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What is IVF?
IVF stands for In Vitro Fertilization and is a method of artificial insemination that dramatically increases the chances of pregnancy. It is one of the assisted reproductive technologies methods used as fertility treatment across the world where other methods have had drastic results.
In simpler terms, a man's sperm is inserted in woman's egg using controlled laboratory environment to proceed with fertilization. These embryos are then carefully put back into the mother's uterus after 4 to 5 days of fertilization in incubator in hopes that the embryo would grow in a full baby. The embryo transfer process needs to be carefully done in order for successful fertilization in the mother's womb.
There are many reasons why IVF is conducted:
- Poor sperm quality - Males having poor sperm quality are unable to achieve fertilization and increase the chances of conception with their female partners. This is male factor infertility due to which people move towards IVF.
- Fallopian tube problems - This is a female factor infertility, in which fallopian tubes either get blocked, or damaged making it complicated and stressful for the embryo to travel to the uterus.
One must approach IVF treatment with patience and a willingness to comply with all the tenets that the treatment is built upon. IVF clinics may vary the treatment a little according to what the patient's condition demands and different clinics may have different methods. The basic methods of IVF treatment however, remain the same. The first step to the treatment is to find the right clinic which complies with factors like availability of resources, cost and quality of treatment. After deciding the clinic, the next step is to understand that IVF treatment happens in cycles and the success rate of conception varies. Patients must also be ready to face any disappointment.
- Ovarian stimulation. Your doctor prescribes a course of drugs for you to take to stimulate your ovaries into hopefully producing 12 to 15 mature eggs.
- Monitoring of your drug response. To monitor the progress of your ovarian stimulation you undergo an ultrasound examination and blood tests.
- Egg maturation. Two days before your eggs are due to be collected you have a hormone injection, which triggers maturation of the eggs.
- Egg collection. You receive a light general anaesthetic for this simple, short procedure, and your doctor retrieves your eggs using an ultrasound-guided technique.
- Sperm production. On the day of egg collection, your partner provides a sperm sample.
- Fertilisation. The embryologist puts sperm and eggs together in the lab and, if all goes well, the eggs fertilise and early embryo development begins.
- Embryo transfer. Two to five days after egg collection, your doctor places one or two embryos in your uterus. Frozen transfer can be planned after a gap of 1 month.
- Embryo freezing. If you have additional embryos suitable for use, they can be frozen and kept for future transfers. Also, frozen embryos are available.
- Pregnancy test. About two weeks after embryo transfer you have a blood test to find out whether the treatment worked.
- If the test is positive, you have your first pregnancy scan two weeks later.
- If the test is negative, you and your partner need to talk to your doctor and decide whether to try the treatment again.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Women are not really sure about frozen embryos’ ability to result in pregnancy. Ironically, the success of Frozen Embryo Transfer has dramatically improved over the last few years. In the days gone by, the chance of women getting pregnant through the use of frozen embryos seemed to be on the lower side compared to that from the transfer of fresh embryos. Recent data related to this suggests that this is no longer the case.
Reasons behind the low success rate of frozen embryo transfer in the past
Previously during the frozen embryo transfer process, the embryos which had to get frozen were the ones that did not get chosen for the fresh embryo transfer initially. The reason being that the embryologist had gone ahead to choose the best possible embryos for getting them transferred initially. As far as the fresh embryo transfer is concerned, quality of embryo has got a major effect on the chance of a woman getting pregnant. On the other hand, if quality of embryos frozen is not good, the rate of survival after it gets thawed along with the rate of pregnancy would be on the lower side.
The second important reason is the amount of embryos that got transferred. Let us consider a couple who produce four very good quality embryos. Two of them are transferred during fresh In Vitro Fertilization Process and the remaining two are frozen. This leads to pregnancy and the woman gives birth to a baby. Later on, the couple once again decides to go for pregnancy by using the frozen embryos. Though only one embryo survives after getting thawed. The frozen embryo transfer is that of a single embryo. The success rate of a frozen embryo transfer through a single embryo is always going to be on the lower side than what it will be when multiple embryo transfer is involved.
Finally the method of freezing embryos has seen a sea change quite a number of years ago. Nowadays the freezing of embryos takes place by a fast method, known as vitrification. This process has got a much better survival rate when embryos get thawed along with good rates of pregnancy when those particular embryos are transferred in a much better manner.
