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!

There is nothing more stressful to a patient and a caring gynaecologist than to face repeated IVF failure or recurrent pregnancy loss following IVF. So to advice couples who have failed one or more attempts, to keep on trying over and over and over; is not an easy job. Here, one can find solution in Ayurvedic treatment. Ayurveda, through its medicines, diet & lifestyle modifications and panchakarma raises a new hope after IVF failure. Ayurvedic treatment enhances success rate of Artificial Reproductive Techniques (IUI, IVF, ICSI-ET) or increases chance of natural conception as per cause of infertility.

What is Infertility?

Infertility is Inability to conceive even after one year of unprotected coitus or inability to carry pregnancy till full term. There are many causes of infertility; such as tubal block, PID, Endometriosis, PCOD in women and low sperm count, low sperm motility in men. When there is severe tubal disease, severe egg factors, failed IUI treatments, severe male factors, unexplained infertility, grade III & IV endometriosis; Test tube baby is suggested.

What is test tube baby? IVF (In-Vitro-Fertilization)?

It is a laboratory procedure in which processed sperm are either placed with oocyte (IVF) or injected into oocyte (ICSI) in a petridish to achieve fertilization. The resultant embryos are transferred into woman's uterus for implantation.

What are causes of IVF failure?

To work out on IVF failures, we should focus on causes of failure.
One of the most common causes of IVF failure is Abnormal Embryo. Abnormal embryo can be formed due to abnormal egg (oocyte) or abnormal sperm or if both are abnormal.
Another common cause is Implantation failure. Endometrium preparation and its receptivity are more important for implantation of an embryo. Endometrium should be 6 mm or more in thickness preferably 8-10 mm. To know details about endometrium preparation, Color Doppler should be done. It has also been observed that when pregnancy is achieved in absence of endometrial and sub-endometrial flow on the day of embryo transfer (ET), more than half of pregnancy will finish as spontaneous miscarriage. 
IVF cycle can be cancelled even before Ovum Pick Up due to Poor Ovarian Response, in which very few or no follicle growth is seen even after fertility injections.
Most neglected but important cause is Pre-treatment STRESS.
HOPE IN AYURVEDA:

According to Ayurveda, four factors are essential for conception; namely seed (oocyte and sperm), soil (reproductive track), season (fertile period) and water (nutrition).
Ayurvedic fertility treatments regularize metabolism of body, purify reproductive organs, maintain hormonal equilibrium, improve endometrium lining & receptivity, increase egg and sperm quality and relieve stress.
Womb preparation treatment of Ayurveda enhances success rate of IUI, IVF, ICSI-ET.

Womb Preparation Treatments:

Ayurvedic medicines
Ayurvedic herbs and medicinal preparations act as natural tonic to male and female reproductive organs. They maintain biological clock of menstruation; hence hormonal imbalance is corrected. They also help in making most potent and healthy sperm & ovum and eventually a healthy pregnancy.

Panchakarma (Detoxification)
Ayurveda can treat infertility by Panchakarma procedures like Basti, Uttarbasti, Vaman, Virechan, Nasya using different Ayurvedic formulations as per cause of infertility & failure of IVF and according to body constitution of patient.

Basti acts on vata predominantly. It increases strength of reproductive organs 
Uttarbasti is an intrauterine instillation of sterile medicated oil or ghee. It acts on endometrial receptors
Vamana and Virechana detox the whole body and improves digestive fire for proper nourishment of reproductive hormones and organs
Yoniprakshalana (Irrigation of vulva and vagina with warm decoction) and Pichudharan (Insertion of a sterile tampoon soaked in medicated ghee or oil in posterior fornix of vagina) are also helpful in infertility
According to Ayurveda; A Cheerful mind forms the basis of pregnancy; so relaxing panchakarma procedures like massage, steam, head massage, Shirodhara are done to reduce stress and its impact on infertility treatments.

Diet:
Like other fertility treatments, Ayurvedic treatment does not depend only on medicines. In fact, it ensures that patient follows a strict diet rules as per Ayurveda and avoids spicy and salty food. The proper food can help to provide proper nutrition to reproductive organs.

Lifestyle modification:
Nowadays infertility has become a part of lifestyle diseases. Ayurvedic Doctor can guide you to modify lifestyle according to your body constitution (Dinacharya) and seasonal variations (Rutucharya). It is always better to avoid cigarette smoking, tobacco and alcohol as they reduce fertility. Exercise is an inevitable part of lifestyle. One should learn exercise, yogasana (e.g. Surya Namaskara, Gomukhasan, Sarvangasan, Pavanmuktasan, Ardhamatsyandrasan, Naukasan, Dhanurasan, Shalabhasan etc.) and Pranayam from an experienced teacher.  

IVF Failure: Hope In Ayurveda!

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.
Unexpected Ovulation
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.

Frozen Embryo Transfer - Complications Associated With It!

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

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!

When we talk about infertility attention usually falls on treatment for women. However, infertility can affect men as well. The condition of infertility, can be described as the inability to become pregnant for a period of 1 year despite having unprotected, well-timed sexual intercourse. A low sperm count is one of the primary reasons for infertility in men.

Typically there should be fifteen million sperm per milliliter of semen. Low sperm count refers to the ejaculation of less than a normal amount of sperm in semen. This can also be termed as oligospermia. A complete absence of sperm in semen is known as azoospermia. Low sperm count does not mean that you cannot impregnate your partner but it reduces the chance of a successful conception. Thus, one of the most common ways to treat infertility caused by low sperm count is IVF.

IVF involves harvesting eggs from the woman s uterus and sperm from the male partner and combining them in a laboratory to form a zygote. When IVF is used to treat male infertility, a semen analysis is the first step. This helps determine the patient s sperm count, sperm motility, volume, pH levels, white blood cell levels etc.
The ejaculated semen is then processed so as to separate the sperm cells from the plasma. In this process sperm cells with higher motility are identified and segregated. These cells have a higher chance of fertilizing the egg.
Sperm cells are then injected into the harvested egg. Some techniques may require the injection of 50,000 or more sperm cells while others such as intracytoplasmic sperm injection (ICSI) can be effective with a single sperm cell. Once the egg is fertilized, it is allowed to develop for a few days in the laboratory. 
Two or three embryos are then selected to be reintroduced into the woman s uterus with the help of a catheter. The remaining fertilized embryos are preserved in an embryo bank in case the pregnancy is not successful. If these need to be used later, the woman does not have to go through the initial stages of IVF treatment to stimulate the follicles and harvest eggs from the ovaries.
When it comes to IVF, the success rates are very high. However, one of the most common side effects is the birth of twins or triplets. This is because multiple embryos are inserted into the uterus. The number of babies born then depends on the number of embryos that are implanted successfully.

Declining Sperm Count - How IVF Can Help Deal With It?

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