In vitro fertilization (IVF) is a process of fertilization where an egg is combined with sperm outside the body, in vitro ("in glass").
The process involves monitoring and stimulating a woman's ovulatory process, removing an ovum or ova (egg or eggs) from the woman's ovaries and letting sperm fertilize them in a liquid in a laboratory.The embryos formed are then put back into the uterus to achieve a pregnancy.
- Tubal pathology
- Severe male infertility
- Hormonal disturbance : if previous treatment with ovulation induction and IUI have been unsuccessful
- Cervical factor/ Immunological infertility
- Unexplained infertility
How Is In Vitro Fertilization Performed?
There are five steps involved in IVF:
A woman normally produces one egg during each menstrual cycle. However, IVF requires multiple eggs. Fertility drugs, taken through injections, are used to stimulate a woman's ovaries to develop multiple mature eggs. This improves chances for fertilization and ultimately pregnancy. The most common medications are prescribed by the physician as and when required and the doses of the same are given under observation of the physician.
When the eggs are mature, they are retrieved by an ultrasound-guided procedure that is performed under light anesthesia on an outpatient basis. During the procedure a needle is placed through the vaginal opening and into the ovaries. There are no abdominal incisions or suturing. The retrieved eggs are then evaluated in our embryology lab. Number and quality of retrieved eggs depends on many factors such as woman's age, response to the medication etc. Risks are minimal and recovery takes an hour or two, although post-operative cramping is common.
Once the eggs arrive in our embryology lab, our skilled embryologist analyzes them for maturity and then incubates them. At this time, husband is asked to collect a fresh semen sample, which is then analyzed, washed and treated to isolate the best sperm for insemination. The sperm is then mixed with the eggs using IVF procedure or injected directly into the eggs using ICSI procedure.
Fertilization &Embryo Culture
It takes approximately 16-18 ± 2 hours to determine if fertilization has occurred. After fertilization happens, the eggs develop into embryo after 48-72hrs. As embryos develop, they are observed by embryologists and each is assigned a grade. We use Gardner system to grade zygote and embryos from the day of fertilization i.e. day 1 to day 5. Three to five days later; the specialist re-implants the good quality embryo back into the uterus.So, during IVF/ICSI process, the oocytes and embryos stays in the laboratory for approximately 2 to 5 days before transfer.
Embryo transfer is a simple technique and anesthesia is not required. On the day of transfer, you, your partner, and our specialist will discuss the number of embryos being transferred, as well as their quality and grade. Selected embryo(s) with the help of catheter are transferred directly into the uterus during a 5-15 minute procedure; sedation is not usually required and there is no recovery period. You will be allowed to get up and leave immediately after the transfer procedure.
What Are the Complications Associated with In Vitro Fertilization?
As with any medical procedure, there are risks associated with IVF. Complications include:
- multiple pregnancies, which increases the risk of low birth weight and premature birth
- miscarriage (pregnancy loss)
- ectopic pregnancy (when the eggs implant outside the uterus)
- ovarian hyperstimulation syndrome (OHSS), a rare condition involving an excess of fluid in the abdomen and chest
- bleeding, infection, or damage to the bowels or bladder (rare)
The factors identified in the reviews and models as being predictive of live birth or pregnancy are female age, number of embryos available, whether embryos are fresh or thawed, previous treatment success, previous pregnancy history and lifestyle factors and body mass index (BMI).
In addition, factors such as duration of infertility and type of infertility have been shown to be predictive of live birth or pregnancy.