Studies about high success rate of frozen embryo transfer
There have been studies performed in women, who have had quite a vigorous stimulation of their ovaries and were considered to be at high risk for Ovarian Hyperstimulation Syndrome. The physicians took the decision of skipping the process of embryo transfer and instead go ahead to freeze all the embryos for use at a later stage.
This tends to significantly decrease the risk of having serious Ovarian Hyperstimulation Syndrome along with decrease in complications. Other cases involved, physicians deciding to move on with a fresh embryo transfer depite the risk of Ovarian Hyperstimulation Syndrome. In both the scenarios the couples have quite a large number of embryos and the embryos selected for transfer were the best embryos.
The studies have shown no difference in the rates of pregnancy between fresh or frozen embryos or for that matter higher rate of pregnancy with frozen embryos. In case you have a concern or query you can always consult an expert & get answers to your questions!
Pregnancy loss could be devastating. Not only does it affect a woman mentally, but it also often takes a huge toll on her confidence. Post miscarriage trauma is a common phenomenon in this case. The range of emotion a woman might go through include denial, guilt, anger, depression, envy and yearning. Although the process of grieving takes a lot of time, the first step towards post miscarriage trauma is to accept the inevitable and move on.
- Take time: While listening to friends and family seems to be the best course of action around this time, your loved ones need not get priorities at this time. If you believe that clearing your baby’s belongings is causing pain to you, take the time to prepare yourself. Clear away the stuff only when you are emotionally ready to do so.
- Create memories: While a lot of people suggest to completely get rid of all the memories that are attached to the baby, it may not be a great thing to do. Studies have shown that creating a memory about your loss helps to heal faster. So go ahead and take a picture with your baby, plant a tree, take a footprint or christen the baby. Good memories attached to your baby will not haunt you about the loss.
- Take care: Do not neglect your personal health and well-being. Eat well, take enough rest, quit smoking and drinking and seek pleasure in your loved one's company. The more you embrace life, better are your chances to get back to the grooves. Following an old hobby or working out one hour per day goes a long way in the process of healing.
- Get your partner’s help: Being open about your emotions is a good thing to do. Express your feelings about the baby to your partner. The process of coping up can be entirely different from each other. What matters is to let each other’s feelings known. Your partner’s broad shoulder is your best bet to come out of your loss.
- Set the expectations right: Women often get cranky and irritated after a miscarriage. Speak to your loved ones and let them know about your feelings. This will help you to get your loved ones support you and let you heal quickly from your loss.
- Support group: It is very comforting to share your feelings with people who have already experienced the kind of loss you have faced. Sharing in person can reduce your pain a great deal. A spiritual healer or a professional psychiatrist can also play a crucial role in your recovery.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Frozen Embryo Transfer or FET is an extremely effective method to conceive a pregnancy. Recent studies have proved that there is a increased chance for pregnancy when the embryos, which get used are frozen and get placed inside the uterus at a time right after the ovaries are stimulated. Still, certain issues can arise with the transfer of frozen embryo, such as:
A Thin Lining of the Uterus
Research has shown that there are not many women who get pregnant if the lining in their uterine does not tend to thicken enough. It is not clear exactly why this problem occurs in most women and moreover there is no sure shot treatment to make the lining of the uterine thick. The experts on fertility would try out different methods like increasing the amount of estrogen or change the way how estrogen is given. There are other instances when women might be given supplemental medicines, while for some, the problem will continue to exist.
What Should Be Done In Case The Problem Persists?
- In case the problem continues for some women, then there are certain approaches which experts might look to adopt. The first one is to cancel the transfer of embryo and try once again at any later stage, that too with a different treatment method.
- The second option which they could think of is to go ahead with the transfer, wherein they might feel that a thin lining does not necessarily mean that it is impossible for a woman to get pregnant but definitely the efficiency would be reduced.
- One last option is to make use of the opportunity for undergoing additional tests which would help them to assess the ability of the uterus to allow implantation of the embryos.
For enabling the embryos to get implanted into uterus, placing them very precisely and at the appropriate time is important. This is regarded as the window of implantation. The time taken, is based on the time frame since progesterone reaches the lining of the uterine.
Doctor knows the exact time to place the embryos, right from the time he or she instructs a woman to start having progesterone supplements. In case a woman was to ovulate, the production of progesterone would begin earlier than the normal time and would lead to the shift of the window of implantation. As identifying the correct time of ovulation is almost impossible, so that would lead to some sort of uncertainty into the timing.
