In vitro fertilization (IVF) is a process of fertilization in which eggs (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 pregnancy.

IVF is one of the several assisted reproductive techniques (ART) used to help infertile couples to conceive a child.

Causes of Infertility

Blocked fallopian tubes
Hormonal imbalance
Endometriosis
Women with ovulation disorder
Uterine fibroids
In the man, low sperm count or poor quality sperm
Genetic disorder
Procedures
Two procedures are done to gain access to ovaries

It involves inserting the needle through the vagina (transvaginally). With the help of an ultrasound machine, the physician guides the needle to the location of the ovaries
In the other procedure, called 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.
Method
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 chorionic gonadotropin (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 transfer- The number to be transferred depends on the number available, the age of the woman and other health and diagnostic factors. Embryos are transferred to the patient's uterus through a thin, plastic catheter, which goes through her vagina and cervix.
Aftercare
After the IVF procedure is performed the woman can resume normal activities. A pregnancy test can be done approximately 12-14 days later to determine if the procedure was successful.

Risks

Multiple pregnancies
Ectopic pregnancy
Ovarian rupture, bleeding
Infections
Complications of anesthesia

In Vitro Fertilization - Quick Facts!

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.

Intracytoplasmic Sperm Injection (ICSI)

What are the factors that make a woman fertile? + The most effective way to address infertility

Infertility is the inability to get pregnant after a year of unprotected intercourse. Both men and women can be infertile.

In about one-third of cases, the cause of infertility involves only the male.

In about one-third of cases, the cause of infertility involves only the female.

In the remaining cases, the cause of infertility involves both the male and female or no cause can be identified.

Women are born with a finite number of eggs. Thus, as the reproductive years progress, the number and quality of the eggs diminish. The chances of having a baby decrease by 3% to 5% per year after the age of 30 and this reduction is noted to a much greater extent after age 40.

Female infertility can also be caused by a number of factors including:

1. Damage to fallopian tubes

Damage to the fallopian tubes can prevent contact between the egg and sperm. Pelvic infections, endometriosis, and pelvic surgeries can lead to fallopian tube damage.

2. Hormonal causes

This can lead to ovulation disorders which prevent the ovaries from releasing eggs such as in polycystic ovary syndrome ,  hyperprolactinemia or disorders of the thyroid gland - hyperthyroidism / hypothyroidism, can interrupt the menstrual cycle and cause infertility.

3. Cervical causes

A small group of women may have a problem in which the sperm cannot pass through the cervical canal. Whatever the reason is , this problem may be treated with intrauterine inseminations.

4. Uterine causes

Abnormal anatomy and distortion of the uterine cavity due to the presence of polyps and fibroids or problem with the endometrial lining can lead to failed implantation of the embryo.

Endometriosis occurs when endometrial tissue grows outside the uterus - often affecting the function of the ovaries, uterus, and fallopian tubes.

5. Primary Ovarian Insufficiency:

Also called as Premature Menopause, when the ovaries stop working prematurely before the age of 40. Certain conditions are associated with early menopause like immune system diseases, radiation or chemotherapy and smoking.

Causes of male infertility may include:

1. Abnormal sperm production or function due to various problems, such as undescended testicles, genetic defects, health problems including diabetes, prior infections such as mumps, trauma or prior surgeries on the testicles or inguinal region.

2. Problems with the delivery of sperm, due to sexual problems, such as premature or retrograde ejaculation, certain genetic diseases, such as cystic fibrosis, structural problems, such as blockage of the epididymis, or damage to the reproductive organs.

3. Overexposure to certain chemicals and toxins, such as pesticides, radiation, tobacco smoke, alcohol, frequent exposure to heat can elevate the testicular temperature, impairing sperm production.

4. Damage related to cancer and its treatment, including radiation or chemotherapy for which timely cryopreservation can be done for future use.

5. Unexplained infertility, In approximately 20% of couples the cause cannot be determined using the currently available methods of investigation.

Why is IVF the best way to treat infertility in women?

Conception is a complicated process that depends on upon many factors:

On the production of healthy sperm by the man and healthy eggs by the woman

The sperm's ability to fertilize the egg when they meet.

The ability of the fertilized egg (embryo) to become implanted in the woman's uterus

IVF (or in-vitro fertilization) is a lab procedure where the sperm and the egg are combined in a dish (where fertilization takes place) and is followed by transferring the embryo (the fertilized egg) into the uterus. It is increasingly being used as a method to conceive as it has been established as a safe procedure that helps bypass a number of complications women may face while conceiving such as ovulation problems and issues with the fallopian tube.

Even women who face issues such as PCOS, endometriosis, and premature ovarian failure can conceive through this process. Moreover, IVF has been in practice since 1978 and has a safe track record. The success rates of IVF are high as well, making it a preferred procedure for couples who suffer from fertility problems. Unexplained infertility can also be treated with the help of this procedure.



What factors that  make a woman fertile? + The most effective way to address infertility

Egg Freezing, which is also known as mature oocyte cryopreservation, refers to the method through which reproductive potential is restored among women. Eggs get harvested from the ovaries, frozen and in an unfertilized manner and are stored for purpose of using them later on. The egg freezing procedure is recommended for those women, who would like to delay conceiving baby due to various kinds of reasons.

Before the freezing of eggs, it is important to first retrieve the eggs. Let us look at how the eggs are retrieved, followed by the procedure of egg freezing through two different ways.

Retrieval of Egg

Egg Retrieval takes place just like it is done in case of in vitro fertilization (IVF). Women would need to be put under medication for hormones or through injections, which shall lead to the stimulation of ovaries, leading to more eggs getting matured. After this women would receive the necessary medication to stimulate ovulation and then the extraction of eggs takes place through the use of a needle. Specialists perform this whole procedure by putting women under the effect of anesthesia and are also guided by ultrasounds. Once the extraction is completed, the freezing takes place.

