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In-Vitro Fertilization

In-Vitro Fertilization –Process, Treatment and its Risk

 

Introduction

In virto fertilization (IVF) is a form of assisted reproductive technology (ART) in which fertilization is carried out outside the body in a laboratory and the embryo is then placed inside the uterus. The procedure is a complex and expensive one and is usually recommended only after other fertility treatments such as drugs have failed.

Treatment Process for In-Vitro Fertilization

Before beginning IVF, certain screening tests such as transvaginal ultrasounds are performed to view the uterus and the ovaries. Oral contraceptive pills and other medicines may also be administered before commencing the treatment.

The first step in IVF is ovarian stimulation which involves injecting medicines to boost production of eggs. The aim is to stimulate production of multiple ovarian follicles containing eggs. Transvaginal ultrasounds are usually performed regularly in the stimulation phase to assess if the follicles have matured and blood tests are performed to check hormone levels. Once the follicles reach a certain stage of development, a final injection, usually of human chorionic gonadotropin (HCG), is administered, and is the final step in the stimulation stage.

The next step is retrieval of eggs and is usually performed after around 36 hours of the HCG injection being administered. The procedure involves inserting a needle through the vaginal wall into the ovaries. The follicles are aspirated through the needle and the fluid containing the mature eggs is removed. In rare instances, the eggs may be removed through laparoscopy. The fluid is examined in a laboratory to ensure it contains eggs. Usually around ten to thirty eggs are removed through this procedure. The woman may be administered some medicines for pain and is advised to rest on the day of the procedure.

The male partner is required to provide a semen sample and the sperm are taken from the semen in a laboratory. The sperm and eggs are then combined in the laboratory (which is the actual fertilization stage). In cases where the sperm function or motility is low, the sperm cell may be injected directly into an egg through an intracytoplasmic sperm injection.

After the fertilization procedure, the eggs are monitored to ascertain if they have been fertilized and are growing as embryos. The embryos are monitored regularly over two or three days (sometimes longer) to check if they are dividing and growing properly.

Usually transfer of embryos into the woman’s uterus takes place after three to five days from egg retrieval. More than one embryo may be transferred depending on the woman’s age, quality of the embryos and other factors. The embryo is transferred into the woman’s uterus through a thin tube known as catheter inserted through her cervix. The procedure does not usually require anesthesia.

Leftover or unused embryos or eggs may be frozen or even donated to fertility clinics or for research.

After the transfer, progesterone is administered to increase chances of implantation (the egg attaching to the uterine wall). After around two weeks of the transfer, a pregnancy test is performed to check if implantation has occurred.

 

Indications

IVF is recommended in certain cases of infertility, especially where other fertility treatments are not expected to be useful or have failed. Where the cause of infertility is damage to or blockage in the fallopian tubes making natural fertilization impossible, IVF may be recommended. It may also be an option for older women and those suffering from endometriosis (a condition in which tissue which is usually supposed to grow inside the uterus starts to grow outside of it).

IVF may also be used to implant a fertilized egg in the uterus of a surrogate where it is not possible for the female partner to carry a pregnancy.

IVF is also an option in cases where infertility in a couple is due to low sperm quality or low sperm count. In such cases, the sperm is inserted directly into the egg (intracytoplasmic sperm injection). Sperm from a donor may also be used if sperm from the male partner cannot be used.

IVF may also be recommended in cases where the cause of infertility cannot be ascertained.

 

Risks

The process is complex and demands a substantial commitment in terms of time and money. This is why it is advisable to first attempt other treatments before resorting to IVF.

There are certain risks associated with the actual procedure. The ovarian stimulation phase may cause ovarian hyperstimulation syndrome. A woman suffering from this may experience symptoms like bloating, cramping and pain. In severe cases, this syndrome may cause excessive weight gain, severe pain in the abdominal region, nausea and shortness of breath. The egg retrieval procedure may also cause bleeding, infection and damage to other organs.

In cases where multiple embryos are transferred to the uterus, there is a risk of multiple pregnancy which increases the likelihood of pregnancy loss, premature births and low weights at birth.

The process can also be a cause for stress and anxiety amongst couples, especially if fertilization fails to occur or if there are other complications.