Due to this reason, there are doctors who would use medication in order to prevent unexpected ovulation from occurring. Generally an injection called Lupron is usually used as medication.
Timing for the Embryo Transfer is Inappropriate
This is a problem related to early ovulation. There are case when the implantation window is shifted, still the timing of the transfer becomes accurate. Recent studies have shown that quite a nominal percentage of women might have a window of implantation, which could be either earlier or later than normal time. A test called the Endometrial Receptivity Array can help determine at what time is the window of implantation open. In case you have a concern or query you can always consult an expert & get answers to your questions!
Fallopian tube blockage is the usual syndrome which affects the women getting pregnant. The blockage in the fallopian tube stops the flow of the sperm and the fertilization of the egg. Every month an egg will be released into the tube which travels from the ovary. When an obstruction is present in the tube the egg will not reach the uterus and even the sperms which travel through the tube to fertilize will also be stopped. This is associated along with some disorders like the pelvic inflammatory disease, bacterial or yeast infection, STD, family planning and much more.
- When women are affected by this fallopian tube blockage, they tend to suffer from unusual pain in the lower abdomen. The pelvic region also may get some pain. The pain will be more during the periods. The women tend to get some discharge from the vagina than the normal. If the problem left untreated the complication may be prolonged. Many women in the world are suffering from this syndrome and finds it very difficult to get pregnant. The efficient solution of this syndrome is the IVF. Through the method of IVF, the dream of having the baby comes true.
- The blockage can be detected with the help of an X-ray called the hysterosalpingogram. To clear the blockage a surgery needs to be performed with laparoscopy. But still, the complication found to proceed. The IVF is one such method where the doctor takes the egg and the sperm keep directly into the uterus. You need not be worried about the blockage since this method is independent of the blockage. Through an ultrasound needle, the egg is taken into the vagina and placed properly into the uterus. Whereas the sperms and the egg kept together to get fused in the lab.
- Most of the women find a good result in the IVF treatment. Then the other fertility methods IVF shows a good result. Many children are being subjected to some chromosomal and genetic disorders. When the couples undergo the IVF treatment there is the chance of choosing the healthier embryos and the chance of getting a healthy baby is also high. Not only the women with the blocked fallopian tube, Men with the low sperm count also won't be able to fertilize the eggs naturally. In that case, IVF will be the better option to insert the healthy sperms into the uterus. The process of In vitro fertilization gives the couple a better hope to have a baby.
In case you have a concern or query you can always consult an expert & get answers to your questions!
What is In- Vitro Fertilization?
In Vitro fertilization (IVF) is a process of fertilization where an egg is combined with sperm outside the body, in vitro ("in glass"). This process involves stimulating a woman's ovulatory process, removing an ovum or ova from the woman's ovaries and fertilizing them with sperms in a liquid in the laboratory. The fertilized egg (zygote) undergoes embryo culture for 2–6 days, and is then transferred to the same or another woman's uterus, to establish a successful pregnancy.The success rate depends on various factors such as maternal age.
Cause of infertility
- Embryo status
- Reproductive history
- Lifestyle factors
Ways to increase the success rate of In-Vitro Fertilization:
- Maternal age: Young age females undergoing IVF are more likely to get pregnant with a donor egg as compared to women older than 41yrs of age. If a woman undergoes IVF treatment by 23–39 years of age, the success rate is higher.
- Reproductive history: Women who have been previously pregnant have higher chances of being successful with IVF treatments than those who have never been pregnant.
- Avoid tobacco smoking: As it reduces the chances of IVF producing a live birth by 34% and increases the risk of an IVF pregnancy miscarrying by 30%.
- Maintain Body mass index (BMI) between 20-27: A body mass index over 27 causes a 33% decrease in likelihood to have a live birth after the first cycle of IVF.
- Avoid obesity: Pregnant women who are obese have higher rates of miscarriage, gestational diabetes, hypertension, thromboembolism and problems during delivery. Obesity in pregnancy may also lead to an increased risk of fetal congenital abnormality.
- Reduce alcohol and caffeine intake: As increased alcohol/caffeine intake decreases success rate of IVF.
- Number of embryos: Increasing the number of embryos transferred in the treatment cycle increases the success rate of conceiving.
- Getting treated for illnesses before IVF: Taking proper treatment for the underlying autoimmune disease before starting with IVF treatment is essential as it plays a role in decreasing IVF success rates by interfering with proper implantation of the embryo after transfer.
