least two years of conception trials resulting in an unknown cause for lack of pregnancy
How is IVF performed?
IVF requires a sequence of steps to be followed:
- Fertility drugs
Usually, an IVF doctor will most likely recommend you to take fertility drugs. These help to stimulate your ovaries to develop mature eggs ready for fertilization.
During a normal menstrual cycle, one egg per month is released. The chances of getting pregnant are better with more eggs and the fertility drugs increase the number of mature eggs that can be harvested.
This is called down-regulation and in some cases the drugs suppress or stop your cycle. The intake frequency is daily for a couple of weeks, either tablets or injections.
There are, however, other shorter ways of taking control of the egg release. Drugs like GnRH antagonists, for example can be taken over a few days, usually at the start of ovulation stimulation and after pre-treatment with the contraception pill (recommended to women at higher risk of severe side effects of fertility drugs).
For endometriosis patients, the GnRH agonist Cetrotide is recommended for several months to help improve egg quality and success chances.
- Hormone injections
The next step involves daily hormone injections. These can be administered for about 12 days and act as a stimulatory (ovulation induction) for your ovaries, that will result in a greater number of mature eggs released.
Women tend to have different ways of coping with these fertility drugs, and in some cases strong side-effects have been seen. Your doctor will closely monitor you through this step to insure that your reactions remain within the normal boundaries - ultrasound scans and possibly blood hormone tests will be conducted, to monitor the way your body is responding to the treatment, for safety purposes and to monitor the development of your eggs.
- Egg retrieval and sperm collection
When your eggs are mature enough, the doctor will then harvest them from your ovaries. This is done by using a fine, hollow needle attached to an ultrasound scan probe. The doctor locates the follicles that contain the eggs with the help of the probe, which can be a bit uncomfortable. Painkillers are prescribed if you experience pain.
While you are undergoing egg retrieval, your partner will be providing a fresh sample of semen.
When donated or frozen sperm are used, the sample is taken from the freezer, washed and the best-quality sperms are extracted ready to fertilize the eggs.
Then the in-vitro fertilization process occurs - the sperm combined with the eggs in a dish are left to culture in an incubator.
- Fertilization and Embryo Transfer
The next day after combining the eggs and sperm, the dish is checked. If the eggs have been fertilized, they will be left to develop for two to five days. After that, the eggs will be transferred into your uterus. The fertilized eggs will have become to divide by now into an embryo or blastocysts. The healthiest embryos are chosen to be transferred to your uterus.
Comprehensive chromosome screening (CCS) is conducted in some clinics. This is a pre-implantation test that screens embryos before being transferred at the blastocyst stage. Only the embryos that are supposed to have a full set of chromosomes are selected, increasing your chances of getting pregnant and reducing the risk of miscarriage in single embryo transfer. CCS is recommended to 35 and over mothers to be using their own eggs.
By now, your uterus should be fully prepared to carry a baby – with the progesterone administration (by IV or gel), which helps thicken your womb’s lining. If your uterus lining (endometrium) is too thin, the embryos are unlikely to implant. In this case, the IVF cycle will be abandoned and you are likely to be recommended to consider surrogacy.
During the egg transfer, one or two embryos are transferred to your womb with a thin catheter (tube) through your cervix into your uterus. Your fertility specialist is likely to use ultrasound to guide him.
With IVF, it is widely known that multiple pregnancy can occur. To avoid this, three embryos are usually transferred.
The number of embryos depends upon your age, chances of success and of course, your particularfertility problem.
- Repeated IVF cycles
If your procedure resulted in extra embryos, these may be frozen for future use, in case the first cycle doesn't succeed, or if you may want another baby after your successful treatment.
After embryo transfer you are usually free to go on with your normal activities, of course, after resting for some minutes immediately afterwards, but it will usually not affect the outcome.
In a successful cycle, one or more embryos will stick on your uterine wall and they will continue to grow. You can take a pregnancy test in about two weeks.
Once you have confirmed pregnancy following IVF, you should have an ultrasound scan at about six weeks, to check that the embryo has implantedin your uterus.
IVF treatment duration
One IVF cycle takes between four weeks and six weeks to complete. You and your partner can expect to spend about half a day at your clinic for the egg retrieval and fertilization procedures. You will go back two days later for the embryo transfer or between five and six days for blastocyst transfer.
IVF Success Rates
The IVF success rates depend upon your age and/or particular fertility problem.
Specialists say that the younger and healthier you are (egg health included) the higher your chances of success.
If you have been pregnant or have had a baby before, you have an higher chance of succeding.
The key to focus on is that success rates are very high but it can take up to 6 IVF attempts for couples with more complicated problems to actually have a baby.
Improve your chances of fertilization success by:
- Reaching and maintaining a healthy weight (BMI between 19 and 30)
- Keeping your alcohol consumption to no more than one unit of alcohol per day (excessive drinking reduces the effectiveness of IVF)
- Stopping smoking
- Lowering caffeine consumption to a minimum (2 - 50mg have been linked to lower IVF success rates).
Your chances of success fall as the number of unsuccessful IVF cycles increases.
Advantages of IVF
- IVF gives the chance of having a baby if a woman is unable to conceive naturally, because of various fertility issues (i.e.Falopian Tube Failure)
- For couples with certain types of infertility, IVF has the obvious benefit of boosting the odds of getting pregnant, sometimes from a near zero odds of pregnancy
- IVF can also be the best choice when men have a low sperm count or other issues impacting their ability to fertilize the egg
- Using IVF and implanting embryos eliminates the need for the sperm to navigate the woman's reproductive tract
- IVF would also be the treatment of choice any time a couple decides to use donor eggs, (premature ovarian failure or other issues with eggs)
- Most children conceived by IVF experience no long-term problems.
Disadvantages of IVF
IVF increases the risk of certain complications:
- Multiple birth - more than one embryo transferred resulting in twins.Many couples consider twins to be a blessing. However, you may be at risk of having a premature birth or a baby with a low birth weight.
- Side-effects - from fertility drugs:These are usually mild, and include hot flushes, headaches and nausea. However, your doctor will monitor you closely for ovarian hyper-stimulation syndrome (OHSS may cancel IVF cycle for a time), particularly if you have polycystic ovary syndrome (PCOS).
- High risk of ectopic pregnancy - embryo implants in a fallopian tube or in your abdominal cavity (This is more likely if you have had problems concerning your fallopian tubes)
- Slightly higher risk of baby being born with a birth defect: However, these problems are not common and the absolute risk of your baby having a problem as a result of ICSI or IVF is very low. More research is underway to identify if there is a link between fertility treatments and birth defects.
Despite these risks, many parents still go on to give birth to their overwhelmingly much-expected IVF babies.
Make your parenthood dream a REALITY!
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