There are two different techniques involved in the egg freezing process. They include:

Slow Egg Freezing Method

A substance called cryoprotectant is used in order to protect the biological tissues from getting damaged out of freezing. This slow freezing method of getting eggs freezed relies on low initial concentrations of crytoprotectant. The cryoprotectant in low concentration is introduced when the egg is at a relatively warm temperature and still continues to experience the usual functions of a living cell. Then the cryptoprotectant would spread all throughtout thus fill the egg, hence replacing most of the water inside the egg. The egg is then inserted into a small container made of plastic and ultimately get placed inside a cooling chamber. The lowering of temperature, to around -6 degree centigrade, takes place through injecting very tiny amounts of liquid nitrogen into the cooling chamber. The cooling process is controlled by a computer.

The main purpose of these techniques is to avoid ice crystals from getting formed in the egg. During the spreading of the cryoprotectant, if the ice crystals are still present, they can cause damage to the egg and hence the egg may not survive the process of thawing. Then the temperature is lowered further to around -32 degree centigrade. By this time, the egg s metabolic rate become slow. The container where the egg was placed, is then dipped inside the liquid nitrogen, forming a solid.

Rapid Egg Freezing Method or Vitrification

At the time of rapid freezing method, there is high concentration of initial cryoprotectant whereas the cell remains at room temperature. The egg is unable to stay for long in this temperature and thus gets poured immediately onto the liquid nitrogen. Cryoprotectant spreads at a rapid rate so as to avoid ice-crystal from getting damaged. Vitrification is a very new method for freeing eggs. Recent research has shown that vitrification of eggs largely improves the possibility for survival after thawing and the rates of pregnancy.

Different Techniques That Can Be Used For Egg Freezing!

It is as important for the man as it is for the woman to undergo certain tests before the IVF cycle is started. Fertility is not only an issue for a woman, but it also might be for the man in question. There are certain tests that need to be conducted on men before they can gear up for IVF:

1. Semen Analysis: One of the most important tests for male infertility is semen analysis. Sometimes, a man may be completely healthy, but his sperm production could be of poor quality. Semen analysis is done to provide an accurate evaluation of sperm number, the ability to move (motility), size and shape (morphology), as well as the consistency and volume of the sample collected.

2. Binding Test: Sometimes agglutination occurs where the sperms might stick to each other by their heads or tails. Sperm antibodies might cause this problem. The IVF treatment's success might be compromised if this happens. A simple binding test is done to determine this.

3. Trial Wash: This is also known as sperm wash. It is mostly done to remove chemicals from the sperm. Not doing a sperm wash might end up affecting the later stages of the IVF treatment. In this process, the misshapen and immotile sperm is separated so a clean sample of motile and healthy sperm can be collected.

4. TUNEL Assay: Since sperms build up about half of a child's genetic makeup, a TUNEL Assay or 'sperm DNA test' is required. This test is done to measure the sperm population that have fragmented DNA. Negative impacts on genetics can hamper the success of the fertility treatment.

TUNEL Assay is usually recommended to men with:
a) Leukocytes detected by the sperm analysis
b) Age approaching 50
c) A history of diabetes II type or prostatitis
d) Exposure to chemicals or prolonged heat at workplaces

5. Screening for Infectious Diseases: This test is done for both the partners to check for diseases like AIDS, Hepatitis C, and so on.

Tests Suggested for Men Before IVF

The fallopian tubes are not mere passages for the egg to travel from the ovaries to the uterus. It is here that conception occurs and hence healthy fallopian tubes are essential for the fertilization of an egg. 

Damaged fallopian tubes are the most common cause of infertility. This damage can fall under three categories. 

 Blocked fallopian tubes
 One blocked and one open fallopian tube
 Tubal scarring

The third is usually an effect of pelvic infections or natural healing after a pelvic surgery. Sadly, in most cases, this condition is discovered only after infertility has been diagnosed. Other causes of fallopian tubal scarring include:

 Stds such as chlamydia trachomatis and neisseria gonorrhea
 Adhesions caused by ruptured ovarian cysts
 Appendicitis
 Peritonitis
 A history of ectopic pregnancies

Fallopian tubal scarring has no recognizable symptoms. Chronic pelvic pain is the only known symptom of this damage and that too can be seen only in severe cases of tubal scarring. On diagnosing infertility, your doctor will perform one of these tests to determine the condition of your fallopian tubes.

 Hysterosalpingogram: this is a type of x-ray. Your doctor will open the vagina with a speculum and inject a liquid into the uterus with the help of a catheter. If the liquid does not pass through the fallopian tubes, it is said to be blocked. This however, does not say much about tubal scarring.
 Laparoscopy: a small incision is made below the belly button and a slim, flexible tube with a camera is passed through the incision. This gives your doctor a clear view of the condition of your fallopian tubes. A laparoscopy can also be used to rule out other causes of infertility such as endometriosis or blocked fallopian tubes. 

Treatment for infertility caused by tubal scarring is of two types:

 Surgery: this is suggested in cases where tubal scarring is minimal. Depending on the intensity and placement of scar tissue, your doctor may decide to perform one of many types of surgeries. He may choose to remove the scarred section of the fallopian tube, create a new opening (in case of blockages) or rebuild the damaged edges of the fallopian tubes.
 In vitro fertilization (ivf): women with badly scarred fallopian tubes usually have poor chances of conceiving naturally. Hence, ivf is the preferred treatment route. However, your doctor may still advise you to undergo surgery and remove the damaged tubes prior to ivf to prevent the tubes from filling with fluid.

Tubal Scarring and Infertility

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