- Treating infectious disease: If the female undergoing IVF is suffering from any infectious disease like Rubella, Toxoplasmosis, etc needs to take treatment for the same as it may increase the failure rate of IVF by causing miscarriage/abortion or it may cause failure to hold the fetus.
- Mental state: The mental state of the female while undergoing IVF plays an important role. Females undergoing any kind of stress either physical or mental have higher chances of failure.
- Good clinic: Getting IVF treatment done from a good clinic and experienced doctor helps in achieving success.
Not being able to get pregnant can be an agonizing experience. The fertility of an individual can be affected by a host of physical and mental factors. The effectiveness of a fertility treatment is enhanced by several folds if there is an accurate diagnosis of the underlying cause of infertility. The In Vitro Fertilization (IVF) that first made its presence felt in 1978 (the first child born through IVF was on 25 July 1978) has been a revolution and is still continuing to change lives of millions of couples dealing with infertility issues.
When we talk about IVF, a question that often comes to our mind is whether IVF is the solution to all infertility problems? To answer this question, one needs to have a proper understanding of the IVF procedure. The
IVF procedure essentially comprises of following things:
- Stimulation of the ovary and development of the follicles involves a series of tests and ultrasounds to closely monitor the ovulation process, including the quality and quantity of eggs released along with the hormonal balance.
- In some instances, medications or hormones may be needed to ensure that the ovaries are stimulated enough to ensure proper development of the follicles (sacs filled with fluids where maturation of eggs take place) along with the release of two or more eggs during each cycle.
- Retrieval of the eggs: This step involves isolation of the eggs or the oocyte from the follicular fluid into a culture media and finally into an incubator.
- Fertilization: With the retrieval of the eggs, the sperm samples (from the partner or a donor) are also collected to facilitate the fertilization process (the chosen active sperm may be injected into the egg or mixed with it).
- Transfer of the embryo: From the embryos resulting from fertilization, a doctor selects the healthiest one and transfer it into the uterus of the recipient woman for implantation to take place.
- Following the implantation of the embryo, many women get pregnant within a few days or weeks. However, a pregnancy test can also result in disappointment for some.The failure of IVF treatment in some patients can be attributed to
- The embryo not being healthy enough to undergo the implantation
- Problems or severe damages to the uterine cavity.
- Abnormalities with the egg or the sperm (can be chromosomal or genetic aberrations).
Can IVF solve all infertility problems?
Having a clearer understanding of the IVF procedure, one can state that IVF does come as a ray of hope, especially for
- Males with a low sperm count
- Tubal damage in women. There may also be problems affecting the cervix and the vagina
- Women with ovulation problems (can be due to Hormonal Imbalance, PCOS, Endometriosis) or those who are above 35 years
In unfortunate cases, where IVF fails to produce the desired result, there are other fertility treatments available such as Intrauterine insemination, Gamete or Zygote Intrafallopian Transfer, Intracytoplasmic sperm injections, to put an end to the infertility problems.
Having a baby is a life changing event. For every couple the process is different. For some getting pregnant happens naturally but for others the whole process of getting pregnant can become an ordeal. For couples experiencing difficulty in getting pregnant, there is IVF (in vitro fertilization) fertility. It should be stressed that IVF is one of the many ways in which a couple can have a child.
The women are generally the one undergoing the treatment. The husband’s male ego maybe hit owing to the fact that he is unable to produce a baby through natural process. The problem of infertility may be traced back to the husband or the wife or both. In an IVF treatment, the woman is generally injected with hormonal medications and the egg is extracted and then fertilized with a sperm and the resulting embryo is implanted in the womb. The whole process might be overwhelming for the woman. The husband basically plays a passive role but is pivotal in providing support and love to his better half.
What can husbands do during an IVF treatment?
- Appreciation- The decision of having a baby is an important one. However, getting pregnant through IVF can take a toll on the woman with mood swings and low self-esteem. In such situations, the husband needs to play the supporting role and appreciate and praise her for doing such an incredible task. If she is feeling down, cheer her up and do not criticize. Pamper and appreciate her.
- Providing Emotional and Physical support- Women are generally emotional by nature and the process of IVF can make them more emotional. A woman can experience fatigue and nausea during the process. The husband should be around to help his wife in doing household chores and any other activities she needs help in doing. Remember a simple hug or just holding hands can create a positive feeling in your partner. You should spend time together
- Research- The women bears the maximum burden, being the one to go through the IVF treatment, experiencing pain and giving birth and taking care of the baby post-delivery. A husband can relieve some stress by undertaking a thorough research on IVF fertility. It’s very important to discuss about the consequences as well, like what measures can be adopted if the treatment is unsuccessful.
