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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 a 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 an 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 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.
Here’s the short version of the steps involved in an IVF treatment cycle:
- 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.
Of a million sperms released in one ejaculation, a single sperm manages to fertilize the egg, which grows into an embryo and then a baby. Due to various reasons, when this does not happen, it is termed as infertility and is currently on the rise.
With IVF, couples sometimes go through multiple sessions to ensure fertilization. ICSI or intracytoplasmic sperm injection improved this chance of fertilization. It is where a single sperm is used to fertilize an egg in an artificially controlled environment and then injected into the uterus where it grows further.
The next step in this technique is IMSI, where the chances of a successful pregnancy are further enhanced and also promises improved quality of the embryo. IMSI, as it stands for, has “morphologically selected” which means under a highly powerful microscope, the best sperms are selected and then used to fertilize the egg. Morphology stands for shape, and the shape of the sperm is a direct indicator of the sperm quality. This not just ensures good success rate but also ensures the sperm which is used produces a high-quality embryo.
- High success rate of fertility
- Reliable and efficient method of ART (assisted reproductive technology)
- More expensive than traditional IVF methods or ICSI
- Requires complex equipment, training, and set-up
- Useful in couples who have failed IVF previously
- Male infertility with unidentifiable cause
- Poor sperm quality
What to expect?
Both partners are prepared both physically and mentally prior to IMSI.
Before the procedure - men:
- A screening is first done to decide if the sperms can be used directly
- In the case of hereditary diseases, a donor is preferred
- The first technical step involves sperm collection, either directly or through a donor
- Sperms are collected either through masturbation or through a small incision in the testicles
- Sperms used could be fresh or frozen; fresh ones may be stored for later use also
Before the procedure – women:
- The woman is put on some ovulation therapy to ensure the release of multiple eggs, so a good one is picked. These high doses of hormones ensure multiple eggs are released.
- Egg release is monitored through blood and urine tests
- They are collected within after 36 hours of release
During the IMSI procedure:
- A healthy egg is chosen and placed in a glass container containing hyaluronidase
- Sperms are placed in a medium which will slow their movement, which enables picking a good sperm for fertilization
- The dual advantage of this is that in addition to a high success rate of fertilization, the quality of the embryo is also assured
In vitro fertilization (IVF) includes empowering the woman with medicines, taking various eggs from her ovaries, fertilizing them with her partner’s sperm, and inserting a portion of the subsequent embryos into her uterus with the trust that one will form into a fetus.
Tubal ligation reversal, on the other hand, requires a laparotomy, which needs a much bigger entry point on the abdomen, usually around four to six fingers long. Since the skin, each of the muscles, and different tissues of the stomach must be sliced through, there is extensively more uneasiness and longer recovery time required after the surgery, when compared with laparoscopic surgery, for example, with a tubal ligation.
Here are a few common differences:
- Sperm quality: The male partner needs a sperm test before basic procedures of either of the two. In case that the sperm quality is great, then the couple could consider proceeding. In case that the sperm quality is poor, in vitro treatment is the better alternative. With IVF, poor sperm quality is effectively overcome.
- Tubal status: The length of the remaining tubal stumps after tubal ligation is an important aspect. The more extended the two remaining stumps are on each side, the better and more effective is the pregnancy. The shorter the stumps, the lower are the odds for pregnancy.
- Status of other pelvic conditions: Pelvic endometriosis or any scar tissue in the range of the tubes or ovaries would diminish the chance for accomplishment after tubal ligation reversal. Although, IVF pregnancy achievement rates are usually not influenced by these conditions. Along these lines, in vitro fertilization is most likely a superior alternative in women with noteworthy endometriosis or pelvic scar tissue.
- Female age: Chances for pregnancy with either tubal ligation or IVF decrease in the mid to late thirties and significantly reduce at the age of thirty-eight. By age forty-three or forty-four, not many women will have the capacity to have a baby using either approach.
- Egg amount and quality: A few women have a decrease in either egg amount or quality prior in life than anticipated. In this manner, the woman’s ovarian capacity needs to be tested before a choice is made in regards to whether to continue with either tubal ligation or in-vitro fertilization. AMH levels, ovarian antral follicle number, and day 3 FSH levels are generally done to evaluate ovarian capacity or hold.
- Doctor intervention: The greatest favourable position of tubal ligation reversal over IVF is that once the woman has experienced the surgery she ideally will not require any medication through the doctor, for example, medications or systems, keeping in mind the end goal to get pregnant.
Intracytoplasmic Sperm Injection i.e. ICSI is different from conventional IVF i.e. In Vitro Fertilization because a single sperm is selected by the embryologist to be injected by a needle into the egg rather than a dish with many sperms placed near the egg so that the fastest swimming sperm enters it. Once the sperm is injected directly into the egg, it fertilizes, after which the embryo is transferred into the womb or uterus.
Your doctor might recommend ICSI treatment for you if you have an extremely low sperm count resulting in infertility or other medical sperm conditions such as poor motility or poor morphology. It may also be suggested if prior attempts at IVF procedures have failed in fertilizing the egg or the fertilization rate is extremely low. You must also consider ICSI treatment if you resort to embryo testing or if the sperm needs to be collected from the epididymis or testicles surgically.
However, you must keep in mind that if your partner has a genetic problem resulting in low sperm count, it could be passed on to your child, if you decide to use your husband's sperm for this process.
Success Rates of ICSI:
The success rate of ICSI treatment depends on your age and your fertility problem. Your eggs are healthier when you are young and as you age, chances are that they will become less healthy.
1. 35 per cent if you are under 35 years of age
2. 29 per cent if you are between 35 to 37 years of age
3. 21 per cent if you are between 38 to 39 years of age
4. 14 per cent if you are between 40 to 42 years of age
5. 6 per cent if you are between 43 to 44 years of age
6. 5 per cent if you are above 44 years of age
Advantages of ICSI Treatment:
Intracytoplasmic Sperm Injection gives you a chance to conceive a child genetically when most other options are exhausted. Males may be unable to ejaculate on the day the eggs are collected due to anxiety. ICSI proves to be advantageous because sperm may also be surgically extracted for this process. It is extremely helpful for those couples who suffer from unexplained infertility. However, one of the most important factors is that ICSI treatment does not affect your child's physical or mental health.