Arc International Fertility & Research Centre

In case the fertility odds are against your favour, you can undergo a procedure called IVF or in vitro fertilisation. It is a form of fertility treatment in which the sperms and eggs are combined in a laboratory. IVF is a very common fertility treatment procedure, involving modern technology. It is carried out by many women and couples worldwide. When you are facing ovulation problems and issues with the quality of eggs, have blocked fallopian tubes or if your male partner has a low sperm count, a sperm donor’s eggs are used via IVF to become pregnant.

The overall process of IVF involves several methods and steps:

1. Ovarian stimulation: You will have to take a fertility drug called gonadotrophin eight to fourteen days before the beginning of your menstrual cycle. This will help to stimulate your ovaries for the development of multiple, mature eggs for fertilisation. You will also be given synthetic hormones like cetrorelix and leuprolide.
2. Development of follicle: You should be visiting your doctor frequently while having the medicines for a check-up of your blood hormone levels. Your ovaries will also be measured using ultrasound. This will allow the doctor to monitor the follicle development.
3. Trigger shot: You will be given a trigger shot injection when the follicles are prepared. This injection leads to full maturation of the eggs, making them ready for fertilisation. The eggs require a period of 36 hours for retrieval after receiving the trigger shot.
4. Gathering of the eggs: An anesthetic will be given to you and an ultrasound probe will be inserted via your vagina for observation of the ovaries and follicles. A thin needle will be inserted through the vaginal wall with which the eggs are removed from the follicles.
5. Fertilisation: The eggs will be observed one final time before being combined with your partner’s sperm. Then they will be incubated overnight. Fertilisation occurs during this period and the abnormal eggs do not get fertilised. Three days after the egg retrieval, some of the successfully fertilised eggs transform into embryos composed of six to ten cells. Within five days, some of these embryos turn into blastocysts composed of fluid-filled cavities and tissue. This separates into the baby and the placenta. The most viable embryos are placed in your uterus. One to five embryos are placed in your uterus by the insertion of a catheter through the cervix. The embryo implants itself to the uterus walls. Gradually, it develops into the baby. The chances of pregnancy are higher when there are multiple embryos.

Before thinking of undergoing IVF, you must consult a doctor to know about the entire process. You also need to know whether you are fit to undergo IVF as there are several criteria you should satisfy for IVF.

The concept of egg quality of a woman is derived from the belief that the embryo implantation probability is powerfully related to the age and ovarian reserve of the woman. Thus, it is regarded that the quality of the egg is almost synonymous with the chances of embryo implantation. Its quality cannot be assessed merely by looking at the egg or measuring its ability to receive the fertilization by sperm or simply observing the initial embryo division.

There are a few important factors that contribute to the success or failure of the embryo implantation and some of them are:

1. Diminished ovarian reserve: A woman with an increased FSH level on the third day of the menses is regarded as having diminished reserve of ovary. This implies that her ovary is not competent in sending feedback signals to the pituitary gland and the body responds by producing an increased amount of FSH for stimulating the ovary. For more than 10 years, it has been found that in over thousands of fertility treatment cycles, women with an increased FSH level have a lower egg quality.
2. Advanced age of maternity: Even though the FSH level is normal, the age of the mother who provides the eggs plays an important role to determine the quality of the egg. Quite like women with increased FSH levels, eggs obtained from women aged more than 40 years can have some problems at a later stage of fertilization. Normal FSH levels are not considered a reassuring factor, owing to the lower implantation rate in females aged over 45 years.
3. Diminished quality of egg: With an increase in age, the capacity of the mitochondria in producing energy slowly decreases. The egg is linked to the circulation before ovulation, and it is linked again after the embryo implantation. But during the one week time ranging from ovulation to implantation, the egg and the resulting embryo are contained in the zona pellucida and function on the basis of mitochondrial energy supply. The older age of the woman doesn’t cause any problem at the initial stage of ovulation. Its fertilization and embryonic development are also normal. But soon, it runs out of energy and stops dividing before reaching the stage of implantation.

Therefore, it is important to have the eggs tested to find out any sort of chromosomal abnormality. In case the mother is deficient of producing high quality eggs, the best option is to have donor eggs.
 