The whole process IVF might seem difficult and expensive but with the support of the right doctors and your partner, you will soon get to experience parenthood and an overwhelming love for your baby. In case you have a concern or query you can always consult an expert & get answers to your questions!
In vitro ova) from a woman's ovary are removed. They are combined with sperm outside the body in a laboratory procedure, and then the fertilized egg (zygote) is transferred to the same or another woman’s uterus for a successful Infertility
- Blocked fallopian tubes
- Women with ovulation disorder
- low sperm count or poor quality sperm
- Genetic disorder
Two procedures are done to gain access to ovaries
- It involves inserting the needle through the vagina (transvaginally). With the help of an laparoscopy, a small thin tube with a viewing lens is inserted through an incision in the navel. This lets physician to see inside the patient, and locate the ovaries.
Without additional techniques, the chances of pregnancy would be extremely small. The additional techniques used in IVF include-
- Ovarian hyperstimulation- Stimulation to induce development of multiple follicles of the ovaries.
- Final maturation induction- Induction of final oocyte maturation is performed, generally by an injection of human HCG), when the ovarian follicles have reached a certain degree of development. This is known as the "trigger shot”
- Egg and sperm preparation- Semen is prepared for fertilization by removing inactive cells and seminal fluid in a process called sperm washing. An oocyte selection may be performed prior to fertilization to select eggs with optimal chances of successful pregnancy.
- Co-incubation- Eggs are removed from the woman and placed in one of the fallopian tubes, along with the man's sperm. This allows fertilization to take place inside the woman's body. Therefore, this variation is actually an in vivo fertilization, not in vitro.
- Embryo culture- The main durations of embryo culture are until cleavage stage (day two to four after co-incubation) or the blastocyst stage (day five or six after co-incubation)
- Embryo Ectopic pregnancy
- Ovarian rupture, anesthesia
Getting pregnant can become an immensely frustrating experience for women with endometriosis or cyst with IVF treatment. Many women with endometriosis worry about whether they will be able to conceive and bear a child. This is because, in such a case, there is a collection of endometrial tissues outside the uterus that results in a painful inflammation along with the formation of blood-filled cysts in the ovary and bands of scar tissues.
How does PCOS or endometriosis affect the process of reproduction?
When a woman has any of these fertility issues, there could be endometrial growths of the tissue hindering the normal functioning of the reproductive organs. When the endometrial tissue formation involves the ovaries, there is a restriction on the release of eggs. On the other hand, when the fallopian tubes are affected, it would prevent the sperm from reaching the egg or it may also stop the fertilized egg from travelling to the uterus. Though each of these instances may sound challenging, experts suggest that IVF treatment can be helpful in offering desired results. It is estimated that about one-third of women suffering from endometriosis can conceive naturally without any treatment whatsoever. But for the rest of the women that suffer from endometriosis, IVF can be the best bet.
How can IVF help in getting pregnant in this scenario?
In order to make pregnancy possible for women with multiple adhesions, endometriosis or PCOS, the doctor would definitely begin with a comprehensive evaluation of hormones along with the presence of other chemicals in the body. Diagnostic tests such as hysteroscopy, hysterosalpingography, and laparoscopy can also be of great value in offering an insight into the individual patient’s condition.
When the IVF process has been successful, the embryo will get implanted in the uterus and cause the much-desired pregnancy. If there is any embryo remaining, it may be stored for use in future or donated to other couples. IVF is deemed successful for overcoming most of the female factor caused infertility including cyst, PCOS, and even endometriosis. There are 5 fundamental steps in IVF and they are:
- Super-ovulation or the process of stimulating the reproductive organs of a woman for releasing numerous healthy eggs. This is the first point of contradiction between IVF and normal pregnancy where a single egg is released and ovulated.
- The second step constitutes retrieval of eggs and sperm collection
- Then there is insemination as well as fertilization of the eggs with the help of the sperm
- Development of embryos and subsequent genetic evaluation when needed
- Transfer of the embryo in the uterus of the woman
Since IVF allows a controlled interaction between the egg and the sperm, it offers a high rate of success even when the patient is affected by complex disorders such as endometriosis, PCOS or cyst. Hence, discuss with your doctor if it is a viable option for the given situation. In case you have a concern or query you can always consult an expert & get answers to your questions!