In vitro fertilisation, commonly known as IVF, is the process of fertilising single or multiple eggs outside the body. This treatment can be performed by either using your own egg and sperm or using donated egg or sperm or sometimes both. The resulting sperms and eggs are evaluated for quality and then one or more of them are positioned properly in the uterus through the cervix. IVF is regarded as one of the most commonly opted treatment plans, and it accounts for more than 99% of assisted reproductive technology processes.

Who are suitable for IVF?
IVF can be helpful for you in case you have some issues with the egg quality or ovulation, fallopian tubes that are blocked in some way or endometriosis. It can also help you get pregnant if your partner has problems with mortality and reduced sperm count and when you have opted for donor eggs. About 1.5% of babies in the United States are conceived through the IVF process.

How does IVF work?
There are several steps through which IVF process works and the timeline follows the following steps:

1. Stimulation for ovary: You will have to take a special kind of fertility drug for 8 to 14 days near the start of your menstruation cycle. This drug aids in the stimulation of your ovaries for developing multiple mature eggs to fertilise instead of a single one. You may also need to take an artificial hormone-like cetrofelix and leuprolide for keeping your body from releasing eggs very early.
2. Development of follicle: When you are under all these medications, you will have to visit your doctor’s office often for checking the hormone levels as well as ultrasound measurements for the ovaries.
3. Getting the trigger shot: Once the follicles are ready, you are likely to receive a trigger shot, which is an injection causing the eggs for maturing fully and becoming capable of being fertilised. Your eggs are ready for being retrieved after about 36 hours of receiving this shot.
4. Gathering the eggs: At this stage, you are likely to receive an aesthetic or ultrasound probe that is inserted through the vagina for checking the ovaries and identifying the follicles. Normally, about 8 to 15 eggs are retrieved through the insertion of a thin needle.
5. Fertlisation: This is the most vital step, where an embryologist is going to examine the eggs before they are combined with the sperm and incubated overnight. Fertilisation happens at this particular time, but abnormal eggs are not fertilised.

Then the embryos slowly develop and are planted on the basis of your age and clinical condition. When the treatment is working, an embryo is implanted in the uterine walls and starts developing. 

In case you have a diseased uterus, which makes you infertile, you can undergo a procedure known as uterus transplant or uterine transplant to get pregnant. In the process of sexual reproduction, a diseased uterus does not allow embryonic implantation. This factor is referred to as uterine factor infertility or UFI. As a result, you will not be able to get pregnant. Learn more about having healthy pregnancy.

Who requires a uterus transplant?
This procedure involves women who have UFI and women who had their uterus removed by hysterectomy. Women who have a damaged uterus on account of an injury or infection, which does not function anymore, can also undergo a uterus transplant procedure. Women from the age of 21 to 45 are eligible for this procedure. Many women are born without having a uterus. This condition is called Mayer-Rokitansky-Küster-Hauser syndrome.

Procedure
Uterus transplantation begins with undertaking a uterus retrieval surgery on the uterus donor. The uterus, which is recovered has to be stored and transported to the location of the patient undergoing the transplant. An ischemic tolerance may last over 24 hours. Three major surgeries have to be carried out with the recipient. Firstly, a transplantation surgery is required in which the donor’s uterus gets transplanted. In case pregnancy develops, a caesarean section surgery has to be performed. The patient is given immune suppressive therapy. After childbirth, a hysterectomy is done in order to terminate the immune suppressive therapy.

Will the women be able to get pregnant after having sex?
Women receiving a uterus transplant will not be capable of becoming pregnant without undergoing fertility treatments. The transplanted uterus is not connected with the fallopian tubes, which is the location of the normal fertilisation process. The women will require to carry out IVF or in vitro fertilisation to become pregnant after a uterus transplant. IVF is a process in which the eggs are removed from the ovaries and get fertilised in a laboratory. Then, they are implanted in the uterus. After undergoing the uterus transplant procedure, a woman has to wait for a period of one year. The uterus requires time for healing and after recovery, the embryo may be implanted for pregnancy. After giving birth successfully, a woman will be able to keep the transplanted uterus. This is a reason why IVF is a popular procedure.

She has the option to get pregnant again. However, after giving birth twice, a hysterectomy must be carried out for the removal of the uterus. This is done so that the woman can stop using the immune suppressant drugs, which are associated with major risks. Uterus transplant is a relatively new technology. In October 2014, the first healthy baby was born to a woman who had undergone a uterus transplant. This surgery is kind of experimental in nature and is usually the last option for getting pregnant.